Why aren’t there more women nurses in executive roles?

Nurses are essential members of any care team, providing a large proportion of direct patient services while completing essential administrative tasks and facilitating communication across the clinical environment.   

In the United States, close to 90% of the nation’s 4 million registered nurses, nurse practitioners, and nurse anesthetists identify as women, making nursing one of the most heavily female-dominated career paths in any sector. However, only a quarter of senior healthcare roles, including C-suite positions, are occupied by women, representing a severe imbalance in earning power, organizational authority, and the ability to implement innovation. 

These stats are probably not surprising to the majority of healthcare professionals, nearly 70% of whom are women themselves. But that doesn’t mean the status quo should be acceptable. Female healthcare workers add enormous value while shouldering the immense emotional, intellectual, and physical burdens of care, and they should be fairly represented in leadership roles across the public and private healthcare ecosystem. 

To jumpstart progress toward a more equitable leadership landscape, a team of researchers from Australia reviewed more than 30 international studies examining the career-related barriers and opportunities facing nurses who identify as female.   

The article, published in a subsidiary journal of The Lancet, found that there was no lack of desire for women nurses to move into leadership roles. Instead, women nurses face a large number of organizational and systemic challenges that can be mapped to three major categories: abilities, motivation, and opportunity. 

Female nursing stereotypes contribute to lower career expectations

Feminism has come far over the past few decades, but not far enough to erase broad cultural norms around what constitutes “women’s work” and “men’s work,” the article notes.   

“The social view of caring as a feminine role… contributes to devaluing nurses in leadership,” the team wrote. “Women in nursing experience unconscious bias alongside barriers impacting on their credibility, capacity and capability, contributing to poor job satisfaction and attrition. These factors collectively both demotivate women from seeking leadership opportunities due to feelings of inadequacy, and overlook qualified women nurses for leadership roles.” 

 “In advancing this field, it is recognized that individual-level solutions to overcome unconscious bias and advance women into healthcare leadership, have proven ineffective to date, with recognition of the need to move from ‘fixing women’ to organizational-level intervention.”  

The article points out that as part of these broader interventions, society will need to understand and accept the value of more diverse leadership strategies, including those historically attributed to women, instead of simply expecting women to adopt traditionally male leadership qualities. 

A perfect storm of systemic barriers to advancement

After combing through both qualitative and quantitative research, the team was able to place common barriers into three distinct buckets keeping women nurses out of the top ranks of leadership.  

• Motivation: Intrinsic motivation may be strong in individual nurses, but over the length of their careers, they may find it difficult to navigate roadblocks in their way. These challenges often include social and cultural expectations around nursing as a gendered profession; internal perceptions of what leadership roles entail; and lack of organizational support and resources to encourage diverse leaders. Social expectations of women in relation to childrearing may also contribute to lack of motivation, since many workplaces still lack adequate work-family integration, and many women feel pressured to choose their home life over their career goals.
• Ability: An absence of nurse-to-nurse mentorship and formal professional development opportunities, combined with high turnover and low staffing, can limit a nurse’s ability to take on more responsibility that leads to executive roles. The studies found that in some settings, higher-ranking nurses were more focused on giving orders to direct subordinates instead of contributing to collaborative care improvement across the organization as a whole, leaving early career nurses without a model for innovative leadership or opportunities to showcase their leadership abilities at scale.
• Opportunity: The team also found that organizations themselves may consciously or unconsciously contribute to keeping women nurses away from top roles. The researchers found that executive committees tend to undervalue the commitment and skills of part-time nurses, and may exhibit unconscious biases around gender, age, and professional accomplishments. The study states that women nurses over 40 were offered fewer opportunities for training and progression, while male RNs were given equal opportunities to progress regardless of age.   

Creating equal opportunities to advance women nurses to leadership

To benefit from everything that women nurses bring to the care environment, healthcare organizations need to address their systemic barriers and unconscious biases. Organizational leaders should review hiring practices that may inadvertently contribute to leaving female nurses out of the running for top executive roles, including being dismissive of flexible workers and those with family-related career breaks. 

Healthcare organizations should also work to create more opportunities for mentorship and coaching, develop clear pipelines for career advancement, and actively recruit older, experienced nurses who are looking for ways to contribute to organizational improvement and innovation. 

By integrating the nursing perspective into leadership, organizations may be able to maximize the value of their existing nursing workforce while enhancing the diversity, creativity, and agility of their executive team. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.