Advice and development

Points to ponder when choosing your first job

The shortage of nurses means those who are newly qualified have more options regarding a career path and where they want to live

The shortage of nurses means those who are newly qualified have more options regarding a career path and where they want to live

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Choosing your first job based on where you had a successful placement is a tried and tested career path for many newly qualified nurses – but it doesn’t have to be that way.

Alongside thinking about what you’ve most enjoyed, the patients you like working with, and whether you prefer being in a hospital or in the community, where you want to live is another key consideration, says RCN professional lead for education standards Gill Coverdale.

‘It’s a good market for newly registered nurses, who have the option to choose where they want to be because there is such a massive shortage of nurses,’ she says.

Geography might play a part in your role

For those considering a move to a new area or even a different country within the UK, she advises thinking about issues such as transport costs and reliability, especially if you don’t drive, and how much you’re likely to spend on housing.

‘You also need to think how geography might play a part in your role,’ says Ms Coverdale. ‘If you’re working in the Outer Hebrides, you’ll be covering a large area and it will be more challenging to get together with colleagues for team meetings. There may also not be the camaraderie you get in a big trust.’

‘Newly qualified nurses can face many challenges as they transition from student to registered practitioner, so it’s vital they have support’

Eileen McKenna, RCN Scotland associate director

But working in Wales, Northern Ireland or Scotland can offer different kinds of benefits. ‘From a theoretical view point, the four countries aren’t that different,’ she says. ‘But in terms of countrywide policies, standards and strategies, it can be easier to roll them out to a smaller group of people and that can be an advantage.’

Opportunities for professional development

Some countries or English regions may also provide more opportunities for professional development, with better funding, she says.

Among the major attractions of working in Wales is pioneering new legislation, which came into force in April, placing a duty on health boards and NHS trusts to calculate and maintain nurse staffing levels in adult acute medical and surgical inpatient wards.

‘It makes Wales the first country in Europe to legislate on nurse staffing levels,’ says all Wales nurse staffing programme manager Joanna Doyle, adding that the new law ‘will support newly registered nurses and protect nurse staffing levels, ensuring that nurses have the time to care sensitively for patients’.

Preferred specialties and locations

She adds: ‘Nursing students, newly qualified nurses and nursing teams are becoming increasingly aware of the benefits.’

Need advice?

The RCN Careers Service offers a variety of open access advice, including help with writing your CV, applying for your first job and preparing for interviews. Members can also have one-to-one support.

Another bonus for those seeking a job in Wales is a new student streamlining service, which matches prospective applicants with their preferences. ‘Nursing students will no longer need to submit multiple applications via NHS Jobs to secure their first post with NHS Wales after qualifying,’ says Ms Doyle.

‘It removes the pressure of applying and being interviewed for multiple jobs, allowing students to indicate their preferred specialties and locations on one form.’

From student to autonomous professional

Preceptorship programmes can help newly qualified nurses develop confidence, easing the move from nursing student to autonomous professional. All NHS employers are obliged to provide a period of preceptorship in the first year of employment, although specific arrangements vary.

In Scotland, Flying Start NHS is the well-established national development programme for all newly qualified nurses, midwives and allied healthcare professionals.

‘It builds on the education they received in their undergraduate programme,’ explains RCN Scotland associate director Eileen McKenna. ‘We know that newly qualified nurses can face many challenges as they transition from student to registered practitioner, so it’s vital they have support, including helping them to develop their clinical knowledge in their chosen area of practice.’

Advising and mentoring new recruits

Facilitators and line managers support and guide newcomers through the programme, which was enhanced last year and is based on four units: clinical practice, facilitating learning, leadership, and evidence, research and development.

Additionally, the Scottish government’s health secretary has announced a pilot programme to recruit 100 recently retired nurses and midwives, who will advise and mentor new recruits to the profession.

‘Take a really close look at what’s on offer and do your homework’

Gill Coverdale, RCN professional lead for education standards

Newly registered nurses in London can take part in a preceptorship framework run by the Capital Nurse programme, which has been co-designed by nurses from a number of settings, including newcomers, directors and academics.

What you don’t know

‘When you’re new, you’re not sure what you don’t know,’ says Georgina Ledwith, who qualified in February.

She started her first job in April at the Royal Brompton Hospital in London – the UK’s largest specialist heart and lung medical centre – where she is on an 18-month cardio-respiratory rotation involving three six-month placements on surgical, cardiology and respiratory wards.

‘You get to see how each ward and team works. It’s quite intense,’ says Ms Ledwith.

Alongside working as a member of the team, participants take part in study days and must complete academic work, including a case study and a presentation. ‘Some people just want to get on with the job and don’t like the idea of rotation, having already moved around a lot as student,’ says Ms Ledwith.

‘But I saw finishing my degree as just the beginning and I wanted more.’

Keep your options open

Whatever you choose, make sure it doesn’t limit you, she advises. ‘It’s really important that you pick somewhere that will keep your options open and you can go deep with your knowledge.’

Interviews are the time to ask searching questions about induction, preceptorship and any other support offered to newcomers, perhaps through staff networks or forums, says Ms Coverdale. ‘Take a really close look at what’s on offer and do your homework.’

Increasing numbers of nurses are working in the independent sector, which includes care homes, private healthcare companies and charities. While some employers follow NHS structures, pay is more variable and sometimes lower. Check to see if your prospective employer has a pay scale and uses a job evaluation scheme.

Nurses’ pay in the four UK countries

Nurses and healthcare support workers in the NHS are paid according to the Agenda for Change (AfC) pay structure. For these staff, new pay deals have been agreed in three of the four UK countries:


For around half of NHS staff, the pay award is worth 6.5% over three years, with some receiving much more, says the RCN. The deal also offers better starting salaries.


A new three-year pay deal for NHS staff was agreed in September 2018. Changes to the pay structure mean that increases for members in Wales may be different from their colleagues, with some doing better than others in individual years, says RCN Wales.


A new three-year pay deal accepted by health trade unions in summer 2018 is expected to deliver rises of at least 9% for most staff by 2021. The agreement includes restructuring of existing pay bands, with a reduction in the number of pay points. Further negotiations on reforming some terms and conditions are expected to conclude by December 2018.

Northern Ireland

A political impasse that has resulted in the lack of an assembly and executive means there is no current public sector pay policy. While the RCN is working with the Department of Health and Social Care to see what a similar deal to those achieved in the other UK countries might look like, the continuing absence of political leadership means any prospect of immediate implementation remains remote.

Lynne Pearce is a health journalist

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