A career in nursing – opportunities in a changing healthcare system

Joy Godden image
By Joy Godden     22/01/2019

If you’d asked me about what job I would have in 2018 when I first started nursing 37 years ago, I could never in a million years have imagined what I am doing now.

My job encompasses being professionally accountable for our 1,700 nurses as well as supporting the operational ‘working’ of the nurses and looking more strategically at issues like recruitment and retention, and future workforce shape. I am also the director of clinical governance – but that’s a whole other story!

But in 1981, the thought of being a ward sister – well, I could hardly imagine that. That was the pinnacle of my ambitions.

My career hasn’t been planned at all and to start with, nursing was something I sort of fell into.

I didn’t have much idea about what went on in hospitals – but I also didn’t know what I wanted to do when I left school. My mum thought that nursing might suit me so I thought I’d try it. And I’m so glad I did – I quickly fell in love with the profession.

Within the first year of your training you are dealing with patients who may be very sick, some who are dying. You are dealing with people who are distressed, anxious, terrified, or delighted, relieved, grateful – you are dealing with all aspects of humanity.

There is something very special and privileged about being able to make a difference to people when they are in their darkest and their highest moments.

My career path

I trained at Guy’s Hospital, got my first nursing job at Guy’s, moved to King’s College Hospital and then came to Royal Brompton to do my cardiothoracic specialist course. I worked here in intensive care for a little while – when it was in the Fulham wing – where Lind ward is now.

After this, I went back to Guy’s as a ward sister on the cardiothoracic surgery ward. I found this area of nursing really suited me, and was very rewarding. It was a great mixture of patients: those who went home about a week after going through major surgery, and those who had really challenging needs – in particular those with lung conditions who could be with us for a long time. I really loved having my own ward, and got such a buzz out of teaching and supporting my nurses – I really felt I owned it – my team, my ward.

Like a lot of people, I first came to Royal Brompton on temporary basis – and stayed! I came here to do a matron / senior nurse role on secondment for one year. I ended up staying for six years, before doing a bit of work in nursing research. After that, and with some encouragement, I took an opportunity to become the General Manager in the Trust’s respiratory division. This was again something I hadn’t planned as a career move, but it gave me a whole different perspective on how services are run and developed, and I hope I was able to keep a focus on what was best for our patients. I stayed in this role for over 10 years before putting my hat in the ring for the director of nursing and clinical governance post.

I do miss delivering hands-on care. After all, that’s where you get the direct feedback that makes all the hard work worthwhile. On the plus side, I do get the opportunity to encourage, challenge and support nurses across the many different areas in the Trust – and I really enjoy this part of my role.

I haven’t ever planned my career path, but have been curious about opportunities when they have come my way. That is a great thing in the NHS – and these hospitals in particular – there are loads of different things to do. If you’re a nurse, your career can go in so many different directions. You can use your skills in many different ways.

Four decades in nursing

Nursing care has changed in the four decades that I’ve been working, but there are some things have stayed the same. The complexity of care now is much greater – but the commitment you need to be a nurse – that is the same.

I think that nursing today has a greater number of roles to work in. You can develop into an expert in the delivery of hands-on care, whether in a general setting or moving into a sub specialty, or you can find a role to support others to do that. There are academic pathways, or you can take your experience and use it in a much broader role in or outside the NHS – the skillsets we develop are very valuable.

I do think that work nowadays is more stressful than in previous times – nurses really do work their socks off. This work ethic has always been there, but now the environment is much more pressured, and finding the humour and enjoying the camaraderie is, I think, harder these days.

The hierarchy has changed too. Nowadays nurses are autonomous in their practice, and they work in a flatter nursing structure. The very rigid top-down approach was altering when I first when into nursing into 1981 – but in those days all ward sisters were still dragons – though often with kind hearts under the scary exterior.

On the other hand, when I first became a nurse, staffing levels were much lower. As a second-year student nurse I would be in charge of a cardiac ward at night, with just one other ‘enrolled nurse’, which was a nursing assistant post. This was terrifying and in hindsight it was an awful lot of responsibility for someone who was only 19 or 20! That, thankfully, wouldn’t happen now.

Patients have also changed in terms of what they expect. I think when I began my career, people didn’t assume that they would fly through complex surgery. Now if their recovery doesn’t go according to plan, patients seem much more thrown by it. People’s expectations are, I think, much more challenging to manage now.

Attracting the new generation of nurses

Attracting new nurses can be quite challenging. In the distant past nursing was viewed as a vocation, something that was an acceptable career for women, as it was the ‘caring profession’. Although it’s great that nursing now attracts a truly diverse workforce, it is also now competing with many roles that were not traditionally available for women in the past.  Since nursing became a degree based profession, students study alongside others who will enter much more lucrative jobs.

Money isn’t everything thank goodness, but as nurses’ pay continues to lag increasingly behind other career salaries – not to mention the removal of bursary support for training at a time of recognised nursing shortage – it becomes harder to attract people into the profession at the start; no matter how exciting a career it may be in the longer term.

Nurses used to be trained on the job, going to nursing school within the hospital. I do think we lost something when that changed to university-based training. Before this, nurses felt associated with a hospital – it anchored them and gave a sense of belonging.

I am not arguing that nurses shouldn’t be educated to degree level entry point – after all, they are providing extremely complex care within their field. But the downside is we have lost the sense of connection – a sense of being part of a long history of professionals building a reputation at that specific hospital. I will always be a ‘Guy’s nurse’ – it gives me a sense of connection with the thousands of nurses who have worked there before me. It meant something to say you were a nurse from a particular hospital; nurses now don’t have that sense of place so readily.

What makes a great nurse?

Can I tell who is going to make a great nurse? It’s an impossible question, as there are so many answers, but I think a great nurse is someone who can apparently effortlessly juggle a great number of competing priorities, whilst making sure that their patient feels that they are all that matters at that time.

Also, not being thrown by whatever comes from left field, and having the ability to show your humanity without making your emotions a burden to others; and being able to work alongside many other staff groups to ‘glue together’ the whole experience that patients have in hospital.

Nurses are the only professionals who stay alongside the patient 24/7, and are therefore well placed to see the detail, as well as the bigger picture, for the individual.

And maybe finally: having the staying power to finish every shift with the knowledge that the next one will be equally busy/challenging/rewarding/exhausting – but come back the next day ready to do it all again!