To Plan Your Career In Nursing, Or Not?

“I think that if you go where you your interest takes you, you will not only build a unique set of skills but sustain your passion for nursing.”

Carol now works as specialist mental health coach and mentor, but life has taken her to many interesting job roles both within and outside of nursing. In this candid and compelling piece, she reflects on her career progression and the importance of going where your interest takes you.

What will you be doing in 5- and 10-years’ time? These used to be common questions in job interviews, suggesting that certain qualities make a person worthy of the job - having your future totally mapped out, having the strategic steps towards the ‘ultimate’ goal broken down, and having the discipline to stick to the plan.

If you are that person, that’s great, and I have respect for you. I, however, am definitely not that person!

Looking back over the forty or so years of my nursing career, I am not dissatisfied with what I have achieved. I guess it depends on what measure of success of you are using. If the objective is to have the highest nursing status, or to earn the most money, then maybe the 5- and 10-year plan approach is the most appropriate.

However, the nurse who is rigidly sticking to ‘the plan’ despite what life is throwing at them, may find themselves constantly fighting their way through a world of stress and unhappiness. Motivations can change as life unfolds, and there is an argument for cutting yourself some slack, listening to what is right for you at the time, going with the flow, or thinking outside the box and taking some risks.

All nurses know about the need for self-compassion and avoiding burnout, but are these just academic concepts? Or are we applying them to our every-day nursing reality?

From Psychology Student To Mental Health Nurse

There are many paths to fulfilment in a nursing career, and I think it is ok if your path meanders and takes in different terrains along the way.

Using my own career as an advert for journeying through nursing off the beaten track, I must confess that even my entry into the profession was not conventional for the time. I started my nurse training after graduating with a degree in psychology.

This is very common in mental health nursing now, with graduates able to undertake a two-year master’s degree rather than the usual three-year undergraduate programme, but in the early 1980’s I was looked upon with much suspicion. Nursing was very much seen as a vocation – nurses were born, often following in the footsteps of their parents at the same hospital, nursing for the privilege of caring. They did not tend to be created out of the blue, having made a calculated decision about what the profession could do for them.

I went into nursing as a strategic move towards becoming a psychologist, as I had lived it up at college and didn’t get good enough grades to go straight into it! Nursing schools were based in hospitals and the first one I applied to turned me down as they didn’t think I would stick it out. To be fair, even my own mother asserted that I would never make a nurse!

Changing Attitudes Towards Graduates

I was accepted at the second school I tried and, although I found the theoretical side of training comfortable, the clinical staff on my placements generally gave me a hard time. There was a perception that graduates would only be interested in a fast track to management and would be reluctant to get their hands dirty.

This view was asserted on a larger scale nearly twenty years later when nursing had become all graduate entry, and nurses were accused in the media of being “too posh to wash”. It was said that this generation of nurses believed personal care should be delegated to less qualified staff. I feel this was certainly unjustified in my case, and for most of the graduate nurses I have worked with since.

The Traditional Route Of Progression

I qualified in 1986. Even if it started out as a steppingstone, by this time nursing had a grip on me. I was definitely a nurse. Mental health nursing at this time was mainly about in-patient care and there was a definite career path from which it was quite difficult to diverge due to limited roles.

One tended to stay in the ‘family’ of the institution one trained in, working up through the hierarchy of stripes over a considerable period of time, from junior Staff Nurse to senior Staff Nurse, to Deputy Sister/Charge Nurse, to Sister/Charge Nurse/Ward Manager, to Nursing Officer if you were exceptionally ambitious.

This traditional progression route may still be the chosen path for some. Although we have been a graduate entry profession for some time now, nursing culture can still be heavy on tradition, hierarchy, and the handing down of knowledge through generations of nurse.

For those of you who haven’t seen comedian Georgie Carroll’s ‘3 stages of nursing’, I highly recommend looking it up on You Tube if you are in need of a self-deprecating laugh – are you a Dolphin? A Penguin? Or if you are an Orca like me, welcome to the pod! There is much more variation in the roles available to nurses now, and a single progression path may not be as obvious.

However, is it important to identify the path you intend to travel? Or can we let in serendipity to make the most of opportunities, without appearing purposeless, indecisive, unambitious, or lacking in self-knowledge and assurance?

Is there a way that we can confidently negotiate a flexible route through our careers that will compliment and support changes in lifestyle, wishes, and needs?

Embracing Challenges

I had been in my first nursing job for about 11 months when an opportunity outside the usual progression route presented itself. I had been allocated (that was the way it happened at the time) to a rehabilitation ward on qualifying, and it felt like the end of the world to me.

Everyone ‘knew’ that the best springboard for your career was to start as a Staff Nurse on the acute wards, and all my friends had got such placements. I think that this perception is only just starting to change now. I did not feel that I was getting the same level of experience as my mates. The acute wards had a rapid turnover of patients and were full of excitement and drama. My shifts were quiet and plodding, requiring the patience of Job.

But I found that, rather than hating it as I had expected, I loved the challenge of thinking outside the box to find ways of helping those who did not respond to common treatment and care approaches. Patients were not even patients here, they were users of our service, which had the purpose of helping them in miniscule increments towards a more independent life in the community. I didn’t realise at first that I was at the cutting edge of something enormous.

‘Care in the Community’ would see the closure of the large psychiatric institutions and was both a threat and a promise. Nobody seemed to want it; the patients were frightened, the staff thought they would be out of a job, and all believed that it wasn’t in anyone’s best interests.

I stand by the assertion that there was a lot of good care in those old psychiatric hospitals, but we did inadvertently institutionalise people with our methods at the time. I felt it was right that we worked towards a better style of care. The advertised job involved assessing people’s needs to ascertain the type of facilities needed in the community and helping to develop programmes of care to ease the transition.

While my peers had been gaining all their acute experience, I had been developing different skills in teaching, mentoring, and complex care planning, which along with transferable skills in research from my degree education, stood in me in good stead to be Project Co-ordinator.

Is there a way that we can confidently negotiate a flexible route through our careers that will compliment and support changes in lifestyle, wishes, and needs?

The Importance Of Mentors

I believe that whatever stage of nursing you are at, it is important to identify mentors. I worked with some amazing nurses on that rehabilitation ward, who encouraged me go for the job even though it was two grades higher than my grade at the time. I applied successfully for a Band 7 (equivalent – they were all letters then).

This was not a normal progression, and it was a year contract rather than permanent, so it felt like a risk. However, I took the job because it was fascinating, and I trusted my mentors when they said I could do it. It was challenging, and at times it felt like others believed I was singlehandedly closing the hospital, but I learned an amazing amount and I loved it. I stretched myself by using the total skill set I had at the time and built on it big time with project management and leadership skills that I couldn’t have hoped to gain for many years on a regular career path.

At the end of the contract, I was again allocated to a ward. This time I got the coveted acute service, but, although a sideways move by banding, I had no post qualification experience in this field and at this level I felt out of my depth. I could have asked for a lower band post, I suppose, but I figured that my managers knew the job and what I could do, and if they felt I could do it, I would trust their judgement.

Again, I drew heavily on the transferrable skills I did have, which sometimes came from unexpected quarters. It was also a lesson in humility, in being open about my strengths and limitations, securing the support of others and working closely as a team, and again, thinking outside the box to resolve issues as they arose.

Motherhood And My Nursing Career

It was a valuable, if stressful, time, which opened doors for new experiences such as working with mums with puerperal disorders and their babies. It was not easy to gain this sort of experience at the time and I was a little bit sad when the post was interrupted – not too much though, as it was due to the arrival of a baby of my own.

Although an amazing time for me personally, motherhood was not a great time for my career. I hope it is different now and that women do not need to sacrifice their careers in the same way that I had to. I thought that I was going to be a ‘career mum’ and that I would be back to full-time nursing when baby was 6 weeks old… nope, not a career mum at all!

My body decided to surprise me with this though and didn’t let me know until after my baby was born. I was not allowed to return to my Band 7 post on a part-time basis but could not contemplate leaving my son (and shortly after his brother) for longer than a couple of shifts a week. I therefore embarked on a series of part-time jobs back at Staff Nurse level, doing what I had to do to fit around the childcare that was available to me.

Although it felt a bit grim at the time, it forced me to try jobs that I would never have sought out in other circumstances, but which really helped advance my later career in surprising ways. I even did things that I felt quite uncomfortable with. No, not exotic dancing! Things like working as an Electro Convulsive Therapy (ECT) recovery nurse. This was the only job that I could find that enabled me to do two set shifts a week when my mother-in-law could look after the kids.

Many years later, this experience meant that I was given the opportunity to write the ECT policy for the organisation I was working in. Policy writing strengthened my CV and led to further senior positions. In retrospect I can see that each one of my Band 5 part-time maternity jobs contributed important knowledge, skills and experiences that have helped to make me the nurse I am today.

I worried that changing jobs quite frequently, to meet ever changing childcare needs, would signify to employers that I was at best unreliable, and at worst a very bad nurse who no-one wanted to keep. The reality was that this did not impact adversely on my career.

Seeking Out New Roles And Sectors

In fact, I have been able to use my broad experience of different roles and different sectors, to write engaging applications.

I have never failed to get an interview for anything I have applied for. I have focused on the opportunities presented by each new role and drawn upon my wide experience to offer evidence of how my skills and knowledge could make me an asset to the potential employer.

While it is obviously important to give a role sufficient time to make informed decisions, being unhappy over a prolonged period of time to try and prove resilience, is seldom good for mental health. Such perseverance in adverse circumstances can backfire on you.

Sometimes when we think we are not being resilient enough, it is really the system that is broken, and resilience is not a reasonable expectation.

Developing My Learning

Continued learning has been very important to me. I have always been on the lookout for opportunities that are relevant, although maybe not nursing specific, rather than just relying on employers to provide or fund Continuing Professional Development opportunities.

In my fist nursing job, I went to night school to do a vocational course in teaching and assessing (City and Guilds). I had realised that I loved teaching the Student Nurses coming through the ward (even though I was only a few months ahead of them realistically) and wanted to do it better.

I followed this up with a Post Graduate Certificate in Education, which was free at the time. It was difficult to fit in studying and placements around night shifts and looking after my small children, but I persevered even though it took me a long time to complete.

This teaching course has been the single most valuable piece of training I ever did, and I firmly believe that it has been instrumental in me getting quite a few of my posts right through my career. Many jobs have a teaching element of some sort, and I could say that I was a qualified teacher.

Another course that helped me hugely was the Counselling Skills Certificate course I did, also very early in my career. This was a relatively low-level course – it did not qualify me as a counsellor, but the skills gained have elevated my nursing practice. They were even recognised by my assessor as enhancing my therapeutic intervention when, much later, I trained in Cognitive Behavioural Therapy at master’s level.

So, I was seeking out roles that supported my personal circumstances rather than working through a carefully crafted plan to reach a predetermined career goal, as well as picking up opportunities to learn along the way. My nursing during this time felt like a means to an end, buying nappies and eating, rather than living the dream.

I have been able to use my broad experience of different roles and sectors, to write engaging applications. I have… drawn upon my wide experience to offer evidence of how my skills and knowledge could make me an asset to the potential employer.

Becoming An A Level Lecturer

However valuable these experiences turned out to be though, I did reach a point where I started wondering what the dream might be, and whether it was actually nursing at all. When an opportunity presented itself at my local Further Education College, I left nursing for a while to become a part time A level psychology lecturer. The main draw was the sociable hours, but it was also a way of testing whether teaching was a possible career for me in its own right, or whether I wanted to keep it within nursing.

It had been a good few years since I had completed my psychology degree and I wasn’t convinced that I remembered any of it! I guess this is a lesson in getting out of your comfort zone. I felt the fear but did it anyway! It turned out that I was not a natural lecturer, and it wasn’t the dream job, but it was still a very useful experience. Having a formal classroom teaching post on my CV has been very beneficial for some of my more senior nursing positions and it gave me confidence in myself.

I now trusted that I would not implode if I found myself in a situation where I was out of my depth, that I had a wealth of personal resources that I could tap into. It also made me realise that experiences outside nursing have also contributed to making me a better nurse. It is so important to consider wider life experiences when looking to meet the criteria for an interesting position.

Continuing My Career In Mental Health

After two years of lecturing, I found I was missing working in the field of mental health. I was worried that staying away for too long may make it difficult to recover my nursing career but did not feel confident to apply for a nursing post. I searched for positions in mental health rather than in nursing and found the role of Advocate with the mental health association MIND.

It felt exciting to become involved from the different perspective of the charity sector. There were not the same revalidation pressures then, so I felt I could afford to follow an interest and take a job that would maybe help to restore my capacity to nurse.

This position enabled me to use my skills in a very different way. It taught me how to communicate effectively with those experiencing serious mental illness on a much more equal footing, without the armour of the nurse label. Exposing and working through my personal vulnerabilities undoubtedly made me a much better and more compassionate nurse when I did return to mainstream services.

Returning As A Band 5 Nurse

It was still only possible for me to return to nursing at a Band 5 if I wanted part-time work, but after my spell away from nursing I felt that this was appropriate. I felt rusty. There was no ‘return to nursing’ requirement then, so I needed to engineer my own programme. I was back where I started in grade, and in my speciality: rehabilitation.

But this time around I was in a small independent hospital in the community. I found my feet quickly. Everything came rushing back and I spent time researching new developments over the preceding few years. My children were getting older and, when a Band 6 post became available in the service, I felt ready. Having successfully applied for this, it was not long before the Band 7 role became available, and I got this too.

In terms of my work history, my family-based reasons for leaving all those jobs seemed to be accepted, and my interviewers were much more interested in how I was able to apply my experience in answering their questions. At this point, my career felt as though it was on a bit of elastic, bouncing between Bands 5 and 7, but after 10 years on the backburner it felt as though it was starting again properly.

I don’t feel that the 10 years were lost, as the experiences were valuable and the time with my children was a priority for me. Perhaps it would have been better if I could have worked my part time jobs at a higher banding, and perhaps this is more likely nowadays. However, pragmatically, I can balance the lower income with not having job stress spilling into my family time.

Ward manager was the highest level of management I felt disposed to do, but for the longest time, there had been a distinct lack of senior clinical roles. I studied for a master’s degree that qualified me in CBT for psychosis, but the jobs that were promised to trainees like myself did not materialise. I needed to look further afield than my usual comfortable commuting distance to find senior roles to progress into, and, with the children growing up and a little more money available, I was able to do this.

When anything crops up that interests me, I have weighed up where I am in my life. If the potential change has fitted with my current lifestyle or aspirations, and would not adversely influence anyone I care about, I have gone for it.

Leaving Direct Clinical Work

I carried out regular job searches to keep an eye on what was available. I used key terms to find jobs that included my particular interests but did not limit the searches to nursing positions. Although I was under a little pressure to now stay in nursing in terms of building my pension, I had learned that a specific nursing role wasn’t essential to job satisfaction for me; I had a wider skill set and could take the nursing to other roles.

I left direct clinical work to become a Practice Development Nurse, working across a small independent hospital, my focus transferring from patients to the education and support of nurses. This has become my passion. I believed that it would be difficult to get back into the NHS after working in the private sector for a while, but the breadth of my experience, and my teaching qualification (again), helped me to secure a position as a Learning and Development Manager in a big Trust.

From here I became a Modern Matron, those lean part-time years in nursing homes empowering me to take on the role of Physical Health Lead for the mental health Trust. I then retired from the NHS and went back for a year as a part-time Specialist Nurse in CAMHS.

Reflecting On My Career Progression

There are times when I look back and ask myself “where would I have got to if I had been the ‘career mum’ I thought I was going to be?” I wish perhaps I had gone further up the ladder, as my pension would be better now!

However, I don’t regret the time I had with my kids and, as I have never had an ideal ‘ultimate goal’ job in mind, I have been able to enjoy all my senior posts without worrying that I was not where I should have been. I have kept a constant eye on job vacancies and when anything has cropped up that interests me, I have weighed up where I am in my life. If the potential change has fitted with my current lifestyle or aspirations, and would not adversely influence anyone I care about, I have gone for it.

I am fortunate to be of an age where I was able to retire from the NHS with a reasonably good pension, but this does not mean I have stopped being a nurse. Retirement has opened up new opportunities for me. I am now free to pursue all sorts of interesting avenues, and I am using my nursing skills in many different ways.

I think that if you go where you your interest takes you, you will not only build a unique set of skills but sustain your passion for nursing.

What Does The Future Hold?

I love studying, but it proved stressful alongside full-time work. I am now loving studying for a Doctorate! I know it is too late to advance my career, but I believe that there are many ways I can use my research to help change mental health nursing for the better. I am using my study skills along with my nursing experience to support university students who have mental health difficulties.

Some time ago, I took an opportunity to train as an executive coach as part of a Trust scheme to support middle and senior managers. It irked me at the time that nurses on the frontline were not offered this coaching opportunity, but I am now using my skills to offer it independently.

I am also combining my coaching and nursing to work with people struggling with their mental health in the community. I am finding it totally refreshing to be able to offer an asset, rather than deficit, -based approach to mental health after all these years of working with illness.

Having not taken to lecturing earlier in my career, I am now finding that I enjoy doing odd bits on the bank for the university where I am a student. This goes to show how much things can change during a career, so never immediately dismiss an opportunity!

Stay Open To Possibilities

I think that there is a need to be open to different possibilities. Don’t assume that you can’t do a role because it isn’t something you have come across before.

Just be curious, explore job descriptions and think broadly about your experiences and how they might support you in the roles you find interesting:

• Would meandering through a career can be more satisfying overall than working in a linear way towards achieving a target position?

• What if one of the of the steps isn’t as you expected it to be?

• Would it be a catastrophe, or could veering off bring about previously unthought of possibilities that, rather than disrupting, may enhance your career?

• What if the ‘ultimate goal’ job doesn’t meet your expectations – does this mean that the whole career has been wasted?

I think that if you go where you your interest takes you, you will not only build a unique set of skills but sustain your passion for nursing.

Thank you for reading.