This is the reality

I originally wrote this article in a different vane in the early nineteen-nineties. I called that version "Careers advice for Gayle Tuesday". The nursing journal, who previously accepted my articles, did not accept that one. Years later, and after three house moves, this is the extent of what I remember writing. I have the advantage of "years later" updates and "better content". My background was qualifying as a Registered General Nurse [RGN] in 1986 and a Registered Mental Nurse [RMN] in 1991 and, in-between, being an ophthalmic trainee in 1987 to 1988, gaining the Ophthalmic Nursing Diploma [OND] in 1988, which is now an obsolete qualification. Many years later, I become a Specialist Community Public Health Nurse [SCPHN] in the occupational health nursing pathway. I am also a freelance writer and published author.

In 1989 I read the booklet "Nursing, what next?" The cover showed a cartoon nurse in a rowing boat, looking out to sea with her telescope. This stereotypical image implied that all nurses were female and they were never out of their uniforms. The only career opportunity I recall it mentioning was The Prison Service. I applied and was rejected, by return of post, and informed "you cannot reapply for two years". But in 1991 I did one day of prison nursing via an agency and it was "boring-boring-boring", although well paid. Working inside a prison without keys is like being asked to work in a hospital ward without arms. I never bothered with either opportunity a second time.

Before returning to my previous career as a nurse in the year 2000, one recruitment consultant, a one-man band operation, was another great example of "after the initial thrust of your sales pitch, once I'd signed a contract, your ability took a rapid nose dive". At my registration interview he assured me there would be no problem getting me a better job and more money. Every time I challenged him about this subsequently he would say "well, it's swings and roundabouts". The last time we spoke I said "You always say that. You can take me off your books". That statement probably did make him start taking notice. "I've been on your books for two years and I have not had a single interview. So I think it is safe to say, your approach has failed". "But if I get anything tomorrow" he whined "I won't be able to contact you about it". "Why will you suddenly get something tomorrow?" I asked. That, you could say, was a rhetorical question. A typical trait of some sales people is their own enduring sense of self-confidence, even when facing defeat. Here was another example of a sales person who would not take no for an answer. Not that I think he was going to lose sleep over it. The problem with his recruitment business, as I saw it, was for him it was just a little hobby! Back then, in 2001, nothing had really changed since my earlier experiences of recruiters.

Historically, and I am talking before the internet, many opportunities were advertised in the nursing press via recruitment consultants, in some instances recruitment consultants pretending they were the employer advertising roles. For the avoidance of doubt, recruitment consultants are sales people. As all "good" sales trainers might say "you're not selling jobs, you're selling the dream". Obviously in some cases, not selling very successfully.

In my early nursing career there were various advertisements talking of opportunities to escape the supposed drudgery of nursing. Maybe, inferring a reference to life being "short-staffed" and not well paid. But doing what? There the mystery of "breaking free" remained. People often said to me "you could easily go and work abroad". From 1988 onwards, that was one opportunity I did consider.

The opportunities were not great. Putting it crudely, if I wanted a sh*t job, with sh*t hours and sh*t money there was no problem. But there was no need to move to the United States for that. One friend told me she was worried about my plans to "Go USA". "Some places are worse than the NHS. Have you never thought about Saudi or Australia?" I have not heard good things about Saudi and Australia, more on that later!

The problem with the United States, as things were in 1989, was that foreign nursing qualifications were not recognised in their own right and this is still the case today. The two routes available were: take the Commission on Graduates of Foreign Nursing Students (CGFNS) examination, which would have got me into the United States. Then it gave me one year to do, or show intention of planning to do, the state licensing examination. Alternatively I could have done the state licensing examination immediately: The National Council Licensure Examination (NCLEX), which sounds like the equivalent of "Direct Access" for motorcyclists. There were a few advertisements by organisations offering to fly candidates to the USA, and all expenses paid, to do NCLEX. The only drawback being "it has a high failure rate". If you failed, you had to return to the same state to resit the examination, all at your own expense. Hence most people, I was told, never bothered.

There was one exception to the above, a hospital in Arkansas. Provided your nurse training was undertaken in the United Kingdom, as mine was, or Ireland, Canada or Australia, you did not need to take NCLEX to get your state license to practice. However, that license was not transferable to work in another states because you had not undertaken an examination to get the license. Another complication was if you had taken, and failed, NCLEX you could not get the license to practice in Arkansas: "Because you failed. A lot of nurses have tried to do that", I was told by the recruitment consultant not recommending the "NCLEX first" route.

I did the CGFNS examination once and failed it. I was recommended to "just do it again". But this came with the repeat expenses involved in travel to London; staying in London the night before; notarising more papers and the cost of the examination for a second time. It made me decide "try the Arkansas route; do CGFNS once I've worked in the USA and then do NCLEX".

My interview with the UK based recruiter for Arkansas started badly, when I was told "I haven't got any paperwork for you". That might have been an interviewer playing games, or just someone very disorganised. I challenged the agency about it afterwards and, they told me, "she was sent your paperwork three weeks ago and we confirmed that she had received it". Going to meet this woman, working out of a London flat, was a waste of time. It did not involve any processes she could not have undertaken by post or by telephone or by sending me their "recruitment video" which I was required to watch. The opportunities available did not match those sold to me by the agency setting up the interview! Three years later I met someone who had worked at that hospital. The reason why it was easier to get a job there? "It's sh*t basically. It's in the middle of nowhere and the pay is poor". That recruiter is now a school secretary, I discovered.

Years later I did consider working in Canada, but I did not meet their entry criteria. Their online screening process suggested I tried Australia! A recruitment company dealing with Australia, "who had many years experience of recruiting" was more interested in knowing what assets I owned before they would look at me.

All the above suggested you cannot "easily go and work abroad". For some people, and some destinations, the processes might be straightforward if you had all the paperwork to let you through the right hoops. But it is worth knowing the skill shortage areas, such as theatre; intensive care; coronary care; midwifery and, in some instances, mental health, are reportedly as short-staffed abroad as in the UK. In the USA, my mental health nursing qualification was not recognised without my general nursing qualification. There is also the question, are you really going abroad for the job or just for the chance to be in another country?

The next opportunity was being a medical sales representative. All the advertising painted a very glamorous picture. A company car; the salary, far more than as a nurse; the bonuses and the foreign holidays. That could be any nurses dream. My first interview, to register with an agency, sent me to see an obnoxious man in a hotel room. Their game was apparently instructing you to go to the wrong hotel room, obviously to see how you coped: the type of ploy sales recruiters might use. I felt like I was undergoing an examination, without any preparation. The only positive was their recommendation to get a book called "compelling selling". I never did! I decided it might be better to apply directly to the pharmaceutical companies most likely to hire me. Then I met Sally, a new colleague at work.

Sally had been a representative with one of the big companies and she gave me lots of "handy hints". One was to "look in the drug trolley for names of the most common manufacturers". She told me about British Pharmacopoeia, the national drug reference book of the UK. Like a "Who's Who", or Writers and Artists Yearbook, of drug manufacturers. It tells you "who they are and what they produce". There was also an exam you had to take within two years, the ABPI (The Association of British Pharmaceutical Industry) exam, "but it's really easy" she told me. Sally also told me, very importantly, who you are selling to. That only consultants had any jurisdiction about purchasing, so seeing anybody else was a waste of your time. "But then every house officer is a future consultant".

From her comments about the role, I had to wonder why Sally no longer did the job. "I never really had to work hard" she said. "I went swimming, or to the cinema, most afternoons. I did work the odd evening".

At interviews, a standard question seemed to be "You call the consultant's secretary to arrange a meeting. The Secretary says 'he doesn't see reps'. What do you do?" The answer recruitment consultants were looking for was to say "I'd join the golf club, so I can meet the consultants that way". Another ex-rep told me "That's rubbish. You write to them! Because there is going to be a day when the secretary is out of the office and the consultant gets to the mail first".

A year later I went digging further. I went to the hospital pharmacy and asked if they had any business cards for representatives and they had a bundle in an elastic band. This gave me the opportunity to identify and speak to some of the current representatives. One said, what she valued most, was having her weekends off. But after being a midwife, where people thought she was wonderful, she found the job very different. "It is about getting known as a familiar face coming and going. Getting into the system and finding ways of beating the system". She recommended "you need to get your training from one of the big guys [companies]".

Ultimately I gave up on the idea. Mainly after my circuit, driving around the M25 at speed. I did ultimately learn, Wednesday was the night for advertisements in national newspapers. However, nothing became of any enquiries made to companies. All I ever got was "we will keep your CV on file". Eventually I did meet another ex-rep who had worked for a company manufacturing asthma inhalers. Her reason for quitting was the second year in the role, reselling the same business and being encouraged to falsify what she had been doing. "I really couldn't see the point!" But ultimately, prior to getting married, she said she didn't want her garage, spare bedroom and her lounge filled with boxes of samples and company literature. Her Friday nights were paperwork nights, she said, because there was no time to do paperwork during the week and it had to be posted Saturday morning to be with her manager by Monday morning. Other reps had told me about driving down the motorway very early in the morning to catch consultants on either side of their ward rounds.

Many years later I did ask a representative for their take on being a medical representative today. "Nurses are not an ideal choice. They aren't used to working alone ("Oh, really?"), they're used to working in teams. You must like driving too. Because if you don't, the job will drive you round the twist". However, I did gain a more positive view from a products representative called Moira. "A fair days work for a fair days pay" she described her company as. "But they will check up on you". The role also involved nights away from home. Suggesting maybe it was more a single person's job.

But all of this seems far removed from the glamourous picture of job fairs and nursing journals. To me, none of these opportunities seemed as good as they were made out to be. I am not overlooking the fact that you will have to work hard, but "wouldn't you be expecting to do that in any job?" As one friend, whose colleague became a medical rep, said "I believe the rewards are there. But you have to be really exceeding, not just meeting, the targets". When I met Cherry, from another recruitment agency, at the Manchester Job Fair I asked "What qualities are you looking for in a rep?" Fairly standard answers, the enthusiasm, the energy, the drive, the commitment... but there was that question (the knock-out question?) on their application form, which she drew my attention to. "Describe yourself in six words. It's hard. You've got to think about it". Last time I was presented with "that old chestnut", two years ago, I wrote "over fifty and still very sexy". In my opinion, it is such a stupid question anyway.

From those who succeeded, where I did not, their stories tell me one thing... I have not missed out on the "amazing opportunities". Like the one-man band recruiter, some of them will instil the idea in you that there is something much better out there, when actually there is not. It is just to try and keep you interested in the unlikely event of them finding you a job. The price this sometimes comes at is them putting you forward for the role they have procured someone else out of.