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Underrepresentation of Women in Critical Care Paramedicine: Experiences and Perceptions From Aotearoa New Zealand

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Thesis embargoed until 18th June 2028(2.5 MB)

Date

2026

Authors

Fasher, Rainbow

Supervisor

Todd, Verity
Webster, Karen
Dicker, Bridget

Item type

Thesis

Degree name

Master of Philosophy

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Publisher

Auckland University of Technology

Abstract

Despite women comprising the majority of the frontline paramedic workforce in Aotearoa New Zealand, they remain markedly underrepresented within the specialist Critical Care Paramedic (CCP) scope of practice. This imbalance represents both an equity concern and a potential limitation to workforce capability and patient care, given established links between workforce diversity, organisational performance, and health outcomes. The purpose of this thesis was to explore the experiences, perceptions, and career progression of women CCPs in Aotearoa New Zealand, with a specific focus on identifying the barriers and enablers influencing advancement into this highest clinical scope of prehospital practice. This research adopted a qualitative descriptive approach guided by a critical realist and postpositivist paradigm. The thesis comprised two interrelated components: a systematic literature review examining international evidence on women paramedics’ career progression, and a qualitative study exploring the lived experiences of women CCPs in Aotearoa New Zealand. The systematic review identified persistent gender‑based barriers within emergency medical services internationally, including gender stereotypes, masculinised workplace cultures, discriminatory norms, and disproportionate caregiving expectations. Opportunities for progression were associated with supportive organisational cultures, flexible work arrangements, mentorship, and visible female role models. These findings provided an analytic foundation for the primary qualitative study. The qualitative study utilised an anonymous online survey with open‑ended questions distributed to all women who had practised as CCPs between 2020 and 2025. Qualitative content analysis was undertaken to identify patterns and themes, allowing findings to remain close to the participants’ language while minimising interpretive bias. Analysis of responses from 36 women CCPs identified five interconnected themes shaping career progression: access to professional development; organisational culture; flexible work‑life balance; women’s representation and collegial support; and psychological and life‑cycle challenges. Participants described enablers such as self‑directed postgraduate education, supportive managers, mentorship, scholarships, and the motivation derived from seeing other women succeed in CCP roles. However, these were frequently overshadowed by structural and cultural barriers. Key barriers included the financial cost of postgraduate study, limited and unevenly distributed CCP internships, relocation requirements, inconsistent preparation for clinical assessment, inflexible rostering, gender discrimination, ageism, and persistent “old boys’ club” dynamics. Caregiving responsibilities, maternity leave, and life‑cycle factors such as perimenopause intersected with these structures to disrupt clinical continuity, confidence, and progression. Psychological responses, including self‑doubt and imposter syndrome, further compounded these challenges. This thesis concludes that the underrepresentation of women in the CCP workforce reflects systemic, organisational, and cultural barriers rather than a lack of individual capability or aspiration. Addressing gender inequity at this advanced clinical level requires coordinated organisational action, including transparent and flexible CCP training pathways, equitable access to internships and assessment preparation, culturally inclusive leadership practices, and workforce structures that accommodate caregiving and life‑course variability. Enhancing equity in CCP progression is essential not only to support women paramedics’ career advancement, but to also build a diverse, resilient, and high‑performing advanced paramedic workforce in Aotearoa New Zealand.

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http://hdl.handle.net/10292/21428

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Masters Theses