Knowledge of employment possibilities within the public, private and non-profit sectors can be elusive to the nursing community, with much onus being placed on career opportunities within the NHS. Traditionally, the role of the nurse has been perceived to be by the beside but, as the healthcare industry and policy landscape expands, nurses are becoming a valuable asset due to their knowledge of healthcare infrastructure and patient experience.
Nursing is a vocation whereby one acquires a diverse set of skills within the clinical environment that could easily be applied to roles and opportunities away from the bedside. In recent years, the role of the nurse has been ever-expanding within the NHS, with more nurses taking on more responsibilities, such as prescribing and governance, that were previously allocated to non-clinical or physician staff members. Other sectors are seeing the transferable skills of nurses and, alongside their clinical expertise, they are an attractive addition to these sectors.
This article seeks to explore the experiences of nurses working away from the bedside, undertaking careers in the governmental, private and non-profit sectors to provide exposure to the roles available to them.
Rebecca Dubben, Patient Safety Programme Manager, UCLPartners
Can you tell us about the organisation that you work for and your role within it?
‘I work for UCLPartners, a health innovation partnership. Our mission is to help 5 million people from North London to the Essex coast live longer, healthier lives. We focus on the biggest health challenges our diverse communities are facing, prioritising the people most in need. We solve health problems through research and innovation and speed up the delivery of solutions that improve health and care.’
What is your clinical experience?
‘I worked within the NHS for about 8.5 years. I started off in trauma and orthopaedics, went to the intensive therapy unit (ITU) and was able to become an extracorporeal membrane oxygenation (ECMO) nurse. I completed a master's degree in cardiorespiratory nursing and then an opportunity came up to work on redesigning specialist referrals into the ITU within my trust.’
What do you enjoy about your current role?
‘I really enjoy patient safety as I can make improvements that matter to staff and patients. I feel like I'm in a position where I'm able to do that at scale. I like working with different teams and bringing them together to learn from each other. I'm able to look at patient safety initiatives from the perspective of a nurse who's had to implement these programmes within a busy clinical environment and design tools to make the adoption easier for doctors and nurses.’
From your clinical experience, what skills are you able to apply to your current role?
‘I have an in-depth understanding of what it is like to be at the bedside, the experience of patients and knowledge of team dynamics. I think you need that perspective within the work that we do. Skills that are already ingrained in nursing, like communication skills, are invaluable. Everyone thinks of nursing as consisting of clinical skills, which are vitally important, but it's those other skills of being able to talk to different people in different ways, being able to break down quite complex information into something that patients can understand where I feel being a nurse adds value.’
How do you maintain a patient focus in your role?
‘Patient safety has got the word “patient” in it. It's about what matters to them when it comes to their safety. At the end of the day, although I don't work directly with patients, everything I do is for the person in outpatients in a chair, making sure they don't fall over, or the person in an ITU bed. I keep the patient at the forefront of what I do.’
What value do you feel that being a nurse has within your current role?
‘I have the knowledge of the complexity of implementing change within the NHS, and that there is no fast solution to challenging problems around patient safety. With my clinical experience, I'm able to give an accurate reflection of the workforce and advocate for them. People have this assumption of what a nurse is and which spaces they should occupy but nursing is a varied, highly skilled and wonderful career path and there are multiple routes and multiple opportunities for us to occupy these spaces.’
Ravinder Mander, Director of Nursing, TRICARE Overseas, International SOS
What is International SOS?
‘International SOS is one of the world's largest medical and travel security services companies. I work for the TRICARE Overseas Program, which delivers care to US military active-duty service members and their families. We provide telephonic medical advice and co-ordinate their care when they are stationed anywhere outside of the USA.’
What is your role?
‘As Director of Nursing, I have oversight of the three TRICARE offices in Philadelphia, USA, London, UK and Singapore.
‘I manage a team of nurses based internationally, define best practice and provide leadership support so that we can ensure the service members and their families receive the best care possible wherever they are in the world.’
What are the challenges from transitioning from a clinical patient-facing role to international telehealth?
‘We deliver global medical case management via the telephone, and we use evidence-based decision-making in that. We don't use medical algorithms to assess our callers because all our staff have a wealth of clinical exposure. This means that we're able to deliver a patient-focused assessment rather than follow a list of predefined questions. Telephonic triage, relationship building, understanding the US military and global health is something that I never had to do within the NHS and that's where our internal training comes in, which is also led by nurses.’
What is the value of nurses within your organisation? Why not employ non-medical professionals to undertake an algorithmic assessment?
‘Our clients call us because they want medical advice. Nurses are not only able to provide a clinical assessment, but it's the interpersonal skill of managing an unwell patient and addressing their fears, concerns and needs that's important to our ethos.
‘We're able to provide medical advice, direct a patient to a hospital anywhere in the world or address their concerns, all in that first phone call. The caller is being provided with a holistic service from an experienced nurse who's been by the bedside, and understands their concerns.
‘I think taking your nursing expertise into other industries, away from a traditional nursing capacity is something some people would probably feel concerned about. It's not in your comfort zone, but you can still provide patient-centred care, but that doesn't necessarily need to be by the bedside.’
‘I think taking your nursing expertise into other industries, away from a traditional nursing capacity, is something some people would probably feel concerned about. It's not in your comfort zone, but you can still provide patient-centred care, but that doesn't necessarily need to be by the bedside’
You've mentioned the role of nurses within your organisation providing telephonic medical advice, are there other roles for nurses within your organisation?
‘We're an international company and we have nurses across the globe. We have clinics in remote overseas locations, nurses on the ground near military bases, nurses who work in medical informatics or account management. Many nurses here are trained in-house on in-flight nursing, so we're able to repatriate a patient if the need arises! Overall nurses are an asset to the company.’
Helen Kirk, Nursing and Midwifery Workforce Lead, Office for Health Improvement and Disparities, Department of Health and Social Care
I think that it's fair to say that you've had a diverse nursing career. What are some of the positions that you've occupied?
‘I started off my nursing career in cardiology in Nottingham, then completed my midwifery training. I then served in the army and was stationed overseas as a nursing officer. I used to get a lot of Star Trek jokes, as I was ‘Captain Kirk’. I developed a passion for occupational health after leaving the military and then studied for my master's degree at Manchester Business School and in Cape Town. Since then, I've lectured and taken on a variety of roles including within a government department and held a variety of positions on national and international committees.’
What is your current role?
‘I lead on work, health and professional issues for public health nurses and midwives. Recently, I've been working with the Nursing and Midwifery Council (NMC) on the specialist community public health nurse standards and I'm now supporting the development of standards for nurses working in inclusion health that never existed before.’
What is inclusion health?
‘Inclusion health relates to populations that can be socially excluded and experience multiple risk factors for poor health, such as those who experience homelessness and Traveller communities, to name a few.’
What's driven you to have such a diverse career?
‘Staff wellbeing has always been a strong motivator of mine and ensuring that nurses and midwives are developed and supported for me is vital. I also have an intellectual curiosity around people and populations, where I constantly want to learn more and improve health.’
What are the benefits from working in the government sector?
‘You get to take a step back. Treating patients directly is vitally important but my passion has always been not only with patients but also with the workforce. You need a happy and healthy workforce to deliver efficient patient care.
‘I want to ensure that the infrastructure is in place to support healthcare workers so that they can best support their patients, clients and populations.’
What are the biggest challenges?
‘Keeping in touch. You don't want to distance yourself from the staff that you're trying to support. I've made sure that I regularly keep one foot in my current role but also get on-the-ground experience, whether this is visiting GP and maternity sites in deprived communities or volunteering at my local pharmacy to deliver COVID-19 vaccinations. Workforce data can only say so much, so I like to see and hear the evidence from those that the data is trying to represent.’
Are there many positions for nurses within the government sector?
‘I've seen nurses in various roles in government and arms-length bodies (ALBs), managing and influencing health improvement, system innovation and other areas. There are lots of opportunities out there such as getting involved in a committee, the NMC or the National Institute for Health and Care Excellence (NICE).’
As a nurse, how did you feel about going into this type of work?
‘I built a career around having exposure to many clinical settings and I've found that people really value that. I think all nurses have the capacity to contribute, regardless of their experience or location of work, to improving healthcare outcomes. You have that voice for the nursing profession and that understanding of the impact that changes can have for patients and staff, and you can advocate for them.’
Nursing: a diverse career
The work of the nurse is diverse and covers a range of sectors in which they can find employment. Nursing offers a variety of career opportunities within and outside of the NHS for roles relating to healthcare, patient advocacy and governance.
‘The role of the nurse has no boundaries. Nurses can define and meet the needs of the patient across all sectors, organisations and governmental bodies. The influence of the nurse is great, no matter where you work, a nurse is a guiding light to better patient care.’
Deborah Small, Chief Nursing Officer, Cleveland Clinic, and member, Florence Nightingale Foundation's Academy Advisory Group
Being aware of the various career opportunities away from bedside roles can be challenging for nurses. However, as the private and public sectors continue to see the value of nurses within their organisations, this will ultimately provide additional opportunities for nurses to be the voice for patients and the healthcare workforce.