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Carving out a successful career in a changing health service

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A job for life is a comfy idea and it used to be a great incentive for taking up nursing. You did your training, got registered, took up a post and worked away loyally. In return, you moved up the pay scale and, if you were extra conscientious, got promoted. Years down the line, you would hit retirement age and live out your remaining years on a guaranteed pension.

A job for life is a comfy idea and it used to be a great incentive for taking up nursing. You did your training, got registered, took up a post and worked away loyally. In return, you moved up the pay scale and, if you were extra conscientious, got promoted. Years down the line, you would hit retirement age and live out your remaining years on a guaranteed pension.

Not any more. The employment landscape has shifted. Like most things, healthcare is becoming market-orientated, and that puts new pressures on nurses, requiring different attitudes and strategies to stay in work. That means you, me and everyone else in the healthcare world.

As a nurse, how do you prepare for a scenario like this? Well, the first thing is to accept that the world is changing fast and you've got to change with it to keep up with the game. Of course, nothing has ever stood still, but it is the speed of change today that's so striking. Work content isn't just changing, it's changing at an ever increasing rate. Information technology and the emergence of the free market are altering everything. Jobs that seemed they'd be here for ever are disappearing off the map. You and I may - and I hope, will - be healthcare professionals for the rest of our days. But healthcare itself will change beyond recognition, and to meet its demands we're constantly have to upgrade our knowledge and skills. A nurse today may still be called a nurse in twenty years, but she won't be doing the same job or enjoy the same conditions of tenure.

Part of the trick is to have a crystal ball permanently beside you and anticipate changes you can turn into opportunities, then acquire the skills and knowledge to secure interesting, paying work with the legs to carry you through five or ten years. Short of a crystal ball, we can take advantage of a familiar tool force on us as a condition of re-registration by the NMC - the Professional Portfolio.

Now, before you groan, I know lots of nurses see this as a piece of bureaucratic bumph, and I admit I got a bit sniffy about it myself when I had to write an essay on it at uni. But the more I've thought of it, the more I've had to eat my words. I don't just enjoy building up my portfolio, I think it is an indispensible tool for steering my career the way I want it to go.

To me, the great thing about portfolio construction is that it enables you to store and shape all your own thoughts. Odd experiences, critical events, ideas, working disasters, interviews, opportunities - you name it - all can be bunged down in your portfolio. Gradually, you accumulate a storehouse of reflections on things done, seen, heard and read. Your present competencies become clear, so do areas of weakness. You consider how to capitalise on the one and eradicate the other. You convert ideas into action. You ask about courses and study days and maybe get permission to shadow working professionals in A&E or nursing research, or whatever else takes your fancy...recording the outcomes in your portfolio at day's end.

The ingredients of the portfolio are well documented in textbooks, so no need to repeat them here. But all of them are centred round three career-boosting questions:

What is happening now?

What is going to happen in the future?

How can I be prepared?

Keep asking and answering these and you're on your way to achieving the life-goals you want. Your enthusiasm will grow and so will your confidence. You'll be perfectly suited for tomorrow's world.

Along the way, you'll also notice a couple of useful things about human nature. Please think about these, because they can serve you well. The first is that when you need help, there are always loads of people anxious to give you it. The more enthusiasm you show, the more this becomes true. People love when you ask them about their work, especially if you treat them as experts. So don't hesitate to approach them.

The second thing you may notice in how work-seeking becomes a kind of two-way switch. In your early days, you'll look here, there and everywhere for opportunities. But as time passes, your abilities will become known. You'll build up a magnetic attraction for employers who make the first approach to get you on to their teams, effectively head-hunting you. When you reach that stage, you'll hardly ever want for work, because a virtuous circle takes over. You establish a reputation and get an approach from a new employer. You do a good job with them, your reputation grows and your market value rises with it, so you get more approaches, etc.

This kind of thinking dovetails neatly with an idea that is catching on in the US. That is, to think of yourself not as an employee in search of a job, but a one-person company with something (i.e. a specific set of nursing skills) to sell to clients prepared to pay for it. Note the shift in mindset here. You don't hang around hoping someone will advertise for a nurse just like yourself, you devise a unique, efficient, cost-effective service and persuade clients it is what they need.

Admittedly it's scary, but it's challenging and creative. And if you're up to it, it sure beats sending out streams of CVs and job applications fewer and fewer people will ever want to read.

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