- 31 July 2019
- 19 min read
How to change your career and become a nurse
"Nursing found me and it is more than just a job for me. It’s part of who I am."
Nurses.co.uk resident nurse and specialist writer, Ruth Underdown, explores why she became a nurse and how.
If you're considering nursing as a job, read on to find out how to set about it - and why it's more than just a job.
When did I decide I wanted to be a nurse?
I didn’t want to be a nurse. When it came to choosing a career, nursing didn’t hold any appeal.
I found a job looking for a physio assistant in the local hospital.
I applied and to my shock, was offered it.
I started in August 1997, a whole 20 years ago. Initially, I really enjoyed it. I loved helping get the patients out of bed after their total knee or hip replacements, and watching as their mobility improved from being crippled with pain pre-operatively, to being discharged on minimal painkillers and crutches or walking sticks 7-10 days after surgery.
We could help fix them, rebuild them, make their lives better. It was a great feeling.
But the physios I worked with had defined roles. We were allowed to walk people to the toilet, but if they needed help coming back? That was a nurse’s job.
One afternoon, I walked onto the ward to see two desperate looking staff nurses; one trying to give out medications, the other trying to answer patient call bells.
They were caring for all 29 patients whilst there was an outbreak of diarrhoea and vomiting affecting half the ward, several patients that required all care, and someone else dying in the side room.
I donned gloves and an apron and began to work with them.
I worked long past my own hours to get as many people comfortable and clean as possible.
I loved every minute of it.
Nursing found me and as much as there are times that I hate how it makes me feel, it is more than just a job for me. It’s part of who I am.
The next day I applied to the nurse bank, and got permission from my boss to work overtime on my weekends off.
Within six months, I had applied and started my Diploma of Higher Education in Adult Nursing.
First steps to becoming a nurse
Things have changed a lot since I began my training.
When I started, we were predominantly bursaried diploma students. If you did the degree, you didn’t get a bursary but you did get academic terms. I chose to do the diploma because of the bursary.
I believe in student nurses getting experience of what the job entails before they jump into a full-time nursing course.
Being a student nurse requires a lot more commitment than an average degree. We were either in teaching, or on placement for 45 weeks a year.
Now, you stick to academic terms for placements, but you are still expected to work the shift roster of the rest of the staff.
You can enter a nursing course through the traditional A-level/Scottish Highers route, but also with an Access to Higher Education or BTEC through a local further education college.
You will also need 5 GCSE’s, including Maths and English, grades A-C.
From completing the entry requirements, you apply for a nursing degree at your chosen university through the University and College Applications Service (UCAS).
You need to choose which branch to go into; adult, child, mental health or learning disabilities.
If you wish to train to be a midwife, this is a different degree path but nurses and midwives usually do some of their training together.
There is also the prospect of nursing apprenticeships appearing in the near future.
This will mean that nurse training will have gone full circle. Before the Project2000/Diploma nurse course that I did, nurses were trained on the ward as part of the routine ward staffing.
What qualifications does a nurse need?
As a nurse, we are professionals and regulated by the Nursing and Midwifery Council (NMC). In order to be called a registered nurse, you must have a qualification that permits you to have entry onto the Nursing and Midwifery Council’s Register.
‘Registered Nurse’ is a legally protected title. Someone who refers to themselves as a registered nurse without being on the register is committing an offence.
These days, most nurses have a degree, but we all have at least a Diploma of Higher Education in nursing.
A lot of newly qualified nurses will go on to complete their Masters in the first year after they complete their degree, and it is expected that nurses who become unit managers or clinical specialists be educated to Masters or equivalent levels.
We study at University for a MINIMUM of three years. Students entering nursing are expected to enter a lifetime of learning, keeping themselves up to date with current practice, best practice and research throughout their working lives.
It is known as Continued Professional Development (CPD) and is mandatory to your continuation.
Watch Chloe's video on how to get into nursing at university for more information on this!
You can start your training with no experience but by the time you qualify, you will have spent approximately half of your degree in clinical practice, working shifts as part of a nursing team.
Before you start applying for a nursing degree, I would wholeheartedly recommend getting some work experience as until you have actually given hands on care, you won’t know if the job is for you.
The moment you change a patient who is distressed, incontinent and embarrassed, and you find yourself reassuring them instead of thinking how gross it is, is when you know you can do this job.
Care homes and the NHS will often take on inexperienced staff and train them to be Healthcare Assistants. This gives exceptionally good grounding for those who do their nurse training as they will develop skills essential to giving good care before they start their course, and reduces the shock value of their placement.
My first post
My first qualified post was at the Royal National Orthopaedic Hospital in North London. At the time, the clinical skills required were assessed by practitioners and tutors but only once. If you did it correctly, that might be the only time you had given an injection.
I can remember giving my first injection of an anti-sickness medication as a qualified nurse, unsupervised.
As someone who is very needle-phobic, I set my mind, checked the drug, the dose, the patient, the route, and the prescription about a hundred times. I found my injection site, gave the injection, and by the time I left the room, I was shaking so much I had to sit down and recover.
What to expect from your job
It’s hard. Really hard.
There are times where you will feel broken emotionally and physically.
There are times when you cry because it’s so hard.
But there are times where you cry because you love the job so much, and you empathise so deeply with the patients you care for.
There are shifts where you never want to go back, and shifts where the feeling of achievement makes you feel like you have made a difference.
You will work shifts that can start as early as 6:45 in the morning. Night shifts between 3am-5am are when you hit the wall of tiredness.
You get cold, hungry, and just want to curl up.
Mentally, you learn to deal with these and what keeps you going.
Private Sector vs NHS - Pay and Salary Scales
I've worked in both private hospitals and care settings and the NHS.
I've most recently been in the private sector working as a Registered Nurse (RGN) in a care home after I left my post as unit manager in the prison. There are pros and cons to both sides.
In the private sector, you may get a flat rate that would be considered an enhanced rate in the NHS. In the NHS you may start at around £11.35 an hour, or £22,128 as a newly qualified nurse, also known as a Band 5, and work your way up to the top of the pay scale with annual increments and pay rises allocated by government pay rises (presently 1% a year.)
When you reach the ceiling of your Bandings pay scale, you no longer receive increments, and just receive the government allocated pay rise (if there is one).
You also receive enhancements for working after 8pm at night until 7am, and also for working weekends and bank holidays. These are usually 30% and 60% above the hourly paid rate for nights and Saturdays and Sundays and bank holidays respectively.
In the private sector, you may enter a position that pays an enhanced rate as soon as you start. This is dictated by your employer and may or may not have enhancement rates for out of hours work.
For example, most care homes in the Southeast will pay between £15-£18 an hour for a nurse, but don't offer increments or pay rises in line with government recommendations.
In the NHS, you receive a good pension, but you also expect to pay a sizeable chunk of your salary into it on a monthly basis.
In the private sector, you tend to have a basic private employment pension, which only has a minimal contribution attached to it.
In private work, you are less likely to have anything other than statutory rights to sick pay and maternity/paternity pay.
This can be something of a shock when going from the NHS where you get six months full pay and six months half pay for sick leave. Equally, this discourages staff from taking sick leave both appropriately, and inappropriately.
Private work encompasses not only working for care homes and private hospitals, but also agency work, private schools, and the introduction of private companies into the NHS when CCG’s have awarded tenders to companies such as CareUK, VirginCare, and BUPA.
You need to read the contracts attached to these jobs carefully, as the terms and conditions are different to those of the NHS.
Working in the NHS
As a nurse, working in the NHS tends to be our default. We generally undertake most, if not all our placements in NHS settings so when we qualify, it tends to be our first choice.
Like most Brits, we're hugely proud of our NHS, and most of us are keen to keep it going no matter how difficult the challenges.
The main challenges are to do with short staffing, low morale, and a feeling of lack of appreciation for the work we do. That said, to get a true grounding of all that nursing is, working in the NHS is worth the hardships as long as they aren't unbearable or unprofessional.
Your first clinical role will be a baptism of fire, and I have seen many nurses quit within the year post training.
I would advise that you think carefully about whether your calling is acute medicine, elderly care, surgery, theatres, community, or something else.
Regardless of what you choose to specialise in, nothing is ever a dead in nursing. There are always other opportunities to use your skills, and other routes that can be taken.
What keeps me excited about nursing?
I love my job. Sure, there are days when I cannot wait to get out of the door, and days when I dread the early morning starts but overall, even after 20 years, I can't see me ever not being a nurse.
I would always advise moving around if you're feeling burnt out. It's a common feeling amongst nurses.
In such an emotionally and physically demanding job, it's good to have a change and burn out is common. Changing direction or doing a stint as an agency nurse can give you this break without forcing you out of the profession entirely.
This is how the private and NHS sectors can work to retain nurses together.
Equally, the NHS offers secondments into different parts of the same organisation, so there are always opportunities to try something new.
What kind of person is a nurse?
The biggest part of this question is 'is it nature or nurture?' Is a nurse born or made?
Once I knew it was what I wanted to do, and I knew that I would never do anything else, I came to the belief that it must be nature.
I've supported the training of many nurses and mentored plenty of junior nurses over my career, but fundamentally, can you teach someone to care?
There are those that go into the job because it allows you travel the world, or as a stepping stone into something else. Those who don't really want to be nurses, don't tend to stay in the profession long.
I always consider that a nurse has to be someone who can put how a patient feels at the heart of what they do.
When you can go to an elderly, confused person who has been faecally incontinent and is just aware enough to feel embarrassed and ashamed, and put how they feel before your own feelings of horror and disgust so that you can clean them up and treat them in a decent and dignified manner, that, to me, is what the essence of nursing is.
Regardless of how many qualifications you have, this is the core of the job. As is the documentation, care planning and drug administration.
Dignity and compassion are not things that can be taught; they are as basic as right and wrong.
What are the career opportunities for an experienced nurse?
Once you are qualified two years, there are so many things you can do with a nursing qualification.
You can work just about anywhere in the world, as long as you meet their registration criteria. New Zealand, Canada, United Arab Emirates and Australia will take British nurse qualifications, and will pay a premium to take you. Read our blogs on working as a nurse in the Middle East, and as a nurse in Australia.
If you go to the USA, you have to sit further exams known as the NCLEX in order to practice.
If you decide to work for agencies part time as well as an NHS job (or instead of), then you can attract a premium hourly rate as a nurse specialist if you have experience in specific areas such as intensive care, A&E, theatres, or renal.
You can diversify away from nursing into research or specialist areas which require further qualifications to practice such as health visiting, district nursing, midwifery, or school nursing, which, as a specialism, still qualify for a fully sponsored bursary from the NHS who will pay for your further training. Once qualified, you are paid a band 6 salary when employed.
How do you deal with the emotions of the job?
Even the hardest-hearted and most experienced of nurses have patients who never leave you.
There are the ones that you didn't do as much as you felt you should have, even if you couldn't have saved them.
There are those patients you've sat with and held their hand as they received bad news.
There are truly heartbreaking moments where you need to quell your own emotions.
This is why, as a profession, we should participate in clinical supervision. It allows us to talk about what went well, what could have been done better, and how we can learn from what has happened.
It is part of the reflective practice cycle that should be part of our everyday practice.
Key soft (personal) skills
- Communication Skills
- Being a good listener
- Emotional intelligence
- Interest in other people
- Ability to work with other people
- Care and compassion for other
- Sense of humour
Your job is to find out about people and fit the information together to be able to look after them kindly and effectively.
People aren't always nice to you. You must be able to manage the situation and care for them without letting your own feelings get in the way. They may be rude and offensive towards you. No, this isn't acceptable, but they are a patient first. If you don't stand up and say if something is wrong when you know it is, then who will? It is part of the duty of candour within nursing that we speak up if we make a mistake, or if we're concerned about others and their practice.
A newly qualified nurse (band 5) should start on a salary of £22,128 with enhancements for working nights and weekends varying between an extra 30-60% per hour.
If you work in or around London, you are given extra salary weightings to account for the higher cost of living.
The band 5 pay scale finishes at £28,746, and there is an area of overlap between the pay bandings.
A Band 6, junior sister/charge nurse or specialist nurse starts on £26,565 and goes up to £35,577.
A band 7 nurse, ward manager/advanced nurse practitioner/clinical lead starts on £31,696 and goes up to £41,787.
These are the most common grades of clinical facing roles.
Band 8 and above nurses tend to be within the senior directorates, matrons, autonomous practitioners or clinical tutors.
CV and interview advice
As a general rule, nurses don't tend be very good at writing CV's.
You will need a CV!
Nurses.co.uk has a blog to help you write the perfect CV.
When going for interview, show that you have researched the organisation, it's CQC reports and about the department you are applying to.
Show that you are interested and enthusiastic. Read up on nursing interview tips and info.
There is such a thing as dressing too smart for a nursing job. It's almost an unwritten rule that if you go dressed to the nines you give the impression of not wanting to get your hands dirty, so smart casual is best when attending a band 5 or 6 interview.
At all interviews I've been to in the last 10 years, I have, without fail, been asked what my understanding of Clinical Governance is. Research it, read it, know it.
It should be something we live by in our practice, so it shouldn't be hard to answer, but still, nurses flounder with this question.