“Time for a Promotion? No, It’s Not for Me…” How Caring for Children with Life-Limiting Conditions Affects Health Care Assistants’ Career Decisions

Abstract

This paper discusses the relationship between the level and experience of care provided by Health Care Assistants (HCAs) to children in palliative care and the HCAs’ views about their career progression. An ethnographic approach was taken to explore the reasoning that informs Health Care Assistants’ choices about whether to pursue a career pathway into nursing. The author, a medical student, conducted the study using participant observation while working as a volunteer for one year in a Children’s Hospice in England. The data presented and analysed here were collected through unstructured conversations with the HCAs. It was found that the main reason why HCAs declined opportunities to progress in their career to nursing was their fear of not being able to be emotionally available to the children with whom they worked. HCAs also wanted to avoid working in hospital settings, where they perceived that they would have to trade off emotional involvement in caring for patients against career advancement. The decision to pass up a promotion, in some cases several times, is not easy, especially when pay may be substantially higher. This study shows that participants’ job satisfaction and valuing of having time to provide compassionate care were the main motivations to avoid progressing from HCA to nursing roles.