Career planning and management - Health care

Introduction – Aims of this chapter
In the previous chapter, we examined some definitions of the concept of employability, which, in the words of Mantz Yorke (2004), consists of ‘a set of achievements – skills, understandings and personal attributes – that make graduates more likely to gain employment and be successful in their chosen occupations, hence benefitting themselves, the workforce, the community and the economy’. Already we can see that the idea of employability is a complex one, embracing many preoccupations that include an individual’s values and personal motivations. We will now consider the similarly complex idea of ‘career’: What is meant by it (both in general and in the context of the healthcare professional)? We will suggest some of the external influences that can affect your own choices (some of which we have already explored in Chapter 1) and also put forward some tools with which to examine your idea of a career.
We will also examine common perspectives that can help early career professionals to understand and better manage their career, considering some of the key factors that influence career choices, and pointing out ways in which harnessing self-awareness can help you to make the right decisions. Throughout the chapter ‘practitioner’s perspective’ will be offered, drawing examples from my experience in careers guidance.
For some people, a career is often seen in hindsight, particularly when a break or change has required them to reflect on where they want to go next: ‘How did I get here and what do I do now?’ That you are reading this book suggests that this is not the case for you, because you are probably looking ahead with a view to understanding where your career might now take you within your chosen health profession.
How people manage their careers has been the subject of countless publications, web sites and blogs, and there are numerous models and guides on the market that can help you to explore this area further.
The importance of reflection
Being accustomed to asking questions about your career can be extremely beneficial. As a health professional, you probably have a distinct advantage over many of your peers, because you have been required to think about your professional development and practice throughout your training and pre-registration placements. By keeping a placement diary, you will have been asking questions about that experience which, whilst primarily intended to help you through your training, will also have contributed to the creation of a comprehensive picture of your career. Where have you thrived? What learning has really stimulated and motivated you? Where were you less happy and why do you think that was? Are you influenced by the people around you more than the tasks you undertake? And what has your experience so far told you about the structure of the healthcare professions and of organisations in general.


What do we mean by ‘Career’?

At its most straightforward, a career is an occupation undertaken for significant length of time during a person’s life and with opportunities for progress. However, it is clear that the concept of a career means different things to different people, and is important for both the individual and wider society and economy. Fifty years ago, a career typically meant employment in one type of role or for one employer over the majority of one’s working life. Progress was linear and incremental, and retirement at 60 or 65 meant the end of your working life. What ‘career’ means today, and indeed will mean in the future, is far more fluid. Changes in the employment market, education, the application of technology, working practices and organisational structures are just a few of the factors changing the shape of careers. Recognising that your career does not exist in a vacuum, but is influenced by a range of external factors is particularly important in the health professions, and many of these are explored in later chapters.

Describing careers

Many different theoretical and practical approaches to careers have emerged over the course of the last century to explain why we do what we do and what influences us in that choice. A lot of this theory focuses on the individual, asking what they are good at, and finding ways to match these skills to the labour market. Indeed the first publication on the subject of careers, Choosing a Vocation, which was published by Frank Parsons in 1909 (in the United States), advocates choosing a career based on a person’s ‘aptitudes, abilities, ambitions, resources and limitations’. This approach, which has since become known as ‘Vocational Personality Theory’ (Holland, 1997), is still commonplace today and is often the starting point in conversations about career. You have probably been asked (perhaps by helpful relatives), ‘So, what do you enjoy doing?’, and this is then followed by a suggestion that ‘matches you’ to a career: ‘Have you thought about….?’ Quite often we align ourselves to vocations in this way without much consideration, ‘I’ve always enjoyed helping people so nursing seemed an obvious choice’. Sometimes such self-awareness can be accurate and effective, hence the increasing use of psychometric testing as an aid to recruitment.

However, there are many critics of this approach. Sociological career theorists are one such an example. They have sought to challenge trait and factor matching, arguing that the external influences of class, gender, race, and the employment market itself have a greater influence on career for many, and suggesting that to truly match capabilities to opportunities would require the removal of all such obstacles. Career, therefore, is better explained as something that is constructed by society and, as such, may include an inherent (or inherited?) advantage or disadvantage. These theorists also argue that we inherit ideas about career that mirror our class or social experience. The British theorist Phil Hodkinson termed these ‘horizons for action’ (Hodkinson, 2009), effectively meaning that the choices you make are directly influenced by what you experience around you: quite literally, what careers are visible to you through your life experience and community. Whilst this might seem irrelevant if you have already chosen and are embarking on your new career, it is worth thinking about the people and experiences that you have encountered and will encounter which might ‘widen’ your own career horizons.

A third common strand of career development theory is one of narrative. Here, career takes the form of story – we tell stories about ourselves to help understand our motivations and actions, past and present experiences, and the connections (obvious or less so) between our many decisions. These more ‘psychology-driven’ ideas place the emphasis on the individual and how they may have been influenced and shaped by experience. We are characters in our own story. Here, an individual’s career is seen as being something shaped and defined by their image of themselves and what they believe others think of them. An example of narrative career might be the researcher who decides to pursue a career in science because their sibling suffered from a childhood disease; or someone who does not consider management roles because they cannot ‘see’ themselves in such a position. Narrative or psychological theories can be helpful when considering how confident we feel about our ‘vocational identity’ – that person who we can visualise working in the outside world, and whose image may be seen reflected in the eyes of family, friends, teachers and contemporaries.

A fourth and very interesting approach is the work of Donal Super, which spanned from 1953 to 1996, beginning with his influential Theory of Career Development (Super, 1953) and subsequent work with Mark Savickas (Super, Savickas and Super, 1996) in developing this still further. Super has been a major influence on career development theories and, in this context, it is useful to draw attention to his idea that our working lives consist of both roles and timescales. Super means by this that we have a chronological aspect to our career (literally starting with our education and ending with our retirement from the labour market), but that we also inhabit different roles throughout our lifetime, one of which is our career (Super, 1984). However, as children, carers, parents, friends, partners, colleagues and members of a community, there are many other factors that impact on our careers. At different stages in our lives we encounter different challenges and opportunities. A simple example is the idea that having and raising children will affect your career choices and priorities. In this case, the role of parent may become more dominant (‘salient’) and cause us to reassess our work-role priorities.

A second strand of Super’s work (and one which we will come back to later in this chapter) is the idea of a career as cyclical. Super argues that our careers are made up of a series of smaller cycles (from deciding upon and engaging in a role through to disengaging and moving on) and this recognition that career is a lifelong process, one that requires you to be ready for and respond to change and opportunity, is resonant with some of the fundamental ideas of employability discussed in the previous chapter (Super, 1994). Where Super’s ideas are particularly helpful are in his call to action (if you want to make good decisions you need to understand the process of your decision making), and in that he is an example of a career theorist whose work developed over many years, taking account of external/societal and internal/psychological factors. As we shall see, his work continues to have a huge influence on the idea of ‘career’ today.Using multiple perspectives
It is, however, important to remember that the ideas briefly introduced to you here are just a few of the theoretical approaches that have been developed in explaining and exploring careers: this is by no means an exhaustive list, and nor have those ideas listed been explored in any more than a brief summary.

In understanding what is influencing our career ideas, adhering to one particular career theory or model can sometimes feel restrictive. Instead, it can help to take a range of perspectives, acknowledging that one’s career choices will be influenced in many ways, and working with this awareness to maximise the opportunities open to you.
The four approaches outlined above are summarised in Box 2.1, in which questions that you might use to interrogate your own career decisions to date are also suggested.