Public Health

The Industrial Relations Commission confirmed that nursing is undervalued because it is mainly done by women – but said the state can’t afford to address the pay gap.

The IRC decision in the Association’s Special Case does not fully remedy the historic undervaluation of nurses’ work on gender grounds, said Dr Michael Lyons, senior lecturer at University of Western Sydney’s School of Business. 

He said the IRC agreed that nurses and midwives work is undervalued on a gender basis. 

However, it also said the government’s financial position constrained the size of the pay increase.  

This “capacity to pay” consideration has historically limited progress on closing the gender pay gap in female-dominated industries including aged care and children’s services, Dr Lyons noted. 

He said the government should take further action to address gender undervaluation in relation to state employees because “it is essential to the legitimacy of the public sector pay-fixing system.” 

In its decision, the IRC said that as of May 2025 there were 69,300 nurses and midwives in the NSW Health service costing about $7.5 billion annually. 

Every one per cent increase in their pay would cost the government an additional $74.5 million per year 
and any pay increase would have to be funded with debt, the IRC said. 

“A consequence of the fact that so many nurses work in the NSW Health service is that any increase in their pay has a stimulatory effect not only on the economy of NSW but also on that of Australia, with the potential in a tight economy to put upward pressure on interest rates,” it added. 

Expert evidence 

Dr Lyons and his UWS colleague Professor Meg Smith co-authored two expert reports to the IRC in support of the gender undervaluation component of the NSWNMA’s pay claim. 

They were among 12 experts called by the Association to give evidence in person or in writing on gender-based undervaluation and work value changes. 

Dr Lyons said the full bench’s formal finding that nurses and midwives work is undervalued on a gender basis is an important outcome. 

“Identifying the problem and its causes is important, even if the remedy is incomplete,” he said. 

He added that the decision helped to establish “caring” as a core element of work value in health roles involving patient interaction and not solely a gender issue. 

Dr Lyons said the IRC awarded bigger increases to ENs and AiNs than to the much larger cohort of registered nurses and midwives partly for cost reasons. 

It also reflected the IRC’s view that the work of ENs and AiNs involves a greater component of historically undervalued “invisible caring skills”. 

The IRC maintained that the 1989 professionalisation increases for nurses partly addressed gender undervaluation of RNs work.  

Dr Lyons disagreed; the 1989 decision was a work value case focused on education and qualifications, with no explicit consideration of gender or caring, he said.  

Invisible skills 

He described gender undervaluation as a broad social issue across all caring-focused roles where skills are often “invisible.”  

“With women comprising two-thirds of the NSW government workforce, failing to address this undervaluation undermines the legitimacy of the state’s pay-fixing system.  

“Therefore, government action beyond the IRC’s order is necessary.” 

Dr Lyons said the NSWNMA presented a comprehensive and robust case. 

“The Association’s evidence on gender undervaluation was sufficiently strong that the Health Secretary did not directly contest much of it. 

“Notably, some of the Health Secretary’s own witnesses didn’t directly challenge the Association’s evidence and some even supported it.”

Caring skills undervalued 

Professor Rae Cooper AO of the University of Sydney was a witness for the NSWNMA at the Special Case hearings. 

The Commission acknowledged her as “an internationally recognised expert in gender equality at work and industrial relations policy and practice”. 

It accepted her conclusion that the work of nurses “involves the exercise of certain invisible skills, sometimes referred to as caring skills, that have historically not been adequately valued; and such skills have not previously been expressly considered by the Commission in setting rates of pay”. 

It noted her opinion that “feminised frontline sectors are essential for, and not merely peripheral to, the functioning of the economy and society” as revealed by the COVID-19 pandemic. 

The Commission also referred to Professor Cooper’s evidence about the impact of the COVID-19 pandemic on women globally. 

“She gave evidence that it impacted heavily feminised frontline workers through a combination of job loss, exposure to health risks, more intense unpaid care responsibilities, and more insecure work, with 55 per cent of people who lost their jobs in the first year of the pandemic being women.  

“Professor Cooper explained that at the same time the closure of schools and childcare facilities drove a spike in women’s unpaid work and a ‘traditionalisation’ of domestic labour, with women taking on a greater load and share of home-learning and household work, constraining labour market participation.”