This story is part of Fast Company‘s Gender Pay Gap package “Short Changed.” In honor of Equal Pay Day, the symbolic day that women have to work for free to match men’s earnings, we are exploring elements of pay inequality though the personal stories of women across industries and career stages who experience it every day. Click here to read the whole series.
Men have historically shied away from jobs that are perceived as women’s work. These so-called pink-collar jobs, which include nursing and teaching, frequently pay less than male-dominated fields and carry the stigma of being more “feminine” work. But research shows that when men do enter fields that are considered women’s work, they often earn more money than their female counterparts or move up the ranks with more ease.
As male-dominated blue-collar jobs have become more scarce, some men have turned to pink-collar work. Over the last five decades, the percentage of men in the nursing industry has reportedly jumped from about 2% to 13%. And multiple studies indicate that the influx of male nurses has been accompanied by a pay gap across specialties, even controlling for workplace experience and differences in career trajectory.
What does that mean for the women who have long been the backbone of the nursing industry?
Kelley Rieger has been a nurse practitioner for 20 years and is a founding member of Time’s Up Healthcare and the chief operating officer of Show Me Your Stethoscope, an advocacy group and online community for nurses and other healthcare providers. Rieger talked to Fast Company about why women gravitate to the nursing field, how men in her field are treated, and what she has learned about negotiating and advocating for herself–and nurses as a whole. Her account has been edited for space and clarity.
“It’s such a different quality of life”
I originally graduated with a bachelor’s degree in a non-nursing field–exercise science–and I took a job working at a virology lab. After about a day or two of working in a lab, looking at microscopes and test tubes all day, I thought that this wasn’t the right choice for me. And then after about a month or two, I realized that it definitely was not the right choice for me. That was the lowest paying job I’ve ever had–$18,000 right out of college. I realized it wasn’t going to work for me financially, or for job happiness.
I worked with a nurse practitioner who was amazing, and I said to her, “I want to do what you do.” It was holistic care–I felt like nurses looked at the whole person and were more conscious of external factors. The nursing philosophy really took into account the stresses of your life. You don’t just say, “Go lose weight.” You say, “Okay, what’s going on? Are you using food as a source of stress relief? Do you need to understand how to make better nutritional choices?” Being able to have extra time with patients, do a lot more education, and take care of the full person is what nursing prides itself on.
If you want to have a family, it’s such a different quality of life from medicine. There’s flexibility; you can go part-time. You can find these creative ways of working in nursing, and it didn’t feel like you have a lot of those options in medicine.
“We’re the largest workforce in healthcare, but we have the smallest voice in healthcare decision making”
Nursing has changed so much from the years where when a physician came up and we were sitting there, we would have to give them their chair and cigarettes. It really wasn’t that long ago. We would wear these white dresses and skirts just 20 years ago. You think about it now–climbing up on top of a patient to give CPR in a freaking skirt and tights. Are you kidding me?
The concept that we are a part of this healthcare team and we are critical thinkers, not just here to execute orders blindly–that has really changed the mentality and helped nurses realize their worth. We’re the largest workforce in healthcare and the most trusted profession, but we have the smallest voice in healthcare decision making. That power dynamic is very, very apparent, and nurses feel it and talk about it.
“There’s so much burnout and stress”
About three years ago, there was, ironically, a Miss America pageant where a contestant was a nurse. For the talent portion, she stood up in her scrubs and stethoscope and gave this beautiful monologue about the patient that she would never forget, and her talents as a nurse. And it was so touching and moving. But the next day, the female hosts on the TV show The View made fun of her and mocked her, saying things like, “Well, why is she wearing a stethoscope? And is she wearing a costume?” I was like, Wow, you just really don’t get what we do. The show apologized and companies pulled advertising.
The founder of Show Me Your Stethoscope, Janie Harvey Garner, started this group thinking she would get 25 colleagues to post a selfie to show pride in nursing. We ended up having 800,000 members in less than a week. So this really resonated with the whole nursing world, all coming together to say this is not okay.
So we had this platform, and we were like, what do we do with this? We decided to become a nonprofit and focus on advocacy, education, and philanthropy–and just being this community of support for nursing, because there’s so much burnout and stress. It’s just a really tough profession at times.
“We’re included in the cost of the room”
There’s something called staffing ratios on the floor, and that’s how many patients a nurse takes care of on their shift. In the intensive care unit (ICU), it may be one or two patients per nurse; on the medical-surgical floor, it can be four or five, or sometimes up to eight or nine. Studies have shown that the more patients that I have to take care of on the floor, the higher the risk of mistakes, and the higher the risk of death. Nationally, California is the only state that has nurse-patient ratios mandated by law.
More From Fast Company’s Gender Pay Gap Series “Short Changed”
- Why are women still making so much less than men?
- What happened when I discovered the men I managed were paid a lot more than me
- I had 15 years of professional experience, but no one cared when I became a mom
- I have to delay my retirement because my male coworkers were paid more
So we have like 15 to 20 years of good, solid data that patient outcomes are better when you have safe levels of care. There was just a bill in Massachusetts proposing the same law as in California, and the American Hospital Association has spent $25 million to fight this law. If the evidence is telling us that this is safer, why are they pushing to not have this?
It comes back to the financial implications. Hospitals don’t get reimbursed for our services. We’re included in the cost of the room–the same as the bed and linens. And the folks making financial decisions typically are going to be male, and they often are not even in healthcare.
“My female colleagues at every level of nursing are not realizing that this is happening in their backyard”
I had no idea what my salary should be. As a new grad, or when you’re starting a new position, you’re worried about negotiating. If I ask for more, are they going to pull the job offer or not like me? Will they think I’m bitchy or bossy or assertive?
For men, it’s very expected. One of my admins at Show Me Your Stethoscope is a male nurse in Pennsylvania. He makes so much more than his female colleagues, who started around the same time. He started on around $26 an hour, and with his differential of working evenings and the times he has negotiated, he’s at $40 an hour right now, which is very high for a nurse in his area.
He makes $5 or $6 more per hour than many of the nurses with the same experience. And I said, Well, why do you think that is? What happened along your path and their path? And he said, ‘I immediately negotiated my first job, and even that dollar difference over a long period of time can make a big difference. And every time they’ve offered me a new position or asked me to take on a new responsibility, I’ve asked for more money.’ So he gets noticed more, and he moves up the career track. And in nursing, it seems that men are more attracted to the emergency room (ER) or ICU–those critical-care nursing roles that end up having a higher pay differential. So if you go on that kind of track, you also end up having a different pay track.
I think so many of my female colleagues at every level of nursing are not realizing that this is happening in their backyard. Another [male] colleague, who is a nurse practitioner as well, just negotiated a $20,000 increase in his salary. He went out and found an offer and came back and leveraged it. He said, “Hey, I’d like to stay. Can you beat it?” And I don’t think that would occur to most of my [female] colleagues, even at the nurse practitioner level–to be that aggressive or reach out to do that.
I just got hired at a salary that is 50% higher than what I was making three years ago. Now, I had a ton of time off, paid and unpaid. I had toddlers, so that was important to me. But still, looking back, I’m like, Oh my God, why did I settle for that?
“They almost encourage us not to negotiate or ask for more”
I posted the Journal of the American Medical Association (JAMA) study about the nursing gender pay gap in Show Me Your Stethoscope and asked people what their experiences were. The reaction has been very strong. A lot of people insisted it wasn’t true–even women said things like, “Stop playing the victim card. I’m so sick of this.” Some men insisted it didn’t happen. And then there are a few voices of reason, and a lot from men that said, Yeah, I know what my colleagues make, and I know I make this much more.
And I wonder if the conversations aren’t happening because I’m not going to go to my colleague and be like, Hey, guess what, I make $5 an hour more than you. When people start talking about salary, if I’m making a lot more, I’m not going to volunteer that; it’s going to put a target on my back. A lot of people are also insisting that new grads get, say, $26.50 an hour when they start at their hospital–that it’s a union job, and based on education and years of experience.
But I think we’ve been kind of sold that this is the way it is by HR and the hospitals. They almost encourage us not to negotiate or ask for more because we don’t do that. It’s just the way it is. It almost feels like they don’t want communication and collaboration to happen, because what happens if you start having those conversations? Then collaboratively we end up having a little bit more power.