Why are experienced nurses falling through a 'trap door' into lower-paid roles?

Professor Alison Leary MBE, Professor of Healthcare and Workforce Modelling at London South Bank University (LSBU), talks to us about a new report led by LSBU for the Queen’s Institute of Community Nursing (QICN).

The Trap Door: Understanding Career Regression in Nursing shows that experienced nurses are not only finding themselves held back from progressing in their careers, but are being forced into lower-paid roles in order to access flexible working opportunities or training.

 

Read the full report: The Trap Door – Understanding Career Regression in Nursing

What were the key findings in your report on forced demotion?

What we’ve essentially found in this report is that forced demotion or regression, career regression is pretty common in nursing.

So we know that from the national data that nurses not only suffer from what we call the sticky floor, so this is something that predominantly affects female workforces, where they don’t progress.

We also can see how they’re falling back in terms of their career, back to lower grades of pay.

And we saw that in the national data from the NHS, compared to other professional groups, nurses are far more likely to regress.

What we wanted to do was understand what that regression looks like and why – the reasons for it.

So what we’ve essentially found now it’s usually the behaviour of employers, particularly refusal for flexible working, but also perhaps some more worrying findings such as refusal of reasonable adjustments.

And increasingly, as we’re seeing that market liberated into different employers, we’re seeing sort of fire and rehire schemes. So people being made redundant and then hired back on lower pay.

What is the ‘trap door’ for nurses?

So it goes back to the work of people like Christine Williams who talks about the sticky floor.

So people often talk about the glass ceiling in careers where people, particularly women, reach a point where they can’t progress any further.

But in predominantly female professions, what we see is what she calls the sticky floor, where people are actually pulled back.

So it’s really hard for them to leave the lowest grades of pay.

And in nursing, we know that particularly affects black women.

And what we’re seeing is not only the sticky floor, so people not being able to progress, we’re actually seeing people go down and regress in their careers.

So they might progress a little bit, but then have to take lower rates of pay to get the flexibility or the career opportunities that they want.

What is the link between flexible working and forced demotion?

What we’re seeing from the data that we’ve collected is that people are asking for flexible working and it’s being refused, but then offered at lower rates of pay.

So for example, people such as district nurses, general practice nurses, or nurses working in hospitals who might be on about a grade six or seven rate of pay who want to drop their hours, perhaps become part time, have compressed hours, job share, are then told that they need to apply for a new job at a lower grade.

What are the personal experiences people have been sharing?

We know that one of the reasons people, you know, don’t stay in healthcare is pay is important, but it’s about being valued, intrinsically being valued.

And I think one of the sort of the themes that the recurring themes that you see in this is that my work is not valued.

So these are knowledge intensive occupations where people work quite hard to join them and then hard to stay in them. And then what they’re told is that that’s really not valued.

So for example, we often see this response that from perhaps people that are managers of services, that the service can’t accommodate part-time working and therefore risk losing talent rather than accommodating part-time working, for example.

Those people are then advised to go and apply for a different job or a lower grade job, which when you read the narratives is essentially the same job but just at lower pay.

Are any groups particularly affected by this issue?

So what we’re seeing, really, are sort of mid-career professionals that are having to regress as they want to work part time and that’s sort of the mid-career issue of maybe childcare.

But we’re also seeing this sandwich generation. So a lot of the responses were people who’d been on the NMC register over 20 years. And what they were finding towards the end of their career and perhaps they wanted to reduce hours because they had caring responsibilities. And quite often this is like a sandwich generation who were looking after children and also looking after older adults as carers. We were finding they were the group that was also very largely affected. And they of course have huge amounts of experience and expertise.

Another group that we found affected were people that were career changers. Nursing’s quite an agile profession, but to change specialities. So for example, if you were an experienced community nurse and you wanted to become a district nurse and take on the DNSPQ qualification, you had to drop right down to a band 5 to be able to do that. And yet essentially, you’re still being asked to work in the role that you were always doing.

What impact is this having on nurses and the NHS?

So I think essentially this career regression is linked to the retention issues that we have, particularly in the NHS.

I’m often told that there’s a shortage of nurses and actually there isn’t a shortage of registered nurses in the UK.

There are over 850,000 on the register, but essentially it’s around people’s desire to work for poorer pay and conditions, I think, that causes a retention issue.

And so what we’re seeing here is not only kind of pay injustice really, but we’re also seeing a complete failure of talent management.

So if you are a very, very experienced nurse with 20 years experience, and then you want to work part time, and then you’re only offered either on retire and return or part time hours, a much lower rate of pay, but still expected to do the job you’ve always done, then that’s a complete failure in terms of talent management and it is unsurprising that those people then decide to leave.

We know that the NHS carries what we call a high rookie factor. So a failure to retain frontline expertise affects productivity, quality and efficiency. And we do see that, we see that in quite a lot of areas now, that failure to retain experienced staff means that the NHS is likely to be less productive.

But also those are the people that we’re going to rely on to train the next generation.
And without that, then essentially we have a really big pipeline failure as well.

How can we start to fix this?

One of the fundamental issues here is that nursing isn’t particularly valued.

It is a knowledge intensive occupation, it’s a safety critical occupation. But I think it still isn’t seen as that. It’s still seen as a sort of semi-skilled technical kind of work. But it’s actually incredibly high risk work and the retention of proficient frontline professionals is incredibly important for safety, quality and productivity.

So I think that needs, there needs to be some sort of cultural shift around that.

But we also need those flexible working policies to be really enacted, I think, in the workplace.

Looking at these data and the experiences people have shared, they obviously have these policies in place, but they’re very easily overridden by perhaps local management or the justification for not offering flexible working is seen as a sort of service or operational need. And I think there needs to be consideration of that.

The flexible working policies that are often quite well thought out need to be implemented and need to be implemented fairly and honestly.