Registered Nurses: who are they and what do they want?

Abstract

Using 1981 and 2001 Census data together with primary data from a 2002 survey of Registered Nurses (RNs) in Western Australia, this paper profiles the nurse workforce. Amongst other things the paper reports on a high level of pay dissatisfaction, particularly amongst younger nurses. Hours of work also emerge as an important issue, with many RNs employed on a part-time basis and many more indicating they' would prefer to work fewer rather than more hours. The demands of work and family are shown as impacting on these preferences, with 30.6 per cent of RNs reporting difficulty in balancing these conflicting demands. In the absence of any renewal strategy, the average age of nurses continues to rise. This age structure will change as RNs retire; one-third of all RN respondents to the 2002 survey plan on leaving the profession before 2008. A sizeable proportion of those who plan to leave are in the 26-30 age groups. The paper should sound a number of alarm bells for those engaged in nurse workforce planning.

Introduction

Although the issue of nurse shortage has been on the public agenda for at least two decades (see Nowak herein), it would be fair to say that there is now genuine concern about predicted skill shortages in this highly critical occupation. Nurse shortages regularly feature in the print media alongside reports detailing the often unattractive work conditions and environments within which the nurses work. Throughout Australia concerted efforts are now being made to recruit and retain qualified nurses, with initiatives ranging from sophisticated television advertisements to increased support for hospital based child-care. In an effort to inform some of these initiatives, this paper draws on a number of data sources to present a contemporary demographic and labour market profile of nurses in Australia.

To assist comparisons, the current paper closely follows an earlier paper by Sloan and Robertson (1988), who used a range of different data sources (including the 1981 Census) to explore the characteristics of nurses and nursing students. Comparisons were made with other highly feminised professional occupations, including teaching and social work. Of their findings, three in particular stood out: (a) significant hours discrepancies between nursing and other feminised professions (with nurses, on average, working longer hours); (b) significant income differences both at the individual level and the family level (the family income in households with a female nurse was, for example, significantly lower than the family income of households with a female teacher); and (c) a significant latent supply of nurses (i.e. a sizeable pool of women holding nursing qualifications but not practicing in the area).

Using Sloan and Robertson as a starting point, this article builds on their analysis with a view to understanding similarities and differences in the nurse labour market twenty years later. (1) Comparisons are drawn with other female intensive professions with similar training requirements as a way of identifying any characteristics and outcomes unique to nursing.

The next section describes the gender character of nursing. This is followed by a discussion of the labour market characteristics of nursing (e.g. hours of work, hour preferences and income). Subsequent sections discuss nursing qualifications and experience levels. The paper ends with a discussion of nurse demographics, including marital status, the presence (or otherwise) of dependent children and leaving intentions.

Nursing as a Female Intensive Occupation

The Australian labour market, like that of many other western developed economies, is highly segregated along gender lines. Currently around 46 per cent of all employees in the Australian labour market are women, although the gender shares differ markedly across different occupational groups. Women, for example, account for 87 per cent of advanced clerical and service workers but only 12.6 per cent of intermediate production and transport workers. In the professional category, women account for 51.5 per cent of all employees, although 61 per cent of these professional women are concentrated in two areas, health and education. These gender-differentiated patterns of employment are even more marked at disaggregated classification levels. In 2001, for example, women accounted for 92.4 per cent of all general registered nurses (RNs) (see Table 1). Of the four nursing categories listed in Table 1, 79 per cent of employed nurses in 2001 were General RNs. Enrolled nurses (EN) represented the next largest group at 11 per cent, followed by midwives (6.5 per cent) and mental health nurses (3.6 per cent). With the exception of mental health, nursing is clearly a highly feminised occupation.

In the two decades to 2001 there has been little change in the gender composition of nurses. Between 1981 and 2001, for example, the male employment share amongst general RNs increased by a mere three percentage points. If these trends are anything to go by, then it is apparent that nursing will remain a highly feminised occupation for the foreseeable future (2). Indeed, a recent large scale survey of first-year university students in Western Australia (the 2003 WA Student Survey) found that, out of a sample of 474 young men, only five indicated that they had seriously considered studying nursing (Nowak, Preston, Dockery and McCabe 2003). The paper by Dockery and Barns (herein) further confirms the contention that few males are attracted to nursing. This, of course, presents a significant challenge for workforce planning. In a climate of expanded occupational opportunities for women, the previously guaranteed supply of female labour may no longer be counted upon. The attraction and retention of nurses is now more complicated and requires attention to matters such as hours of work, rostering and salary, as well as family friendly initiatives.

Hours of Work

Table 2 presents data on the pattern of hours worked. Of the select occupations listed, the groups that are most likely to be employed full-time (which the Australian Bureau of Statistics (ABS) defines as 35 or more hours per week) are teachers, social workers and mental health RNs. Of the general RNs, less than half (46.2 per cent) were employed full-time in 2001. This compares to the situation in 1981 when two-thirds (64.3 per cent) of all RNs worked 35 or more hours per week. This trend towards part-time employment is not unusual in a broader labour market context. Since the early 1990s, most jobs growth has been in the part-time sector and much of it has been of a casual nature (Preston 2001). Growth in casual employment has, in large part, been fuelled by employer preferences for flexibility and cost savings, particularly during periods of economic uncertainty (Campbell and Brosnan 1999) and a desire to shift the risks of the employment relationship on to the employee (Watson 2005).

In the nursing sector the observed trends most likely reflect a growth in agency nursing during the 1990s. The latter reflected RN demand for flexible scheduling, although the extent to which this was underpinned by inefficient rostering systems is unclear. It may be that appointing agency nurses was easier than managing a complex roster system. (3) Either way, it is apparent that, since 1981, there has been a significant fall in the number of RNs employed full-time (see Figure 1). While this may also be reflective of 'stage in life', it is interesting to note that the full-time employment shares in the other highly feminised occupations have been maintained.

[FIGURE 1 OMITTED]

Further insight into the issue of working hours may be gleaned from a recent survey of 5,000 RNs in Western Australia (2002 WARN Survey). (4) Table 3 describes the mean working hours for RNs in their 'main job' disaggregated by full-time and part-time status, while Figure 2 plots the distribution of hours by RN age. Although a large proportion of RNs are employed part-time, it is apparent from these data that part-timers supply a relatively large number of hours. As shown, the average RN employed part-time in their main job works around 25 hours (or around three days) per week in all jobs. Amongst RNs employed full-time, the average work week in the main job is around 39.9 hours, rising to 41.5 hours in all jobs (main and second).

[FIGURE 2 OMITTED]

Part-time work, as noted above, is fairly characteristic of the RN labour force. It is particularly prevalent amongst those aged 30 or more (Figure 2), suggesting that stage in life plays an important role in affecting hours of work preferences. That said, the current observed work schedules of RNs do not necessarily match their preferences. In the 2002 WA RN Survey, 48.1 per cent of the practicing RNs who were employed full-time in their main jobs indicated that they would prefer to work fewer hours (see Table 4).

It seems that within nursing, multiple jobs holding is a fairly common practice, particularly amongst RNs employed part-time. Of all Western Australian RNs who were employed full-time in their main jobs, 11.6 per cent also held a second job. The corresponding figure for RNs employed part-time in their main jobs was 21.1 per cent. It is beyond the scope of this paper to examine the determinants of multiple job holding, although it is suggested that this may constitute another way of arranging work hours (and schedules) to suit preferences. Anecdotal evidence suggests that part-time workers are more able to secure their preferred shift rosters. This is reflected in Figure 3, which shows that 40 per cent of RNs who work part-time are always given their shift preferences versus 31 per cent of RNs employed full-time. Of course, multiple job holding is also an important way by which people supplement income earned in the main jobs. The following section sheds more light on this issue of earnings and income.

[FIGURE 3 OMITTED]

Income

Nursing is widely perceived as a relatively low paying occupation (see Nowak and Preston 2001) and the data shown here support this contention. In 2001 the mean weekly income (from all sources) for a RN employed full-time was $833 or 82.2 per cent of the mean weekly income for the average professional employee in full-time work (McCabe, Nowak and Preston 2003). Of the select occupational groupings shown in Table 5, only two other groups (EN and pre-primary school teachers) received less than general RNs.

Figure 4 shows the trend in RN average weekly ordinary time earnings (AWOTE) relative to male AWOTE. Over the latter part of the 1980s the average pay of an RN significantly improved. Around this time, a number of changes operated simultaneously including the shift away from hospital based training towards tertiary education and training, implementation of the career structure and a perceived shortage of some categories of nursing skills (Nowak herein). Since the early 1990s, however, the pay advantage of nurses relative to the average male employee has gradually declined. Comparable trends are evident amongst teachers, another occupation where the returns (pay) are perceived as low. These trends may be set against gains in other occupational areas, the example given here being computing professionals. The comparisons are even more marked when one takes into consideration the fact that much nursing work is undertaken during non-standard hours of the week and therefore attracts penalty or premium rates. The AWOTE data reported in Figure 4 do not differentiate between standard payments and payments at premium rates.

[FIGURE 4 OMITTED]

As noted below, the relative pay position of RNs appears to be in decline. Does this matter? In the vast literature on wages, the matter of relativities does appear to play a significant role. People frequently assess their pay as being 'fair' by reference to the rates around them (Brown and Sisson, 1975). In Australia, collective bargaining and the use of written, public documents has tended to reinforce notions of traditional relativities, although this is gradually changing in the shift towards enterprise bargaining. At the workplace level, however, 'fair pay' perceptions still carry considerable sway, particularly as an attraction and retention device.

How, then, do RNs perceive their relative pay position? The 2002 WARN Survey asked a series of questions on this point. Table 6 shows responses to a number of these questions. The most immediate point of comparison is, of course, the workplace. Table 6 shows that 63.4 per cent of respondents believe RNs are poorly paid when benchmarked against other employees within the workplace; 80.4 per cent regarded the pay of an RN as low when compared to other jobs requiring similar skills and responsibilities within the health industry; and 89.6 per cent rated the pay of an RN low when compared with comparable jobs in other industries.

Overall, nearly half (49.4 per cent) of all practising RNs reported that they were dissatisfied (fairly or very) with their pay as nurses (see Figure 5). When the data are disaggregated by age, it is apparent that dissatisfaction is greater amongst younger cohorts; in 2002 54.9 per cent of RNs aged 21-34 were dissatisfied with their pay.

[FIGURE 5 OMITTED]

Qualifications and Employment Experience

In the literature on earnings, qualifications and work experience are typically regarded as the most important factors explaining different pay relativities. Although we do not have ready access to Australia-wide information on either of these variables, we are able to proxy work experience by the use of age. Table 7 shows little difference in the average age of employees in the select occupational groups contained in this paper. At the time of the 2001 Population Census the average RN was 41 years old, as was the average primary school teacher, enrolled nurse and social worker. The average secondary school teacher was aged 42 in 2001.

Using data from the 2002 WA RN Survey, we can see from Figure 6 that the age distribution is more skewed towards older workers; at the time of the survey, 66 per cent of RNs were over the age of 40, and thus well into their careers.

[FIGURE 6 OMITTED]

Notwithstanding the over-representation of older nurses in the nurse workforce, data on qualifications show that many RNs (45.6 per cent) hold tertiary nursing qualifications (see Figure 7). The age (experience) and qualifications have, however, not translated into significant career advancements for many practicing RNs. Of all RNs in the WA sample, 49.1 per cent were employed as Level 1 RNs at the time of the survey. (5) At a more disaggregated level, it is apparent that one-fifth of all Level 1 RNs have 25 or more years of experience (see Figure 8). Without more detailed analysis, it is not possible to explain why Level 1 RNs have so many years of experience, except that there is some evidence that nurses who leave the workforce often return at lower levels. (6) In other words, previous years of experience are discounted. This would go some way to explaining the lower relative pay position of nurses. If this is the case, it also suggests that the pay gap between RNs and other professionals owes more to institutional discrimination than it does to any human capital factors (such as experience and qualifications). Improving the qualifications and experience of RNs will, therefore, do little to close the gap. It requires policy initiatives focused on institutional and structural factors, such as policies with respect to promotion and recognition of previous years of experience. The high level of pay dissatisfaction amongst younger nursing cohorts, combined with the need to attract and retain RNs, suggests this might be a fruitful area for further inquiry.

[FIGURE 8 OMITTED]

Demographic Characteristics

In the pay literature, demographic features are also accorded significant attention since they too affect wage outcomes. Women with dependent children, for example, typically earn less than comparable women without dependent children. This may reflect discriminatory employment practices such as hampered promotional prospects.

In the following discussion a range of demographic characteristics is presented, although the purpose has less to do with understanding wage outcomes and more to do with knowing who our RNs are. Only selected characteristics are profiled. These include marital status and dependent children. We are interested in marital status, since this variable is highly correlated with participation (labour supply) decisions. Recent decades have seen significant increases in female participation rates, particularly amongst married women (see Figure 9).

[FIGURE 9 OMITTED]

Both Table 7 and Figure 9 present Census data on marital status disaggregated by select occupation. Little can be inferred about participation rates from these data, but it is noteworthy that the share of employed RNs who are married is substantially lower than the comparable shares of primary and secondary school teachers (e.g. 58.7 per cent versus 65 and 64 per cent, respectively). It may be that these observed differences are reflective of work schedules, with teachers perhaps being better able to negotiate work schedules that fit in with other family commitments. This may suggest that there is a potential pool of married RNs who would return to RN practice if suitable schedules could be negotiated. Indeed, negotiation of working hours may be more stressful at the family level than at the workplace level. The role of partners in influencing hours worked should not go without statement: it is an important stressor in contemporary work lives.

Table 4 above showed that 48.1 per cent of all practicing RNs who are employed full-time in their main jobs would prefer to work fewer hours. Of those who have spouses or partners, nearly half(47 per cent) have spouses or partners who want them to work fewer hours (see Table 8). It is not clear why they want them to work fewer hours. It may be that they want them to 'slow down', indeed retire as they themselves move into retirement. Alternatively, it may be that they wish their partners to reduce their workloads in order to carry more family responsibilities (eg. care for children or elders). Either way, it would be fair to say that the preferences of spouses play an important role in affecting the preferences of practicing RNs. In the 2002 WARN Survey, 30.6 per cent of RNs reported that they found it difficult to balance their work and family responsibilities.

Children

In 2002 73 per cent of all practicing RNs who responded to the 2002 WARN Survey indicated that they had children. Of those with children, 58 per cent had dependent children (aged 15 and under). The majority (44 per cent) of RNs with dependent children reported having two; 37 per cent had only one: and 15 per cent had three (see Figure 10).

[FIGURE 10 OMITTED]

The majority (67.5 per cent) of these dependent children are of school age. In 2002, 23 per cent of practising RNs with dependent children in WA had one child under the age of five. A further 10 per cent had two children under the age of five. Figure 11 shows the distribution of responses to an attitudinal question about 'work and family' balance. The responses are disaggregated by whether or not the RN has a dependent child under the age of five. It is apparent from this chart that RNs with young children are more likely to report that they find balancing work and family difficult. One may conclude from this that initiatives aimed at assisting parents of young children to balance work and family would constitute a productive investment. (7)

[FIGURE 11 OMITTED]

The survey did not ask about elder care responsibilities, although clearly this is an important consideration, especially when we take account of the age composition of the workforce. It has been suggested that elder care responsibilities typically fall on daughters, and on nursing daughters in particular since it is often perceived that they have the skills and knowledge of both the medical and the health system to carry this responsibility. (8) The stresses associated with elder care responsibilities amongst RNs in Australia are as yet unclear and should be the focus of future research. It may be that one response to these stresses and pressures is induced early retirement, creating further pressure on the supply of nursing labour. Some 15.6 per cent of all RN respondents to the 2002 WARN Survey indicated they intended to retire in the next five years. This anticipated retirement timeline may in part be prompted by the physical intensiveness of the work or by reactive or preventative health reasons.

Of perhaps more concern is that one-third of all respondents indicated they would cease nursing practice in the next five years; 47 per cent of this group would cease for retirement reasons, while 24 per cent planned on changing occupation. If these plans are actioned, they will, of course, have enormous cost effects (e.g. cost associated with turnover) as well as significantly impacting on supply and the pool of nursing experience. Figure 12 shows the distribution of stayers and leavers within age groups. As expected, many who plan on leaving are in the older age groups. It is of concern to note that 41 per cent of RNs aged 26-30 anticipate leaving in the next five years. Twenty-three per cent of this group see themselves leaving to change occupation. The majority (61.5 per cent) will leave for family (e.g. child-care) reasons.

[FIGURE 12 OMITTED]

Conclusion

The aim of this paper has been to build a profile of the labour market and demographic characteristics of nurses in Australia. The analysis has relied upon a number of data sources including census data, ABS data on earnings and income and data from a recent 2002 survey of RNs in Western Australia. The profile created by these combined data sources confirms many widely held perceptions about nursing and supports many of the earlier conclusions (and warnings) by Sloan and Robertson (1988) based on 1981 data.

Nursing remains a highly feminised and ageing occupational group, with members of the profession poorly remunerated relative to other occupations with similar skills and training requirements. Today most employment in this sector is of a part-time nature, with many RNs indicating a preference for fewer rather than more hours of work. In 1981 the majority of RNs were employed full-time. Turnover intentions amongst RNs are high. One third of respondents to the 2002 WARN Survey anticipated leaving the profession before 2008; of the group of RNs aged 26-30, 41 per cent indicated an intention to quit.

Attraction and retention thus remain a critical issue for this highly significant profession. Although a number of initiatives have been (and are being) put in place to deal with underlying problems such as work and family pressures, (9) these developments are unlikely to impact significantly on the nurse labour market imbalance. So long as nursing draws upon a supply of just women (and there is little evidence to suggest any shift in preferences of men towards nursing), nursing will remain in competition with other occupations also competing for women. Whilst pay may not have been an important factor influencing the career choice decisions of older generations, data in this paper suggest that it is a highly important consideration for younger generations. Dockery and Barns paper (herein) also support this conclusion.

Fiscal pressures and a monopsonistic market structure (Nowak and Preston 2001) have thus far constrained the pay rises awarded to nurses. As the shortages continue to bite, we may see some changes here. In the meantime, the biggest challenge is that of tapping into the latent supply pool of nurses who hold an RN qualification but either do not practice or do so only on a short-term and part-time basis. Moreover, we are unlikely to see any significant shift in participation patterns of younger generations. Australia seems very much wedded to a structure wherein Australian women meet family care needs through part-time work (see Preston and Burgess 2003). Perhaps this, in the end, might be the saving for the nursing profession, since there is little evidence of other professional occupations being able to accommodate women when they demand part-time work. Studies of women in law, of women in engineering and of women in IT, for example, all note the absence of part-time work as a significant retention issue (Preston and Burgess 2003).

Appendix A: Tables of Statistics

Table 1: Share of all jobs held by women,
2001 select occupations, 1981 and

                                       1981    2001

RN, general                            95.4    92.4
RN, other(a) / midwives (b)            97.5    98.9
RN, psych(a) / mental health (b)       49.3    65.6
Nursing aide(a) / enrolled nurse (b)   95.3    91.4
Teachers--primary and secondary        57.4    70.8
Teachers--pre-primary                  96.9    98.3
Social worker                          66.4    81.3

Notes: 2001 data from unpublished ABS Census data; 1981
data from the 1981 Census, as published in Sloan and
Robertson (1988), p.508; (a) indicates the occupational
category to which the 1981 data refers; (b) indicates the
occupational category to which the 2001 data refers.

Table 2: Hours of Work in Select
Occupational Groups, 1981 and 2001

                        none    1-    16-    25-    35+
                                15     24     34
2001
RN, general             7.0    6.7    19.6   20.5   46.2

RN, midwives            9.5    7.2    26.8   22.8   33.7

RN, mental health       7.7    3.2    11.2   12.1   65.8

Enrolled nurse          0.1    7.2    20.0   21.6   43.6

Teachers--primary and   3.6    7.3    7.9    11.0   70.2
secondary

Teachers--pre-primary   3.2    9.9    15.2   14.2   57.5

Social worker           6.0    4.3    11.6   12.9   65.2
1981

RN, general             3.2    7.4    15.7   8.0    64.3

RN, psych               6.0    2.4    4.6    1.8    84.5

Nursing aide            3.5    7.9    16.6   10.2   60.1

Teachers--primary and   2.1    8.5    5.9    27.6   54.7
secondary

Teachers--pre-primary   1.2    11.0   14.5   21.9   50.2
Social worker           2.4    5.4    10.8   7.8    72.8

                        35-    40     41-    49 or
                        39            48     more
2001

RN, general             14.8   20.5   5.4    5.5

RN, midwives            10.7   15.8   4.0    3.2

RN, mental health       20.4   31.2   7.5    6.8

Enrolled nurse          15.6   19.2   4.2    4.6

Teachers--primary and   13.5   19.6   16.5   20.7
secondary

Teachers--pre-primary   17.8   21.1   10.7   8.0

Social worker           26.1   21.6   11.5   6.1

1981

RN, general             --     --     --     --

RN, psych               --     --     --     --

Nursing aide            --     --     --     --

Teachers--primary and   --     --     --     --
secondary

Teachers--pre-primary   --     --     --     --
Social worker           --     --     --     --

Notes: source unpublished 2001 census data. The'not stated'
category has been excluded from the calculations. The 1981
Census data are from Sloan and Robertson 1988.
Disaggregation beyond 35 hours per week is not possible
with the 1981 data.

Table 3: RN Hours Worked, Main Job and All Jobs,
Western Australia, 2002

                Employed        Employed
                full-time       part-time        Total
                (Main job)      (Main job)       hours

           Mean    St Dev   Mean   St Dev   Mean    St Dev

Main job   39.94    4.1     22.0    8.0     29.2     11.1
All jobs   41.55    5.7     24.9    9.2     31.5     11.4

Source: 2002 WARN Survey.

Table 4: RN Hours Preferences by Hours Worked

                                              Main Job
                                         Employment status
                                           --(main job)

                                      Full-time   Part-time
                                       percent    per cent

Yes, would like to work fewer hours     48.1        20.1
Yes, would like to work more hours       4.1         6.6
No, cannot work extra hours
  because of earning constraints         0.3         1.5
No, cannot work extra hours
  because of other time commitments      5.4        24.2
No, do not want extra hours--extra
  responsibility/unsuit. hrs             1.0         2.7
No, happy with number of hours          41.1        44.8
Total (per cent)                        100.0       100.0

Source: 2002 WARN Survey

Table 5: Mean weekly income by occupation for
full-time employees and allemployees (part-timers
and full-timers), Australia, 2001

                                                       Occupational
                                                     income relative
                                                       to the mean
                                                      income of all
                                                       professionals

                             Employed      All      Employed      All
                             full-time  employees  full-time  employees

                                 $           $      per cent   per cent

(2323) Registered nurses        833         693        82.2        76.5

(2324) Registered midwives      922         718        91.0        79.2

(2325) Registered mental        967         876        95.5        96.7
health nurses

(341111) Enrolled nurses        613         516        60.5        57.0

(241111) Pre-primary            787         659        77.7        72.7
school teachers

(241211) Primary school         970         845        95.8        93.3
teachers

(241311) Secondary school      1036         958        102.3      105.7
teachers

(251111) Social workers         872         784        86.1        86.5

(2) Professionals              1013         906        100.0      100.0

Source: 2001 unpublished Census data. Note: income refers to income
from all sources; the above calculations exclude those with zero
income, unstated income and income unknown. (ASCO codes are shown
in parentheses).

Table 6: Perceptions of Pay for Nursing

                            High    About     Low
                                    right
                           percent  percent  percent

Pay for nursing as          2.1      34.5     63.4
compared with employees
in other jobs in
your workplace
(n = 1,507)

Pay for nursing as          0.5      19.1     80.4
compared with jobs
requiring similar
skills and
responsibilities
within the health
industry
(n=1,506)

Pay for nursing as          0.5      9.9      89.6
compared with jobs
requiring similar
skills and
responsibilities
within other
industries (n = 1,506)

Source: 2002 WARN Survey

Appreciation:

This paper was financed, in part, by an ARC SPIRT Grant, which the author gratefully acknowledges.

The author would also like to thank the two anonymous ABL referees for their comments and Kim Woods for research assistance.

References

Australian Bureau of Statistics (2001) 2001 Census, retrieved 2004 from: http://www.abs.gov.au/ausstats/abs@.nsf/2.6.2?OpenView 

Brown, W. and Sisson, K. (1975), 'The Use of Comparison in Workplace Wage Determination', British Journal of Industrial Relations, vol. 26, pp.339-361.

Campbell, I. and Brosnan, P. (1999), 'Labour Market Deregulation in Australia: The Slow Combustion Approach to Workplace Change', International Review of Applied Economics, vol. 13, pp. 353-394.

McCabe, R. Nowak, M. and Preston, A.C. (2003), Under Pressure: Report on the Western Australian Nurse Workforce in 2002, WEAPU, Curtin University.

Nowak, M., Preston, A., Dockery, M. and McCabe, R. (2003), Study of Occupational Choice: 2003 Survey of 1st Year University Students in Western Australia, Computer File. Women's Economic Policy Analysis Unit, Curtin University of Technology.

Nowak, M. and Preston, A.C. (2001), ' Can Human Capital Theory Explain Why Nurses Are So Poorly Paid?', Australian Economic Papers, vol 40, pp. 232-245.

Preston, A.C. (200l), 'The Changing Australian Labour Market: Developments During the 1990s', Australian Bulletin of Labour, vol 28, pp. 153-176.

Preston, A.C. and Burgess, J. (2003), 'Women's Work in Australia: Trends, Issues and Prospects', in Preston, A. and Burgess J. (Eds.), Women and Work: Research and Policy Issues, A Special Issue of the Australian Journal of Labour Economics, vol. 6, pp.497-519.

Sloan, J. and Robertson, F. (1988), 'A Labour Market Profile of Nurses in Australia', Australian Bulletin of Labour, vol. 14, pp. 507-528.

Watson, I. (2005), 'The Earnings of Casual Employees: The Problem of Unobservables'. Paper prepared for the 2005 HILDA Survey Research Conference, The University of Melbourne, September.

Endnotes

(1) For further information on the historical context of the 1980s study see introductory paper by Nowak herein.

(2) The argument behind the encouragement of males into nursing is that, in the absence of an expanding male RN pool, the overall RN potential labour supply will shrink as women's occupational alternatives continue to grow. In the past there was almost a guaranteed labour supply as women seeking professional careers could basically only choose between nursing and teaching.

(3) Since the establishment of Nurse West, a nurse placement agency in Western Australia within the Western Australian Health Department, the number of agency nurses in Western Australia has significantly fallen. The new arrangements also require nurse managers to manage better their rosters.

(4) The survey, conducted in 2002, was of of 5,000 RNs in Western Australia. After allowing for incorrect addresses, the response rate was 38.3 per cent (n=1,884). For further details and limitations, see Nowak (herein) and McCabe, Nowak and Preston (2003).

(5) A new classification structure was introduced to Western Australia in 1987. A Level 1 RN is at the bottom of the scale. Above Level 1 there is a Level 2 Clinical Nurse (CN), Level 3 Clinical Nurse Specialist (CNS) and Level 4 Coordinator, Clinical Nursing. The Director of Nursing (DON) is level 5A (see Nowak herein).

(6) Data from the 2002 WARN survey suggest that, of those RNs who had a career break and returned to nursing, around 23.3 per cent returned at lower levels; 3.8 per cent returned at higher levels; while the remainder (72.9 per cent) returned at the same level (McCabe et al. 2003, p.33).

(7) For more information, see Human Rights and Equal Opportunity Commission (2005) Striking the Balance: Women, Men, Work and Family, Working Paper, http://www.hreoc.gov.au/sex discrimination/strikingbalance/index.html

(8) This discussion point emerged during a session at the Work, Employment and Society Conference, Manchester, 2004.

(9) In Western Australia a 'Family Friendly Network' has been established to assist in the identification of options to assist balancing work and family needs (for details see http: //www.heath.wa.gov.au/family.friendly/welcome/).

Alison Preston, Graduate School of Business, Curtin University of Technology

Table 1: Share of all jobs held by women, select
occupations, 1981 and 2001

                                       1981   2001

RN, general                            95.4   92.4
RN, other(a) / midwives (b)            97.5   98.9
RN, psych(a) / mental health (b)       49.3   65.6
Nursing aide(a) / enrolled nurse (b)   95.3   91.4
Teachers--primary and secondary        57.4   70.8
Teachers--pre-primary                  96.9   98.3
Social worker                          66.4   81.3

Notes: 2001 data from unpublished ABS Census data; 1981
data from the 1981 Census, as published in Sloan and
Robertson (1988), p.508; (a) indicates the occupational
category to which the 1981 data refers; (b) indicates
the occupational category to which the 2001 data refers.

Table 2: Hours of work in select occupational
groups, 1981 and 2001

                         none   1-15   16-    25-     35+
                                       24     34
2001

RN, general               7.0    6.7   19.6    20.5   46.2
RN, midwives              9.5    7.2   26.8    22.8   33.7
RN, mental health         7.7    3.2   11.2    12.1   65.8
Enrolled nurse            0.1    7.2   20.0    21.6   43.6
Teachers--primary &       3.6    7.3    7.9    11.0   70.2
secondary
Teachers--pre-primary     3.2    9.9   15.2    14.2   57.5
Social worker             6.0    4.3   11.6    12.9   65.2

1981

RN, general               3.2    7.4   15.7     8.0   64.3
RN, psych                 6.0    2.4    4.6     1.8   84.5
Nursing aide              3.5    7.9   16.6    10.2   60.1
Teachers--primary &
secordary                 2.1    8.5    5.9    27.6   54.7
Teachers-pre-             1.2   11.0   14.5    21.9   50.2
primary
Social worker             2.4    5.4   10.8     7.8   72.8

                          35-     40    41-    49 or
                          39            48     more
2001

RN, general              14.8   20.5    5.4     5.5
RN, midwives             10.7   15.8    4.0     3.2
RN, mental health        20.4   31.2    7.5     6.8
Enrolled nurse           15.6   19.2    4.2     4.6
Teachers--primary &      13.5   19.6   16.5    20.7
secondary
Teachers--pre-primary    17.8   21.1   10.7     8.0
Social worker            26.1   21.6   11.5     6.1

1981

RN, general               --     --     --      --
RN, psych                 --     --     --      --
Nursing aide              --     --     --      --
Teachers--primary &
secordary                 --     --     --      --
Teachers--pre-            --     --     --      --
primary
Social worker             --     --     --      --

Notes: Source unpublished 2001 census data. The 'not stated'
category has been excluded from the calculations. The 1981
Census data are from Sloan and Robertson 1988. Disaggregation
beyond 35 hours per week is not possible with the 1981 data.

Table 3: RN hours worked, main job and all jobs,
Western Australia, 2002

           Employed         Employed
           full-time        part-time       Total hours
           (Main job)       (Main job)

           Mean    St Dev   Mean   St Dev   Mean   St Dev

Main job   39.9     4.1     22.0    8.0     29.2    11.1
All jobs   41.5     5.7     24.9    9.2     31.5    11.4

Source: 2002 WARN Survey.

Table 4: RN hours preferences by hours worked main job

                               Employment status--
                                  (main job)

                            Full-time   Part-time
                             percent     percent

Yes, would like to
  work fewer hours            48.1        20.1

Yes, would like
  to work more hours           4.1         6.6
No, cannot work extra
  hours because of
  earning constraints          0.3         1.5

No, cannot work extra
   hours because of
   other time commitments      5.4        24.2

No, do not want extra
  hours--extra
  responsibility/
  unsuit. hrs                  1.0         2.7
No, happy with
  number of hours             41.1        44.8
Total (per cent)              100.0       100.0

Source: 2002 WARN Survey

Table 5: Mean weekly income by occupation for full-time
employees and all employees (part-timers and
full-timers), Australia, 2001

                                            Employed       All
                                            full-time   employees
                                                $           $

 2323    Registered nurses                     833         693
 2324    Registered midwives                   922         718
 2325    Registered mental health nurses       967         876
341111   Enrolled nurses                       613         516
241111   Pre-primary school teachers           787         659
241211   Primary school teachers               970         845
241311   Secondary school teachers            1036         958
251111   Social workers                        872         784
  2      Professionals                        1013         906

                                               Occupational income
                                                 relative to the
                                                 mean income of
                                                all Professionals

                                            Employed       All
                                            full-time   employees
                                             percent    per cent

 2323    Registered nurses                    82.2        76.5
 2324    Registered midwives                  91.0        79.2
 2325    Registered mental health nurses      95.5        96.7
341111   Enrolled nurses                      60.5        57.0
241111   Pre-primary school teachers          77.7        72.7
241211   Primary school teachers              95.8        93.3
241311   Secondary school teachers            102.3       105.7
251111   Social workers                       86.1        86.5
  2      Professionals                        100.0        100

Source: 2001 unpublished Census data.

Note: income refers to income from all sources; the above calculations
exclude those with zero income, unstated income and income unknown.
(ASCO codes are shown in parentheses).

Table 6: Perceptions of Pay for Nursing

                            High      About       Low
                                      right

Pay for nursing as         2.1 per   34.5 per   63.4 per
compared with               cent       cent       cent
employees in other
jobs in your
workplace
... (n = 1,507)

Pay for nursing as          0.50      19.10      80.40
compared with jobs           per       per        per
requiring similar           cent       cent       cent
skills and
responsibilities
within the health
industry
(n=1,506)

Pay for nursing             0.50       9.90      89.60
as compared with             per       per        per
jobs requiring similar      cent       cent       cent
skills and
responsibilities
within other industries
(n = 1,506)

Source: 2002 WARN Survey

Table 7: Age and marital status of select occupational
groups, August 2001

                                       Married     Married in
                                         in a         a de
                                      registered     facto
                                       marriage     marriage
                           Mean age    percent      percent

Registered nurses             41         58.7         8.0

Registered midwives           41         66.4         5.3

Registered mental health      43         50.0         12.7
nurses

Enrolled nurse                41         56.5         8.3

Pre-primary school            38         61.1         7.7
teacher

Primary school teacher        41         64.9         6.1

Secondary school              42         63.8         6.9
teacher

Social worker                 41         48.9         12.2

                             Not         Not
                           married    applicable
                           per cent    percent

Registered nurses            28.7        4.5
                                         5.1
Registered midwives          23.3

Registered mental health     32.9        4.4
nurses

Enrolled nurse               30.1        5.0

Pre-primary school           28.6        2.6
teacher

Primary school teacher       26.4        2.5

Secondary school             26.4        2.9
teacher

Social worker                34.4        4.5

Source: unpublished 2001 census data.

Table 8: Practising RNs--Employment Status by Revealed
Hours Preferences by Believed Preferences Held by
Spouse / Partner, Western Australia.

Q: Would you like to work more or fewer hours
(main job)?

                                                No, happy
                                                with
                          Yes, to would         number of
                          work fewer hours      hours
Is your spouse/
partner happy with the    Employed   Employed   Employed    Employed
hours you work.           FT         PT         FT          PT

No, s/he would prefer
  I worked less           47.0       43.0       22.0        20.0
No, s/he would prefer
  I worked more           1.0        2.0        1.1         2.4
  hours
Yes, s/he is happy
  with the hours I work   36.6       40.4       65.5        71.2

Don't know                15.3       14.6       11.3        6.5
                          100.0%     100.0%     100.0%      100.0%

Source: 2002 WA RN Survey

Figure 7: Practicing RNs highest nursing education award

Hospital based
diploma/certificates
in nursing                 54.5%

Degree/tertiary
diploma in Nursing         43.8%

Masters degree in
Nursing                     0.2%

Doctoral degree in
Nursing                     1.6%

Source: McCabe, Nowak & Preston, 2003 (Fig 12)

Note: Table made from pie chart.