ORIGINAL RESEARCH
Employers’ and employees’ views on responsibilities for career management in nursing: a cross-sectional survey Julia Philippou Accepted for publication 7 June 2014
Correspondence to J. Philippou: e-mail: [email protected] Julia Philippou PhD RN Lecturer Florence Nightingale School of Nursing and Midwifery, King’s College London, UK
P H I L I P P O U J . ( 2 0 1 5 ) Employers’ and employees’ views on responsibilities for career management in nursing: a cross-sectional survey. Journal of Advanced Nursing 71(1), 78–89. doi: 10.1111/jan.12473
Abstract Aim. To examine nurse employees’ and employers’ views about responsibilities for managing nurses’ careers. Background. Career management policies are associated with cost savings, in terms of workforce recruitment and retention and an increase in job and career satisfaction. In nursing, responsibility for career management remains relatively unexplored. Design. A multicenter, cross-sectional questionnaire survey. Methods. Data were collected from 871 nurse employees and employers in the British National Health Service. The study was conducted in 2008, a period when policy reforms aimed at modernizing the healthcare workforce in England. In the current discussions in Europe and the USA about the future of nursing, these data reveal insights not previously reported. Exploratory analyses were undertaken using descriptive and inferential statistics. Results. The analysis indicated a temporal dimension to career management responsibilities. Short-term responsibilities for securing funding and time for development lay more with employers. Medium-term responsibilities for assessing nurses’ strengths and weakness, determining job-related knowledge and skills and identifying education and training needs appeared to be shared. Long-term responsibilities for developing individual careers and future development plans lay primarily with employees. Conclusion. New ways of managing nurses’ career development that lead to greater independence for employees and greater flexibility for employers, while retaining a high-calibre and competent workforce, are needed. Ultimately, career management responsibilities should not tilt to either side but rather be shared to benefit both parties. Clarifying employers’ and employees’ responsibilities for career management may help both parties to develop a common understanding of each other’s role and to meet their obligations in a constructive dialogue. Keywords: career management, nurses, nursing careers, recruitment and retention, survey research
78
© 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
Why is this research needed? ● Effective career management has long been associated with effective workforce recruitment and retention; however, in nursing this issue has rarely been explored. ● The careers literature identifies a shift in career management responsibilities from the employer to the employee; however, the extent to which nurses are willing to assume primary responsibility for managing their careers is unclear.
What are the key findings? ● Different career management responsibilities lie with different actors, either employer or employee, depending on the temporal nature of the particular responsibility,
Responsibilities for career management in nursing
European Commission (2012) estimated that by 2020, 14% of nursing care in Europe will not be covered due to a predicted shortage of 590,000 nurses. Effective career management has long been associated with effective workforce recruitment and retention (Sturges et al. 2002); however, in nursing, this issue remains relatively unexplored in the international literature (Buchan 2013). At a time when slow global economic growth leads hospitals to employ a range of cost-containment strategies, including layoffs, hiring freezes and cuts in educational funds (European Federation of Nurses Associations (EFN) 2012), the present study’s exploration of hospital nurses’ employees and employers’ views about responsibilities for career management is opportune.
namely short-term, medium-term and long-term responsibilities. ● Demographic characteristics, employment profile, academic qualifications and caring responsibilities significantly affect employees’ engagement with career management responsibilities.
How should the findings be used to influence policy/ practice/research/education? ● Health-care organizations should assist the development of their employees by clarifying and making explicit what they see as employer versus employee obligations regarding career management. ● Career management policies should not tilt responsibilities to one side or the other in the employment relationship but rather encourage a shared approach that brings longterm benefits to both parties. ● Researchers should examine nurses’ motives for and intentions concerning embracing career management responsibilities and the extent to which nurses are adequately prepared to assume greater responsibility for their career management.
Introduction The contribution of the nursing workforce to the quality of healthcare services and the efficiency of healthcare systems is widely reported and recognized. Growing international evidence demonstrates that lower nurse staffing levels are associated with increased risks for a variety of negative outcomes, including mortality rates, adverse events and medication errors (Kane et al. 2007, Aiken et al. 2012). Despite this evidence, healthcare systems have yet to identify adequate solutions to retain nurses in the profession at a time when demand for nursing care is increasing while supply is decreasing (Buchan & Seccombe 2013). For example, the © 2014 John Wiley & Sons Ltd
Background Factors associated with nurses’ intentions to leave their job have been the focus of many studies (Flinkman et al. 2010, Brewer et al. 2012, Heinen et al. 2013). In a recent literature review of 68 international studies, Hayes et al. (2012) identified three main categories of factors that act as nurse turnover determinants: organizational, individual and career advancement and pay/benefits. While organizational factors such as workload, stress and burnout (McGillis Hall 2005, Aiken et al. 2012) and individual factors such as social commitments and caring responsibilities (Barriball et al. 2007, Firmin & Bailey 2008) have already received considerable research attention, career-related factors have received less attention (National Nursing Research Unit 2008). This is despite evidence demonstrating that effective career management policies are associated with cost savings, in terms of workforce recruitment and retention and increases in job and career satisfaction among employees, which in turn result in greater organizational commitment (Yarnall 2008, Carter & Tourangeau 2012). The limited focus on nurses’ career management may be because career progression for nurses has long been typified as a simple linear advancement from staff nurse to ward sister or charge nurse and then, for a few, a move into management (Robinson & Murrells 1998). Also career management is often perceived to be too complicated and too future oriented to be justified on the basis of immediate financial returns (King 2004). Recently, in response to wide economic, technological, societal and organizational changes, healthcare systems internationally have become increasingly more complex in terms of service provision and delivery and as a result healthcare professionals’ careers are changing (Department of Health 2008, Prime Ministers Commission on the future 79
J. Philippou
of nursing and midwifery in England 2010, Institute of Medicine 2011). In the UK, for example, political and financial pressures have led the National Health Service (NHS) to undergo considerable changes, including the introduction of internal markets, the increasing focus on the consumer, the efficiency and effectiveness of services and increasing demand for new ways of working (McCabe & Sambrook 2013). These have influenced the way healthcare professionals work, creating new roles for nurses ranging from senior-level clinical roles with enhanced clinical responsibilities to nurse-led services, nurse specialists, nurse prescribers and nurse consultant roles with increasing focus on transferring care services to the community (Robinson et al. 2006, Sambrook 2006). In line with these changes are different expectations about how individuals and organizations engage with current and future career management. In particular, it has been argued that having a career is now seen less in terms of job security in a single organization and more in terms of individual employability and mobility across organizations and labour markets (Hall 2002, Baruch 2004, Arthur et al. 2005). The rhetoric of this new notion endorses the idea that the onus of managing careers rests primarily on the individual, while the balance between organizational and individual responsibility previously believed to have existed is gradually diminishing (Arthur & Rousseau 1996, Stickland 1996, Sturges et al. 2000). New career assumptions identified in the wider careers literature advocate individual employees engaging with career self-management (King 2001, 2004). Changes in nursing, in terms of expanding new roles and settings, follow the trend of changing philosophies in the field of career management (Sturges & Guest 2001). Healthcare policies advocate that employees should take responsibility for their own career development, while employers should ensure that individuals have access to resources to equip them with skills to manage their own careers (Department of Health 2004, 2008). Moreover, in the international scene Donner and Wheeler (2001a,b) have issued a call for nurses to take control of their careers and proposed a set of strategies that nurses could use to self-manage their careers. The shift of career management responsibilities from organization to individual is, however, thought to present several challenges. On the one hand, employees are now expected to anticipate changes in the working environment and invest in skills acquisition and their employability to remain competitive in the labour market; and on the other, organizations are struggling with recruitment and retention of talented and committed employees (Cliffe 1998, Sturges et al. 2000, King et al. 2005). Research on nurses’ careers has shown that lack of career development opportunities 80
and lack of career discussions and career guidance were some of the main sources of dissatisfaction reported by nurses and were often cited as reasons for considering leaving their jobs (Davies et al. 2000, Cox et al. 2003, Robinson et al. 2005). The extent to which employees have acknowledged that they now have the primary responsibility for managing their careers is unclear and it is not known what type of responsibilities they are willing to assume. At the same time, whether organizations and employers have indeed transferred the responsibility of career management to their employees and what types of responsibilities this may involve are underexplored. If responsibility for career management is to lie primarily with the individual as the basis of the new employment contracts in the organizations, then it is important to understand the type of responsibilities employees are willing to assume and the extent to which organizations are willing to ascribe responsibility to their employees. This study explored these issues in relation to nursing in the UK, which until recently has had a history of great career stability, at a time when policy reforms were aimed at modernizing nursing careers (Department of Health 2006). In the recent discussions in Europe (European Commission 2012) and North America (Institute of Medicine 2011) about the future of nursing, this study reveals insights not previously considered that can inform policy developments.
The study Aim The aim of this study was to identify and compare the views of nurse employees and employers about responsibilities for managing individual nurses’ careers.
Design The design employed was a multicenter, cross-sectional questionnaire survey.
Sample Data were collected from five NHS Trusts purposively selected to encompass a wide variation of services including adults’ and children’s nursing services; care settings, including both outpatient and inpatient; and different specialties, including medical, surgical and emergency care. Following a mapping of services provided in each of the five NHS Trusts, a purposively selected sample of © 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
departments was used to ensure that participants in the sample represented nurses working across the organization. All the nursing staff working in these departments were invited to participate in the project. A total of 1678 questionnaires were distributed to both employees (n = 1588) and employers (n = 90). Of these 871 were returned giving a total response rate of 52%; 813 questionnaires were returned from the employees group (51% response rate) and 58 from the employers group (64% response rate).
Data collection The study was conducted between January–September 2008. Data about participants’ demographic (age, gender), employment (band level, working post and pattern) and academic (highest qualification) profile and their caring responsibilities, were collected through a structured questionnaire. In addition, seven items about career management responsibilities were included, developed through a preliminary interview-based study with a total of 41 participants (Philippou 2011). These focused around seven key areas of career management responsibility: securing funding for training; securing time to participate in educational activities; identifying education and training needs; assessing strengths and weaknesses for development; determining job-related knowledge and skills; developing individual career plans; and planning future career development. The items were presented in two questions asking participants to rank from 1, responsibility lies with the nurse, to 10, responsibility lies with employers. Both questions had the same statements; however, the first question asked participants to indicate where they would ‘ideally’ like different responsibilities to lie (ideal responsibility), while the second question asked them to indicate where these currently lie from their ‘actual’ experiences in their Trusts (actual responsibility).
Ethical considerations Ethical approval was obtained through the Central Office of Research Ethics Committee and the Research and Development (R&D) departments of the five participating NHS Trusts.
Data analysis Data were analysed using SPSS version 17 (IBM, Chicago, IL, USA). The Chi-square test (v2) was used to examine relationships between categorical variables. The Wilcoxon © 2014 John Wiley & Sons Ltd
Responsibilities for career management in nursing
signed-rank test (Z) was used to identify differences between actual and ideal career management responsibilities; the Mann–Whitney test (U) to identify differences in responses between the nurse employees’ and employers’ groups; and the Kruskal–Wallis test (H) was used to identify differences between independent variables from participants’ demographic, employment and academic profiles. If the results of the Kruskal–Wallis test (H) indicated significant differences in outcomes, post hoc tests using the Bonferroni method were performed to identify which groups differed from each other. The level of significance was set at P < 005.
Validity and reliability Validity and reliability were enhanced through extensive preliminary work, which included input from nurses, managers and a panel of experts (Philippou 2011). The instrument did not use multi-item measures and standard reliability testing (Cronbach 1951, Cohen 1960) did not apply. Following de Vaus (2002), reliability was addressed through ensuring use of well-tested questions, careful consideration of question wording and systematic methods of coding. Acceptability and feasibility of the questionnaire were assured through a postal pilot and structured face-toface interviews undertaken with nurse employees and employers (n = 98) from one NHS Hospital not included in this study.
Results Characteristics of sample Table 1 presents summary statistics for both the employer and employee groups with regard to their demographic, academic and employment profile. The employee group consisted of staff nurses (n = 496, 61%), charge nurses (n = 174, 21%) such as ward managers/sisters and specialist nurses (n = 142, 18%) such as clinical nurse specialists/ nurse practitioners working in a variety of settings and specialties. The employer group was represented by participants holding senior managerial positions in the organization and providing leadership to other management or specialist staff, such as matrons (n = 28, 48%); senior nursing staff such as heads and deputy directors of nursing services (n = 16, 28%) who were part of the executive board in their organizations with overall responsibilities for strategic and corporate issues; and other senior managers, including human resource managers (n = 14, 24%). 81
J. Philippou
Table 1 Characteristics of the sample.
Table 2 Participants’ band profiles.
Sample groups
Demographic characteristics Age (mean) Female, n (%) Male, n (%) Highest academic qualification, Certificate Diploma level Degree level Master’s level Doctoral level Working post, n (%) Staff nurses Charge nurses/sisters Specialist nurses Matrons Heads/directors of nursing Senior managers (e.g. HR) Seniority level, n (%) Band 5 Band 6 Band 7 Band 8 Employment pattern, n (%) Full-time Part-time Caring responsibilities, n (%) Yes No
Employee group
Employer group
38 (SD 9) 722 (89) 91 (11) n (%) 206 (25) 237 (29) 328 (41) 41 (5) –
43 (SD 75) 48 (83) 10 (17)
9 20 22 2
496 (61) 174 (21) 142 (18) – – –
– – – 28 (48) 16 (28) 14 (24)
369 181 249 12
(45) (22) (31) (2)
– – – –
747 (92) 66 (8)
– –
351 (43) 462 (57)
– –
Description*
Band 5
Junior nurses providing direct clinical care and supervising healthcare assistants. Clinical knowledge acquired through training to a degree or diploma level. Specialist nurses or team leaders with relevant postregistration qualifications performing a wide range of clinical activities with leadership responsibilities over junior nurses. Professional knowledge acquired through a degree supplemented by further specialist training, experience and short courses. Nurses with additional leadership and managerial responsibilities (such as managing a ward). Usually holding delegated budget for the department/ward. Professional knowledge acquired through a degree supplemented by further specialist training and/or managerial training. A mix of nurse managers and nurse consultants. For this study this category included primarily nurse consultants practicing autonomously at an advanced level with a significant proportion of their role involving direct clinical care and education, research and management activities. Professional knowledge acquired through specialist training or equivalent experience at master’s level.
Band 6
– (15) (40) (41) (4)
The majority of participants were female (n = 770, 88%) and only 12% (n = 101) were male. Participants ranged in age from 20–65 years old, with a mean age of 385 years old. Employers tended to be older (Mean = 43 years old, SD 75) than employees (Mean = 38 years old, SD 9). Over half of employees (n = 443, 54%) held a certificate or diploma as their highest academic qualification, followed by 41% (n = 328) holding a degree. Only a small percentage (n = 41, 5%) held a master’s degree. With regard to employers, a small number of participants (n = 9, 15%) indicated that they held a diploma, 40% (n = 20) a degree and 41% (n = 22) a master’s degree as their highest academic qualification. Two participants (4%) held doctoral qualification. Employees’ seniority levels ranged from newly qualified Band 5 to experienced Band 8 nurses. Table 2 provides an indicative job profile of these participants. Forty five per cent (n = 369) of participants were in Band 5, 22% (n = 181) in Band 6, 31% (n = 249) in Band 7 and only 2% (n = 12) in Band 8. The majority of participants were in full-time employment (n = 747, 92%), with 8% (n = 66) indicating working on a part-time basis. Forty-three per 82
Band level
Band 7
Band 8
*The table provides an indication of the main features of participants’ band profile to contextualize the sample of the study. Detailed description is available through the UK National Profile for Nursing Services: http://www.nhsemployers.org/PayAndContracts/AgendaForChange/NationalJobProfiles/Documents/Nursing_ Services.pdf.
cent (n = 351) of participants in the employee group indicated they were taking care of dependents, including children (n = 278, 79%) and/or elderly relatives (n = 44, 13%) and others (n = 29, 8%) (i.e. disabled dependents). The participants indicated that they attended both mandatory training and training for career development equally. While the two kinds of training are not interchangeable (Inkson & Arthur 2001), respondents in this study appeared to blur the two. This is probably because this distinction is not made explicit in nurses’ development pathways in the British NHS (Department of Health 2004, 2008, 2013).
Views on ideal and actual career management responsibilities The analysis indicated a shared approach to career management, with certain responsibilities lying primarily with © 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
Responsibilities for career management in nursing
employees and others with employers. For ease of reporting, responsibilities were grouped as short-term (securing funding, securing time for training), medium-term (assessing strengths and weakness, determining job-related knowledge and skills, identifying education and training needs) and long-term responsibilities (developing individual career plans, planning future career development plans) (Table 3). Short-term career management responsibilities Findings from both groups indicated that short-term career management responsibilities lie primarily with employers. In particular, both ideal and actual responsibility for ‘securing resources’ were reported to lie with employers (Median = 8). However, with regard to ‘securing time’ to participate in developmental activities, although participants indicated that this should ideally lie with employers (Median = 8), this was actually reported as shared between employers and employees (Median = 5) (z = 1184, P < 0001).
Table 3 Participants’ views on where actual and ideal career management responsibilities lie (N = 871). Median (IQR)* Responsibility for
All respondents
Employers
Employees
Short-term responsibilities Securing resources Ideal 8 7 (6–9) 8 (6–10) Actual 8 8 (7–9) 8 (5–10) Securing time Ideal 8 6 (5–8) 8 (5–10) Actual 5 7 (4–8) 5 (3–8) Medium-term responsibilities Identifying education and training needs Ideal 5 5 (5–6) 5 (4–6) Actual 4 6 (4–8) 4 (2–5) Assessing strengths and weaknesses Ideal 5 6 (5–7) 5 (4–6) Actual 5 7 (6–8) 4 (2–5) Determining job-related knowledge and skills Ideal 5 7 (5–8) 5 (3–6) Actual 5 8 (6–9) 5 (2–6) Long-term responsibilities Developing individual career plans Ideal 4 5 (3–5) 3 (2–5) Actual 3 5 (2–7) 3 (1–5) Planning future career development Ideal 3 5 (3–5) 3 (2–5) Actual 3 5 (3–7) 3 (1–5)
P values
001 – 0003 –
–
Employers’ and employees’ views on responsibilities for career management in nursing: a cross-sectional survey Julia Philippou Accepted for publication 7 June 2014
Correspondence to J. Philippou: e-mail: [email protected] Julia Philippou PhD RN Lecturer Florence Nightingale School of Nursing and Midwifery, King’s College London, UK
P H I L I P P O U J . ( 2 0 1 5 ) Employers’ and employees’ views on responsibilities for career management in nursing: a cross-sectional survey. Journal of Advanced Nursing 71(1), 78–89. doi: 10.1111/jan.12473
Abstract Aim. To examine nurse employees’ and employers’ views about responsibilities for managing nurses’ careers. Background. Career management policies are associated with cost savings, in terms of workforce recruitment and retention and an increase in job and career satisfaction. In nursing, responsibility for career management remains relatively unexplored. Design. A multicenter, cross-sectional questionnaire survey. Methods. Data were collected from 871 nurse employees and employers in the British National Health Service. The study was conducted in 2008, a period when policy reforms aimed at modernizing the healthcare workforce in England. In the current discussions in Europe and the USA about the future of nursing, these data reveal insights not previously reported. Exploratory analyses were undertaken using descriptive and inferential statistics. Results. The analysis indicated a temporal dimension to career management responsibilities. Short-term responsibilities for securing funding and time for development lay more with employers. Medium-term responsibilities for assessing nurses’ strengths and weakness, determining job-related knowledge and skills and identifying education and training needs appeared to be shared. Long-term responsibilities for developing individual careers and future development plans lay primarily with employees. Conclusion. New ways of managing nurses’ career development that lead to greater independence for employees and greater flexibility for employers, while retaining a high-calibre and competent workforce, are needed. Ultimately, career management responsibilities should not tilt to either side but rather be shared to benefit both parties. Clarifying employers’ and employees’ responsibilities for career management may help both parties to develop a common understanding of each other’s role and to meet their obligations in a constructive dialogue. Keywords: career management, nurses, nursing careers, recruitment and retention, survey research
78
© 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
Why is this research needed? ● Effective career management has long been associated with effective workforce recruitment and retention; however, in nursing this issue has rarely been explored. ● The careers literature identifies a shift in career management responsibilities from the employer to the employee; however, the extent to which nurses are willing to assume primary responsibility for managing their careers is unclear.
What are the key findings? ● Different career management responsibilities lie with different actors, either employer or employee, depending on the temporal nature of the particular responsibility,
Responsibilities for career management in nursing
European Commission (2012) estimated that by 2020, 14% of nursing care in Europe will not be covered due to a predicted shortage of 590,000 nurses. Effective career management has long been associated with effective workforce recruitment and retention (Sturges et al. 2002); however, in nursing, this issue remains relatively unexplored in the international literature (Buchan 2013). At a time when slow global economic growth leads hospitals to employ a range of cost-containment strategies, including layoffs, hiring freezes and cuts in educational funds (European Federation of Nurses Associations (EFN) 2012), the present study’s exploration of hospital nurses’ employees and employers’ views about responsibilities for career management is opportune.
namely short-term, medium-term and long-term responsibilities. ● Demographic characteristics, employment profile, academic qualifications and caring responsibilities significantly affect employees’ engagement with career management responsibilities.
How should the findings be used to influence policy/ practice/research/education? ● Health-care organizations should assist the development of their employees by clarifying and making explicit what they see as employer versus employee obligations regarding career management. ● Career management policies should not tilt responsibilities to one side or the other in the employment relationship but rather encourage a shared approach that brings longterm benefits to both parties. ● Researchers should examine nurses’ motives for and intentions concerning embracing career management responsibilities and the extent to which nurses are adequately prepared to assume greater responsibility for their career management.
Introduction The contribution of the nursing workforce to the quality of healthcare services and the efficiency of healthcare systems is widely reported and recognized. Growing international evidence demonstrates that lower nurse staffing levels are associated with increased risks for a variety of negative outcomes, including mortality rates, adverse events and medication errors (Kane et al. 2007, Aiken et al. 2012). Despite this evidence, healthcare systems have yet to identify adequate solutions to retain nurses in the profession at a time when demand for nursing care is increasing while supply is decreasing (Buchan & Seccombe 2013). For example, the © 2014 John Wiley & Sons Ltd
Background Factors associated with nurses’ intentions to leave their job have been the focus of many studies (Flinkman et al. 2010, Brewer et al. 2012, Heinen et al. 2013). In a recent literature review of 68 international studies, Hayes et al. (2012) identified three main categories of factors that act as nurse turnover determinants: organizational, individual and career advancement and pay/benefits. While organizational factors such as workload, stress and burnout (McGillis Hall 2005, Aiken et al. 2012) and individual factors such as social commitments and caring responsibilities (Barriball et al. 2007, Firmin & Bailey 2008) have already received considerable research attention, career-related factors have received less attention (National Nursing Research Unit 2008). This is despite evidence demonstrating that effective career management policies are associated with cost savings, in terms of workforce recruitment and retention and increases in job and career satisfaction among employees, which in turn result in greater organizational commitment (Yarnall 2008, Carter & Tourangeau 2012). The limited focus on nurses’ career management may be because career progression for nurses has long been typified as a simple linear advancement from staff nurse to ward sister or charge nurse and then, for a few, a move into management (Robinson & Murrells 1998). Also career management is often perceived to be too complicated and too future oriented to be justified on the basis of immediate financial returns (King 2004). Recently, in response to wide economic, technological, societal and organizational changes, healthcare systems internationally have become increasingly more complex in terms of service provision and delivery and as a result healthcare professionals’ careers are changing (Department of Health 2008, Prime Ministers Commission on the future 79
J. Philippou
of nursing and midwifery in England 2010, Institute of Medicine 2011). In the UK, for example, political and financial pressures have led the National Health Service (NHS) to undergo considerable changes, including the introduction of internal markets, the increasing focus on the consumer, the efficiency and effectiveness of services and increasing demand for new ways of working (McCabe & Sambrook 2013). These have influenced the way healthcare professionals work, creating new roles for nurses ranging from senior-level clinical roles with enhanced clinical responsibilities to nurse-led services, nurse specialists, nurse prescribers and nurse consultant roles with increasing focus on transferring care services to the community (Robinson et al. 2006, Sambrook 2006). In line with these changes are different expectations about how individuals and organizations engage with current and future career management. In particular, it has been argued that having a career is now seen less in terms of job security in a single organization and more in terms of individual employability and mobility across organizations and labour markets (Hall 2002, Baruch 2004, Arthur et al. 2005). The rhetoric of this new notion endorses the idea that the onus of managing careers rests primarily on the individual, while the balance between organizational and individual responsibility previously believed to have existed is gradually diminishing (Arthur & Rousseau 1996, Stickland 1996, Sturges et al. 2000). New career assumptions identified in the wider careers literature advocate individual employees engaging with career self-management (King 2001, 2004). Changes in nursing, in terms of expanding new roles and settings, follow the trend of changing philosophies in the field of career management (Sturges & Guest 2001). Healthcare policies advocate that employees should take responsibility for their own career development, while employers should ensure that individuals have access to resources to equip them with skills to manage their own careers (Department of Health 2004, 2008). Moreover, in the international scene Donner and Wheeler (2001a,b) have issued a call for nurses to take control of their careers and proposed a set of strategies that nurses could use to self-manage their careers. The shift of career management responsibilities from organization to individual is, however, thought to present several challenges. On the one hand, employees are now expected to anticipate changes in the working environment and invest in skills acquisition and their employability to remain competitive in the labour market; and on the other, organizations are struggling with recruitment and retention of talented and committed employees (Cliffe 1998, Sturges et al. 2000, King et al. 2005). Research on nurses’ careers has shown that lack of career development opportunities 80
and lack of career discussions and career guidance were some of the main sources of dissatisfaction reported by nurses and were often cited as reasons for considering leaving their jobs (Davies et al. 2000, Cox et al. 2003, Robinson et al. 2005). The extent to which employees have acknowledged that they now have the primary responsibility for managing their careers is unclear and it is not known what type of responsibilities they are willing to assume. At the same time, whether organizations and employers have indeed transferred the responsibility of career management to their employees and what types of responsibilities this may involve are underexplored. If responsibility for career management is to lie primarily with the individual as the basis of the new employment contracts in the organizations, then it is important to understand the type of responsibilities employees are willing to assume and the extent to which organizations are willing to ascribe responsibility to their employees. This study explored these issues in relation to nursing in the UK, which until recently has had a history of great career stability, at a time when policy reforms were aimed at modernizing nursing careers (Department of Health 2006). In the recent discussions in Europe (European Commission 2012) and North America (Institute of Medicine 2011) about the future of nursing, this study reveals insights not previously considered that can inform policy developments.
The study Aim The aim of this study was to identify and compare the views of nurse employees and employers about responsibilities for managing individual nurses’ careers.
Design The design employed was a multicenter, cross-sectional questionnaire survey.
Sample Data were collected from five NHS Trusts purposively selected to encompass a wide variation of services including adults’ and children’s nursing services; care settings, including both outpatient and inpatient; and different specialties, including medical, surgical and emergency care. Following a mapping of services provided in each of the five NHS Trusts, a purposively selected sample of © 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
departments was used to ensure that participants in the sample represented nurses working across the organization. All the nursing staff working in these departments were invited to participate in the project. A total of 1678 questionnaires were distributed to both employees (n = 1588) and employers (n = 90). Of these 871 were returned giving a total response rate of 52%; 813 questionnaires were returned from the employees group (51% response rate) and 58 from the employers group (64% response rate).
Data collection The study was conducted between January–September 2008. Data about participants’ demographic (age, gender), employment (band level, working post and pattern) and academic (highest qualification) profile and their caring responsibilities, were collected through a structured questionnaire. In addition, seven items about career management responsibilities were included, developed through a preliminary interview-based study with a total of 41 participants (Philippou 2011). These focused around seven key areas of career management responsibility: securing funding for training; securing time to participate in educational activities; identifying education and training needs; assessing strengths and weaknesses for development; determining job-related knowledge and skills; developing individual career plans; and planning future career development. The items were presented in two questions asking participants to rank from 1, responsibility lies with the nurse, to 10, responsibility lies with employers. Both questions had the same statements; however, the first question asked participants to indicate where they would ‘ideally’ like different responsibilities to lie (ideal responsibility), while the second question asked them to indicate where these currently lie from their ‘actual’ experiences in their Trusts (actual responsibility).
Ethical considerations Ethical approval was obtained through the Central Office of Research Ethics Committee and the Research and Development (R&D) departments of the five participating NHS Trusts.
Data analysis Data were analysed using SPSS version 17 (IBM, Chicago, IL, USA). The Chi-square test (v2) was used to examine relationships between categorical variables. The Wilcoxon © 2014 John Wiley & Sons Ltd
Responsibilities for career management in nursing
signed-rank test (Z) was used to identify differences between actual and ideal career management responsibilities; the Mann–Whitney test (U) to identify differences in responses between the nurse employees’ and employers’ groups; and the Kruskal–Wallis test (H) was used to identify differences between independent variables from participants’ demographic, employment and academic profiles. If the results of the Kruskal–Wallis test (H) indicated significant differences in outcomes, post hoc tests using the Bonferroni method were performed to identify which groups differed from each other. The level of significance was set at P < 005.
Validity and reliability Validity and reliability were enhanced through extensive preliminary work, which included input from nurses, managers and a panel of experts (Philippou 2011). The instrument did not use multi-item measures and standard reliability testing (Cronbach 1951, Cohen 1960) did not apply. Following de Vaus (2002), reliability was addressed through ensuring use of well-tested questions, careful consideration of question wording and systematic methods of coding. Acceptability and feasibility of the questionnaire were assured through a postal pilot and structured face-toface interviews undertaken with nurse employees and employers (n = 98) from one NHS Hospital not included in this study.
Results Characteristics of sample Table 1 presents summary statistics for both the employer and employee groups with regard to their demographic, academic and employment profile. The employee group consisted of staff nurses (n = 496, 61%), charge nurses (n = 174, 21%) such as ward managers/sisters and specialist nurses (n = 142, 18%) such as clinical nurse specialists/ nurse practitioners working in a variety of settings and specialties. The employer group was represented by participants holding senior managerial positions in the organization and providing leadership to other management or specialist staff, such as matrons (n = 28, 48%); senior nursing staff such as heads and deputy directors of nursing services (n = 16, 28%) who were part of the executive board in their organizations with overall responsibilities for strategic and corporate issues; and other senior managers, including human resource managers (n = 14, 24%). 81
J. Philippou
Table 1 Characteristics of the sample.
Table 2 Participants’ band profiles.
Sample groups
Demographic characteristics Age (mean) Female, n (%) Male, n (%) Highest academic qualification, Certificate Diploma level Degree level Master’s level Doctoral level Working post, n (%) Staff nurses Charge nurses/sisters Specialist nurses Matrons Heads/directors of nursing Senior managers (e.g. HR) Seniority level, n (%) Band 5 Band 6 Band 7 Band 8 Employment pattern, n (%) Full-time Part-time Caring responsibilities, n (%) Yes No
Employee group
Employer group
38 (SD 9) 722 (89) 91 (11) n (%) 206 (25) 237 (29) 328 (41) 41 (5) –
43 (SD 75) 48 (83) 10 (17)
9 20 22 2
496 (61) 174 (21) 142 (18) – – –
– – – 28 (48) 16 (28) 14 (24)
369 181 249 12
(45) (22) (31) (2)
– – – –
747 (92) 66 (8)
– –
351 (43) 462 (57)
– –
Description*
Band 5
Junior nurses providing direct clinical care and supervising healthcare assistants. Clinical knowledge acquired through training to a degree or diploma level. Specialist nurses or team leaders with relevant postregistration qualifications performing a wide range of clinical activities with leadership responsibilities over junior nurses. Professional knowledge acquired through a degree supplemented by further specialist training, experience and short courses. Nurses with additional leadership and managerial responsibilities (such as managing a ward). Usually holding delegated budget for the department/ward. Professional knowledge acquired through a degree supplemented by further specialist training and/or managerial training. A mix of nurse managers and nurse consultants. For this study this category included primarily nurse consultants practicing autonomously at an advanced level with a significant proportion of their role involving direct clinical care and education, research and management activities. Professional knowledge acquired through specialist training or equivalent experience at master’s level.
Band 6
– (15) (40) (41) (4)
The majority of participants were female (n = 770, 88%) and only 12% (n = 101) were male. Participants ranged in age from 20–65 years old, with a mean age of 385 years old. Employers tended to be older (Mean = 43 years old, SD 75) than employees (Mean = 38 years old, SD 9). Over half of employees (n = 443, 54%) held a certificate or diploma as their highest academic qualification, followed by 41% (n = 328) holding a degree. Only a small percentage (n = 41, 5%) held a master’s degree. With regard to employers, a small number of participants (n = 9, 15%) indicated that they held a diploma, 40% (n = 20) a degree and 41% (n = 22) a master’s degree as their highest academic qualification. Two participants (4%) held doctoral qualification. Employees’ seniority levels ranged from newly qualified Band 5 to experienced Band 8 nurses. Table 2 provides an indicative job profile of these participants. Forty five per cent (n = 369) of participants were in Band 5, 22% (n = 181) in Band 6, 31% (n = 249) in Band 7 and only 2% (n = 12) in Band 8. The majority of participants were in full-time employment (n = 747, 92%), with 8% (n = 66) indicating working on a part-time basis. Forty-three per 82
Band level
Band 7
Band 8
*The table provides an indication of the main features of participants’ band profile to contextualize the sample of the study. Detailed description is available through the UK National Profile for Nursing Services: http://www.nhsemployers.org/PayAndContracts/AgendaForChange/NationalJobProfiles/Documents/Nursing_ Services.pdf.
cent (n = 351) of participants in the employee group indicated they were taking care of dependents, including children (n = 278, 79%) and/or elderly relatives (n = 44, 13%) and others (n = 29, 8%) (i.e. disabled dependents). The participants indicated that they attended both mandatory training and training for career development equally. While the two kinds of training are not interchangeable (Inkson & Arthur 2001), respondents in this study appeared to blur the two. This is probably because this distinction is not made explicit in nurses’ development pathways in the British NHS (Department of Health 2004, 2008, 2013).
Views on ideal and actual career management responsibilities The analysis indicated a shared approach to career management, with certain responsibilities lying primarily with © 2014 John Wiley & Sons Ltd
JAN: ORIGINAL RESEARCH
Responsibilities for career management in nursing
employees and others with employers. For ease of reporting, responsibilities were grouped as short-term (securing funding, securing time for training), medium-term (assessing strengths and weakness, determining job-related knowledge and skills, identifying education and training needs) and long-term responsibilities (developing individual career plans, planning future career development plans) (Table 3). Short-term career management responsibilities Findings from both groups indicated that short-term career management responsibilities lie primarily with employers. In particular, both ideal and actual responsibility for ‘securing resources’ were reported to lie with employers (Median = 8). However, with regard to ‘securing time’ to participate in developmental activities, although participants indicated that this should ideally lie with employers (Median = 8), this was actually reported as shared between employers and employees (Median = 5) (z = 1184, P < 0001).
Table 3 Participants’ views on where actual and ideal career management responsibilities lie (N = 871). Median (IQR)* Responsibility for
All respondents
Employers
Employees
Short-term responsibilities Securing resources Ideal 8 7 (6–9) 8 (6–10) Actual 8 8 (7–9) 8 (5–10) Securing time Ideal 8 6 (5–8) 8 (5–10) Actual 5 7 (4–8) 5 (3–8) Medium-term responsibilities Identifying education and training needs Ideal 5 5 (5–6) 5 (4–6) Actual 4 6 (4–8) 4 (2–5) Assessing strengths and weaknesses Ideal 5 6 (5–7) 5 (4–6) Actual 5 7 (6–8) 4 (2–5) Determining job-related knowledge and skills Ideal 5 7 (5–8) 5 (3–6) Actual 5 8 (6–9) 5 (2–6) Long-term responsibilities Developing individual career plans Ideal 4 5 (3–5) 3 (2–5) Actual 3 5 (2–7) 3 (1–5) Planning future career development Ideal 3 5 (3–5) 3 (2–5) Actual 3 5 (3–7) 3 (1–5)
P values
001 – 0003 –
–
