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What influences nurses' career decisions?

Coutts, A. M. (2020). What influences nurses' career decisions?. (Unpublished Doctoral thesis, City, University of London)



This inquiry explores the career stories of nurses, to establish what influences their career decisions.

The Nursing and Midwifery Council has over half a million nurses on its register, mostly employed within the National Health Service. There are increasing opportunities within this varied and extensive profession for fulfilling careers, yet many nurses leave the profession early.

Research aims

This inquiry aimed to provide evidence about the influences on nurses’ career decisions. It will establish an evidence-base for those who endeavour to assist nurses’ career progression.


A narrative review into existing literature concerning nursing careers was undertaken. This demonstrated careers are much researched and there is a significant theoretical basis, but careers in nursing are a novel area of research.

Ethics approval was granted for a narrative inquiry amongst twenty experienced London nurses and ex-nurses. Semi-structured interviews were conducted to elicit their career stories. Three nurse managers and three nurse educators also participated. The emerging ideas were tested with a survey, sent to all participants.


From the transcripts of the interviews, the career stories of the nurse and ex-nurse participants were derived. These were coded and the codes grouped to form narratives. Some of these were tested using an online survey of participants.


Multiple complex challenges, priorities, and fears were revealed which influence nurses’ career decisions. These are presented as five narratives. The most important of these to nurses is relationships. These have been overlooked in much career research, yet this inquiry showed relationships at work, especially with other nurses, are a source of enjoyment and discourage career moves. The other narratives are job satisfaction, finding the right job, stress, and work-life balance.


The nursing career structure can be obscure and information difficult to obtain. Relationships at work are an important source of guidance as well as being enjoyable. This thesis concludes by proposing a graphic and two tools. The graphic depicts the five narratives and could aid nurses to visualise their sources of career fulfilment. The first tool is for nurses to reflect upon their careers and the second helps managers evaluate nursing posts and may be particularly useful if a post is likely to be difficult to fill.

Publication Type: Thesis (Doctoral)
Subjects: R Medicine > RT Nursing
Departments: Doctoral Theses
Professional Services
Professional Services > Learning, Enhancement and Development
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