One of Australia's leading nursing unions is calling for more research to battle the sexualisation of the workforce.
In early March, 120,000 NSW registered nurses and midwives received an email from the Nursing and Midwifery Council of NSW (NMC) warning them not to post content on OnlyFans.
OnlyFans is a subscription-based platform best known for its explicit adult-only content.
Michael Whaites, assistant general secretary of the NSW Nurses and Midwives' Association (NSWNMA), said there needs to be greater understanding of people's rights to make individual choices.
"There's this significant concern about sexual exploitation driven by economic circumstances," Whaites said.
"But we don't have any evidence of that, which is problematic.
"We don't know what's driven them to do that."
It's estimated that nearly nine out of ten nurses and midwives in Australia identify as female.
Over 60 per cent of the nursing workforce have reported experiencing sexual harassment and violence in the workplace at least once.
Some email recipients took to social media, labelling NMC's move 'moralising and slut-shaming.'
One of the examples described a situation where a senior manager gave a female nurse preferential rostering after recognising her on OnlyFans.
The senior manager later asked through her OnlyFans account for the favour to be returned.
Whaites said the way the NMC expressed their concerns was 'problematic' in the examples they gave.
"There's no excuse for sexual harassment - full stop," Whaites said.
"In this example, an inference could be made that a person was being sexually harassed by their employer, but somehow, the nurses' actions were problematic.
"The council was ill-advised on the scenarios they used to get their point across."
The NMC works with the NSW Health Care Complaints Commission (HCCC) to receive and manage complaints about registered nurses and midwives in NSW.
Of the 120,000 registered nurses in NSW, the council said it had received complaints against less than 1 per cent in the last financial year.
"The most recent newsletter aimed to reinforce professional standards for nurses and midwives, including the appropriate behaviour on social media," a spokesperson for the NCA NSW said.
"And how inappropriate behaviour can lead to complaints of unsatisfactory professional conduct or professional misconduct.
"The social media guidelines ensure that nurses and midwives meet their obligations under the National Law."
The industry's professional complaints body said that nurses and midwives posting content on OnlyFans could pose a 'distraction to patients' and be 'deemed unprofessional.'
It said it held the authority to consider social media use in an employee's private life if it questioned a practitioner's fitness to hold registration.
"If a practitioner is recognised for publishing photographs in uniform, they could be reported for their conduct," a NCA NSW spokesperson said.
"The social media guidance is clear on the obligations of nurses and midwives to maintain professional boundaries."
According to the NCA's social media guidelines, a nurse could receive complaints if endorsing 'activity that contradicts public health orders or reputable scientific evidence.'
It said that any online activity ranging from commenting to posting likes or dislikes without comments would be seen as an endorsement.
It was also considered inappropriate if nurses and midwives engaged in activities not in line with their professional responsibility while being photographed or videoed.
NSWNMA's legal team told Nursing Review that participation in unlawful behaviour or not upholding professional standards was generally considered the benchmark for bringing the profession into disrepute.
"Importantly, this needs to be assessed on a case-by-case basis," the NSWNMA legal team said.
"Being a content creator for OnlyFans is not illegal – it's up to the individual to assess any risk of being a content creator."
The team said the NMC should not 'have grounds to interfere' with a health practitioner as long as the content creator on OnlyFans used an alias or hadn't identified themselves as such.
"If the NMC wanted to apply the Code of Conduct, it must be in line with unlawful behaviour that 'may or may not damage the profession's reputation," the NSWNMA team said.
"Technically, the Council does not cross any borders, but it's perhaps a conservative view towards the use of social media in 2023."
Whaites said the issue addressed the challenge of whether or not clarifying potential 'damaging behaviour to the reputation' meant.
"The conundrum is that you cannot bring the profession into disrepute, but the 'how' is not defined," he said.
"It's difficult because when you become prescriptive, you automatically cancel other scenarios out.
"And once you become prescriptive about what is bringing a service into disrepute (and what is not), every scenario would need to be refined and challenged through time."
Whaites said that people should be able to express their sexuality – with the caveat of not harming others, being of legal age of consent, and being within the nurses' conduct guidelines.
Media outlets, such as The Guardian, have suggested that nurses and midwives are turning to other income streams like OnlyFans to make ends meet.
The number of Australians working two jobs increased by 1.7 per cent over the last quarter of 2022 to nearly 1 million people.
People working in healthcare and social assistance are among the country's top three industries holding a second job.
"If they feel this is needed because their current wages are insufficient in helping them make ends meet, then that's a problem," Whaites said.
"Because that would demonstrate that broader issues are at play here."
Of OnlyFans' 1.5 million content creators, it's estimated that 1 per cent of the accounts earned 33 per cent of all the global website's money.
One of the top-tiered content creators is said to earn over $100,000 each month.
But generally, a consistent OnlyFans creator received about $151 monthly.
The average wage for a registered nurse or midwife in NSW is just over $7,000 a month, or $84,000 a year.
The code of conduct requires that a working nurse or midwife in NSW discusses taking up secondary employment with their primary employer.
If there is a potential conflict of interest with NSW Health employment or the total work being undertaken raises issues about excessive working hours, the code guidelines read.
"Such approval for other employment must not be unreasonably withheld."
Generally, any secondary job must not impact the performance in the primary position, the NSWNMA legal team said.
"Being an OnlyFans creator may be intended by someone as a pass-time or an income stream," they said.
"The employer would need to establish that the employee was damaging the organisation's reputation in creating content.
"However, employers and health practitioner regulators can face challenges when understanding emerging trends in social media and related complaints."
They emphasised that any complaint against a health practitioner should be assessed on the individual case and not influenced by assumptions or moral judgements.
Whaites said whether nurses and midwives needed to discuss their earnings from OnlyFans with their primary employer was questionable.
"If, for example, in my spare time, I made jam.
"And then I sell jam at a local fare every weekend.
"I don't need to talk to my employer about that because it clearly doesn't impinge on my contract with them."
A nurse or midwife who received a notice of complaint made against them should refer to the Fair Work Commission's 'Unfair Dismissal Benchbook.'Do you have an idea for a story?
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