Abstract
Background:
Armed forces are reinventive institutions that shape the identity of their members. Leaving the military involves an adjustment to civilian employment that may be turbulent at times.
Objective:
The aim is to understand the experiences of self and other military healthcare professionals’ midlife career transitions.
Methods:
This qualitative study applied heuristic inquiry research methods. This included a thematic analysis of the researcher’s personal experience (diary and reflections) combined with data from interviews or communication with other veterans (n = 10) within a creative synthesis.
Results:
The themes identified within the study were: The tipping point for leaving; adjustment as a veteran; progression within a new workplace. We experienced a divergence in values away from military service leading to a tipping point for leaving that was followed by a triple whammy of uncertainty about leaving, insecurity in a new job, and loss of identity that impacted mental wellbeing and needed to be overcome.
Conclusion:
This study has revealed new insights about being a military veteran and transitioning to civilian employment. These insights could lead to changes in how veterans prepare for a midlife career change, retention of personnel within military forces, and how civilian employers support veterans.
Introduction
The military is a reinventive institution, which means that people adopt new roles, experience a change of status and construct a new social identity [1]. A professional identity involves the acquisition of skills or knowledge and the adoption of the norms and values associated with that profession [2]. It can be operationalised in the way we explain and perform our occupational roles to others and how we see ourselves within those roles [3]. Military service involves socialisation to a distinct and unique cultural group that has different skills, knowledge, practices, and routines from civilian work roles [4]. For example, a few of the unique cultural practices are saluting, warfighting, and military hierarchy. The military is viewed as a profession in its own right [5]. It seems likely that membership of an institution like the military contributes to identity as a hole and professional identity specifically. However, modern professional identity may be a flexible, amalgamation of a variety of work-based roles [2]. A military identity may only be one part of a professional identity, as many military healthcare professionals also hold a professional identity and legal status specific to their area of expertise, such as, a nursing registration.
The Transtheoretical Model is a theoretical framework about change behaviours that was originally developed to explain behavioural change in people experiencing addictions [1]. It has been adapted to explain change in different healthcare and organisational settings [2, 3]. The Transtheoretical Model consists of the following stages of change, precontemplation, contemplation, preparation, action, and maintenance. Applied to voluntary midlife career change, the precontemplation stage suggests that a person might initially be naive to the idea that change is going to occur, or feel some discontent within work [6]. The contemplation stage involves a person beginning to weigh up the benefits of change as outweighing the potential costs [7]. Leading to a preparation stage of more focused contemplation about career choices that results in exploring available options before taking action. The formation of a new identity within a new work environment may be the result of taking action. This is followed by the consolidation and maintenance of that new work role [6]. While this model has been applied to a voluntary midlife career change in civilian settings [6] and retirement from sport [8], it has not previously been applied to a military career change. The application of this model to military career change will offer insights into decision to leave the military and the process of identifying as a veteran within a civilian work role.
Veterans with long periods of service who exit the military are reported to fare better as civilians than early service leavers [4]. Not all service leavers experience a smooth transition, with those leaving the military more prone to mental health problems than those currently serving [9]. Mental distress in veterans may be associated with lower education levels and reduced employment prospects [10]. Those who maintain a strong link with veterans’ associations may experience a more problematic transition, partly due to reduced social integration within their civilian communities [9]. Those leaving the service following a long career may hold an idealised view about the value of their previous military work experience and a naive view of civilian work [11]. Military personnel are encouraged to hold values that include placing the military’s needs first by viewing their role as a service instead of a job [12]. This indicates that leaving the military involves an adjustment to civilian employment that may be turbulent at times.
This study explores military healthcare professionals’ experiences of midlife career change from active service to veteran. The findings will contribute new insights into how modern armed forces and civilian healthcare services can both retain their personnel and support them to transition to civilian employment. This is important to military services because replacing personnel who leave early involves significant recruitment and training costs. For example, consider that 56.8% of personnel voluntarily choose to leave the UK military early, compared to 19% who leave because their contract has expired [13]. It is also important to civilian services because of concerns about healthcare staff retention, and the capacity to meet future healthcare needs [14, 15]. As I am a veteran and a healthcare professional, I have adopted an insider researcher’s position and used a heuristic inquiry methodology to answer the research question: What do I understand about the experiences of self and other military healthcare professionals’ midlife career transition to civilian employment?
Materials and method
Methodology
Heuristic inquiry involves the researcher’s journey of discovery [16], which means a focus on a topic of personal relevance to the researcher [17, 18]. Heuristic inquiry leads to an interpretation of the phenomenon that is informed by the researcher’s lived experience [19]. It can be purely autobiographical, or the researcher can include people who have shared a similar experience [20, 21]. The main tenant of this study is autobiographical, and the researcher’s journey of discovery is augmented by learning about the experiences of other veterans.
Sampling
As a military nurse and veteran, I am the primary data source. This study also included a purposive sample of veterans who were military healthcare professionals. This group was sampled because they shared a common military experience. I utilised my position as an insider researcher to recruit participants via social media. The inclusion criteria were healthcare professionals who had retired from the UK armed forces. 10 veterans were recruited, an acceptable sample size for heuristic inquiry [20]. Mean age was 44, length of service 21 years, and time since leaving is five years. Further socio-demographic data is presented in Table 1. Recruitment ended because of time constraints and no further volunteers. There was a high degree of commonality or data saturation in participant’s experiences about the themes.
Sociodemographic data
Sociodemographic data
My experience of career transition occurred over an extended period; longitudinal strategies such as remembering events from the past and journaling are recommended for capturing this type of autobiographical data [22, 23]. I kept a journal for a six-month period during the transition into new employment. An unstructured approach to journaling was adopted as this offered greater scope for themes to emerge from the data [24]. There was no set format, but diary entries focused on my expectations, what happened, and how I felt. As the journaling started at the point that I left the armed forces, I also wrote about my memories and reflections of the build-up to leaving.
Following the initial six-month period of personal data collection, participants were invited to a one-off, virtual, and semi-structured interview that was audio-recorded and transcribed verbatim. On average, the interviews lasted one hour. Because I shared a common language, cultural identity, and work experience, I felt able to understand both jargon and context. During the interviews, I noticed that I identified with their experiences, saw the connections with my own transition to a veteran, and began to reflect upon this in relation to the themes that had emerged from my personal data. Testimonial validity involved sending participants a copy of their transcript and sharing with them how their data and direct quotes fitted within the themes, so that they could review the contents and make any necessary revisions or redactions [25–27].
Not all participants were able to make themselves available for an interview. In recognition that this was a difficult to access and geographically disparate population, excluding their input would have excluded their voices and their narrative. Therefore, participants were offered the opportunity to submit written responses to the topics within the semi-structured interview schedule (Table 2). These were treated as written transcripts for the purposes of data analysis. In total, eight participants attended an interview and two participants forwarded written responses.
Interview aide-memoire
Interview aide-memoire
Data from transcripts was examined, and significant themes and patterns within the data were identified [28]. The themes that emerged from the initial analysis were from my personal experience. To better understand my experience and journey of discovery, these themes were then applied a priori to the analysis of other people’s accounts and subthemes were developed that reflected the similarities and differences in people’s experiences. Thematic analysis sat within a broader process of data analysis that is outlined in Table 3 [16, 20]. A creative synthesis is the final phase of data analysis within a heuristic inquiry. This study’s creative synthesis captured the implicit and explicit knowledge that I had gained from both my own experience and the experiences of others.
Ethical approval was from a university research ethics committee (FHMREC Reference: FHMREC16081). Access to potential participants was gained through my position as an insider researcher. There was a risk that participants might feel obliged to participate and that I was using my position as leverage to recruit participants [29]. An initial opt-in message was sent out and further information provided to those who expressed an interest. It was made clear that participation was voluntary and detailed information was provided about the research project. Informed consent was gained from participants to include either direct or paraphrased quotes. This was based upon an initial plan to present data in a manner that would not have required specific quotes from others. However, as the study evolved, it was recognised that there was an opportunity to more fully account for the experiences of others. This adjustment to the data analysis strategy was approved by the ethics committee and further permission was sought to use specific direct quotes as opposed to paraphrased quotes. Where further consent was not gained, then paraphrased quotes were used, this means that the quotes represent the authors interpretation of the meaning from the data gathered from those participants.
Results
Self
The following themes emerged from the qualitative content analysis of my reflective account that I had recorded in a journal and my written reflections upon the topics within the aide-memoire that I used when speaking to other veterans: Reaching a tipping point about deciding to leave the forces Uncertainty when leaving the forces and starting a civilian job Managing insecurity within the civilian workplace Building new working relationships Seeking stability in the face of non-work life stressors Experiencing a change in identity
Reaching a tipping point about deciding to leave the forces
“I had been on a warning for a draft (job change) that moved me further away from academia and I felt that over time this would reduce my options. Yes, that is basically it, for most of my RN career I could see the options ahead of me but in my final year these were lessening, and the civilian options seemed greater” (Reflection upon interview themes)
My goal was not to leave the forces but, eventually, the opportunities for further professional development reduced and the option of leaving became more apparent. This is not to say that I was angry or upset; I accepted the situation for what it was and tried to be pragmatic. However, I also felt that I needed to protect my skill set as a nurse specialist as I realised it had value beyond my military career. This was probably when I realised that what was important to me and what was important to the military were beginning to part company. My commitment to the service began to weaken, and my identity as an independent person with a skill set of value to a wider labour market became more obvious to me. The reality is that most military personnel are obliged to seek a midlife career change, and my career would have come to an end anyway.
Uncertainty when leaving the forces and starting a civilian job
A lengthy notice period (8-months) made job seeking difficult and, I feel, weakened my position when negotiating the terms of a new job. This is because I had to focus on agreeing to the notice period and ask for flexibility by any potential new employer. This placed me in a weaker position when negotiating other conditions, such as pay. Indeed, one potential employer explained that the notice period was the reason they disregarded me at the point of application. However, it afforded financial advantages too, as it meant I moved beyond my pension point and was entitled to an immediate pension. I did not blame the military for this process but observed how challenging it felt at the time. Then, when it happened, the reality of my career-ending struck me.
“On my last day at work, I handed in my ID card and received a piece of paper. I then walked out of the base, knowing that it would be very difficult to walk back in again ... I was no longer in the ‘club’ and access that I had taken for granted would now be denied. I felt the difference between serving and veteran. A loss of status reflected in a loss of access. It was immediate but happened without pomp or ceremony. The signature on a piece of paper by a civilian in a small side office then I walked out of the base” (Reflection upon interview themes)
Eventually, I was in a position to start my new job. I had moved my family, relocated geographically, and given up my navy pay. There was no way back now, and I felt the uncertainty of a new role, I was anxious but remained keen to make it work. I did not know what to expect from the first day but I hoped that I had made the right choice for my family and myself and now needed to see it through.
“What a warm welcome. ... it feels like it went well. I managed to fall into a friendly pattern of meeting new people and did not feel anxious, reminding myself how effective I actually am at liaison. But remembering that I am no longer protected by a long contract and years of experience. Reminding me how important these new working relationships are going to be to my survival in this new place of work” (Journal)
Managing insecurity within the civilian workplace
“What I discovered was a lot of shining stars. People who had been a real success in their clinical/managerial roles and with lots more corporate knowledge of the geographical application of their previous skills to the environment that we were now all working in. I am not the shining star, and I have very little to offer that is not already here. This feeds into my low self-esteem, and I feel scared that I will shortly be asked to leave – redundancies, cuts, someone better comes along” (Reflection upon interview themes)
Over time I realised that I may compare unfavourably when competing with both more established employees and new employees from more traditional healthcare settings. I had committed my family to a significant geographical move, which resulted in a loss of connections and relationships. This made the threat feel worse to me, as I felt exposed and I found the uncertainty difficult to bear. I felt more vulnerable than during most of my career in the armed forces. In the forces, vulnerability is not about deploying to combat zones, as you prepare for that. Nor was it about the dynamics of the workplace, as you learn to operate within the system and how to exert agency. When I injured myself early in my career, failed a very physical course, and thought my military career was at risk if I did not recover from my injury, that was when I had previously felt this vulnerable. Only, on that occasion, I had no family and no children. Whereas this time, in a different part of the UK, in a rented house, with a family dependent upon my income, I think it weighed more heavily.
Building new working relationships
Building new friendships in new places has always felt difficult for me. I lived in a lot of different locations as a child, both in the UK and abroad. This meant countless schools where I felt odd, awkward, different, and was bullied at times. This has led to me feeling self-conscious and anxious when forming relationships. However, I recognised the value in work relationships, was conscious of the need to develop them, and was concerned about ‘getting it wrong’. Every military training course or deployment and most challenging work situations that I have experienced have always relied upon teamwork. Despite my anxiety, I am a good team player. However, I am always faced with an internal conflict between my anxiety and desire to escape or avoid social or group situations versus my experience of the value of working with others. Over the years, I have learnt to make a better first impression and to try to maintain work relationships. In my personal life, I am more typical of somebody with social anxiety, have a very narrow circle of friends, and depend upon my wife for friendship as well as love.
“A tough day today. Felt anxious in a meeting. Worried about building bridges. Very conscious of the need to be a team player and not to become too entrenched. Feel this nearly happened today although this was not my intention. Relationships seem very important and can be tough to build” (Journal)
I decided that collaborating on work projects was a way to achieve new and positive working relationships. I sought out opportunities to work with others and aimed not to isolate myself. Seeking to isolate myself would have been an easy option and my default setting in new social situations. Despite my anxiety, I am also a good and proven team player, collaborating on work projects was a way to manage my social anxiety and to allow me to play to my strengths. However, when combined with job uncertainty, it would have been easy to take on too high a workload and to volunteer for too many projects.
“I have a lot going on, illness, house move, parental relationships, fitness, weight, love, happiness, dog, broken car, PhD etc. How to deliver and be reliable. Do I slim down and just try to deliver on 1 or 2 things, or do I volunteer for everything? The standing joke in the forces is never volunteer. But I always have and still am....for everything. Do I need to be more strategic?” (Journal)
Seeking stability in the face of non-work life stressors
As a new veteran, I opted for cheaper rented accommodation than whilst in the military. This was because I was uncertain about my net monthly wage once pensions and tax had been removed. I knew that I would be earning less money than my military wage and wanted a financial safety net. This resulted in an immediate and obvious environmental impact upon my family.
“It was a lot to manage – house move. The check-in people (estate agents) were not booked, so the house was not ready. It was dirty and run down as we later found out the cleaners only had one day to sort it out, and it was one of the dirtiest houses they had ever cleaned from the previous tenant. The kids did not like it and were unhappy... The living area was too small for my family, and we were under each other’s feet at a time when we probably needed space” (Reflection upon interview themes)
The impact of additional life stressors affected me at a time when I did not know how to access civilian healthcare services for either physical or psychological health problems. Within the military, I was very confident about how to access healthcare to meet my needs. While I had not reached the point of needing psychological support, I consider that my mental health could easily have worsened. Accessing help did not feel straightforward when I first became a veteran.
“It has taken me eight months to understand the dental system. I probably had an unnecessary extraction, decision based on cost. Because of my ignorance of how to access the NHS. I now understand the dental system, but previously had no concept of how civilian dental care worked. My mental health was affected by the stressors around relocating. Everyone was unsettled, and I blamed myself, felt guilty” (Reflection upon interview themes)
I experienced several life stressors that included financial insecurity, geographical moves, and health problems. These seemed greater than at most times during my military career. I am uncertain if this is because of leaving or a coincidence because my family and I are now older and are likely to have more needs. On reflection, I think it may have been a combination of both, which exacerbated the distress experienced during this period of adjustment. This felt like walking a tightrope, one missed step and I could easily have spiralled into increased distress and then not functioned effectively at work at the exact time when I needed to be demonstrating my value as an employee.
Experiencing a change in identity
My military role involved liaison with different parts of the armed forces and civilian healthcare services. Each of these groups would hold a different world view and, to liaise effectively, I would have to adapt my approach to account for this. Adopting an entrenched or rigid approach to my military work had never been useful, and I took this learning into leaving the forces. The main difference with leaving the military for a new career was that previously I sought to accommodate the social norms of other groups from the position of knowing who I was. On this occasion, I had relinquished my strong foundation as a credible expert in military mental health nursing.
“I am sat on a train on my way to work. Opposite a man in his 50 s, wearing a blue Gortex jacket with an RM (Royal Marines) badge sewn on to it. I think about feeling vulnerable and now understand why he wears it” (Journal)
My interpretation was that the man on the train was reminding himself (and others) of the position of strength from which he derived. Without it, he was another man in his 50 s sat on a train, but with it, he and others knew where he came from. I remember when I got promoted in the forces to a rank that represented credibility within my role. It involved the right to wear a slightly different uniform – peaked cap, long sleeve shirt, tie and different rank slides. To me, this uniform represented credibility because rank was associated with skill and experience in my military role. It helped others to understand my skill and experience, and without it, I felt more vulnerable.
“I kind of hoped I would be some sort of shining star, delivering everything that was missing and highly prized. Stepping out of one work environment where I was doing ok in my field and leaping feet first into another where those skills were ready to go” (Reflection upon interview themes)
The reality was very different, and my military experiences, or point of reference, seemed to contribute very little compared to my peers’ NHS experiences. My expected strong platform upon which to launch a civilian career seemed weaker than I first thought, and I compared myself unfavourably to my civilian peers. I had to shift my perspective and adjust my new identity to reflect this change of status. This was driven by a motivation to overcome the challenges that I faced and to make my new situation work. I had left the forces a credible expert and joined my new organisation as a novice on probation. Seeing things from this new perspective of novice helped me to develop a flexible strategy that focused upon learning new skills while building upon existing ones. When adopting this strategy, I began to feel more confident and could begin to understand why they had employed me, which was not for what I was but instead for what I might become within their organisation.
Other people
The above personal construction of transition from a military to a civilian work role has shaped this heuristic inquiry. The next stage involved using my personal construction as a frame of reference when exploring other veterans’ experiences.
Reaching a tipping point about deciding to leave the forces
The main subthemes relating to reaching a tipping point for deciding to leave the forces were about opportunities and values. Weighing up military and civilian opportunities was a prominent subtheme that led to a tipping point for choosing to leave.
“... mindful of the currency in up to date qualifications and transferable skills. Chose to develop self in the forces with managerial skills that were transferable across industries... ” (Participant B: Paraphrased)
The concept of it being ‘my time to go’ resonated with most types of service leavers and represented a moving apart of previously shared values between the organisation and the employee. This shift seemed most pronounced for those who left whilst experiencing a glass ceiling, and they typically reported a period of conflict and significant unhappiness in the workplace.
“I wasn’t valued at all. And I felt very undervalued. In fact, I started getting into trouble. I ended up getting two warnings. Coz I had a massive dose of the f**k ems, to be honest” (Participant G)
Participants were also able to make comparisons with other people who had already left and to make a prediction about what to expect. For example, Participant G went on to explain that they found it helpful to know that people who had left did not regret doing so, and that their portfolio of skills and experience were comparable to veteran peers. Knowing that their skills were marketable, combined with discontent, seemed to lead to a tipping point for leaving. This period of conflict and unhappiness was shared with those who left more suddenly than planned due to health issues. This group perceived that their contract with the military had been broken and reported feeling undervalued, let down, and a subsequent period of loss. By comparison, those leaving at the end of their career reported a more gradual process of change that included a need to accept a shift in opportunities within the forces, age-related physical limitations, and a growing tiredness or apathy with military life.
“... I was just tired with everything. I knew I was tired with the navy at the time. It was right, it was 22 years I’d done you know, and I was getting more and more bad with knee injuries and everything... it’s a choice I made I’m quite happy with” (Participant I)
Uncertainty when leaving the forces and starting a civilian job
The subthemes about uncertainty when leaving the forces were an emotional reaction to leaving, preparation for leaving, and transferable skills. The emotional reaction tended to be anxiety, which was commonly experienced at the point of leaving. It would seem that a degree of anxiety was both a typical and a normal part of experiencing the uncertainty about leaving a stable job for the unknown of civilian employment.
“... for me the biggest thing was when I first left was that all of a sudden that realisation that you’re out of the service, you’re out of your, I guess, almost comfort zone...” (Participant C)
For other people, this anxiety persisted, and this did not seem to be dependent upon the reason for leaving the forces or at what stage in a person’s career they chose to leave. Instead, it was driven by an extended period of uncertainty about future civilian employment once they had left and were no longer receiving military pay. The reasons for uncertainty when starting a civilian job were varied but included the process of emigrating, redundancy, job offers falling through, human resources errors, and zero-hours contracts.
Preparedness for leaving was something that many of the participants reported was helped by the sorts of experiences and training opportunities that they had exposure to whilst in the forces. In common with all military personnel, there were opportunities available to participants for additional resettlement training. The perceived usefulness of the resettlement training was variable. However, all participants felt that time needed to be better protected for resettlement and the process of transition. For those who considered that they possessed transferable skills or experience, this reduced uncertainty, led to a speedier process of securing appropriate employment, and less reliance upon the resettlement training opportunities.
“... I got the phone call you need to go to the transitional workshop, and I went, what for? They went to allow you to transition to a civilian environment and get a job. I went, I have got one. ... I won’t be attending your workshop” (Participant G)
Others had started their career within a role that would lead to less transferable skills and may have hoped to resolve that while serving. Where they were unsuccessful in gaining transferable skills, due to military commitments, this led to greater dependence upon the resettlement process. This meant that securing civilian employment became about making use of networking skills, while also trying to invest wisely in resettlement and post-military training. The hope was that the resettlement training would lead to greater civilian job stability, however training courses could be costly and did not always lead to employment.
Managing insecurity within the civilian workplace
“The military provided continuity with wages and employment... Coming out into civilian street and not knowing if the wages are coming in or if your next job is coming in, it was the hardest thing” (Participant F)
Some participants reported perceived insecurity in their civilian workplaces. Subthemes were the emotional reaction it caused, credibility, and skills. The types of insecurity or unexpected events reported were the threat of a job falling through, problems with administrative processes, no permanent work, and redundancy. Whatever the unexpected event, a dominant feature was the impact upon how the participant felt in the situation, more specifically, their emotional reaction to negative workplace events. On occasion, this was exacerbated by other life experiences or their previous military role. For some people, this period of insecurity seemed to pass within a few months, whereas other people had to tolerate job insecurity for an extended period. Insecurity about civilian work included extended periods away from home, unsatisfying work roles, long hours, and non-permanent contracts that impacted upon mental wellbeing.
“That transition period was probably the worst six months for me... Because of the insecurity and believing that I made - convincing myself that I made a big mistake in terms leaving and all that kinds of stuff” (Participant C)
“... the last year has been very stressful. It’s probably had a stressful impact on my health. I can see weight loss; I can see quite a few more regular attendances at the GP [Physician] with stress...” (Participant F)
Participants described how they planned for stressful events and problem solved how to manage them and to improve their situation. This included planning for predicted periods of insecurity, contingency planning for different eventualities, and identifying a goal to work towards when faced with adversity. Two factors that impacted upon those plans were perceived credibility in their role and possessing transferable skills.
Building new working relationships
Building new working relationships was fundamental to participants’ experience of civilian employment, with soft skills and valuing military or shared experiences reported as the main subthemes. Some reported that they sought out employment that had similarities to military life with an expectation of a shared understanding. While there may have been some similarities, ultimately the civilian employment was in a different organisational structure that seemed less cohesive at times.
“... the NHS is very different. And obviously, it has to be because it’s not the military, it’s not doing the same function. But that kind of, as you say, I think my expectation that it was very similar to the military. It was probably a little bit overestimated, but it’s kind of there to a certain extent. And, again, there’s a few people that you kind of develop sort of close working friendships or not just working, but close friendships and bonded with that you’ve worked with over a period of time” (Participant C)
One participant suggested that useful characteristics from the military were self-discipline, motivation, and getting things done without prompting (Participant A). Whilst another suggested that qualifications will only get a person so far, as other skills are important to climb the corporate ladder (Participant B). Sometimes the application of soft skills was reported as challenging. Nevertheless, more generally, the application of soft skills was perceived as a strength derived from military life.
“I think the military teaches you how to cope and play along and you do a good job because you are smart, and you turn up on time, you are polite, and you are very keen to work in a team, and it’s not all about you” (Participant E)
Soft skills were perceived as an important tool within the workplace. Interpersonal skills were valued at times of uncertainty to build working relationships, to gain permanent employment, or to create promotional opportunities. Most viewed this as very much a long game and, given that all participants had served a minimum of 12 years in the military, this may have been consistent with their previous work experience.
“... I’d say in our kind of world is the fact that we usually just get in there and then and getting on with stuff. And a lot of places like that, that you’ll just get on with the job and it means you are then appreciated, and people will ask for you to go back to other places again” (Participant I)
Seeking stability in the face of non-work life stressors
One other participant shared my experience of a non-work-related negative life event when leaving the forces and transitioning into civilian employment. This life event was a relationship breakdown and they observed that a geographical move and lack of immediate social network meant it was harder to meet new people. Another participant recognised that their civilian employment was impacting upon their ability to enjoy family life, which was because they had made choices that involved working away from home. They recognised this was like being separated from family due to a deployment and realised it was now optional rather than a mandatory part of life. By comparison, most participants reported that civilian employment had resulted in a more stable social and family setting.
“I look at people... I have got a life now. I can, I am more in charge of what I am doing and that, my families future. If I had stayed in, I would have probably been posted and seen my family at the weekends. I see my family every single day” (Participant G)
Experiencing a change in identity
Participants reported that their military values shaped their civilian identity and that they identified with the term veteran. In general, military experience was not always as highly prized by their civilian employers as they had expected it to be. More rarely, previous military experience or status added value to new employment or shaped how the employer might perceive the veteran within the workplace. On occasion, this led to the employer holding unrealistic expectations about how the veteran would perform their role.
“My first job, having met the manager at the time, she was very keen on me over others because she thought I could go in there and sort them out. Sort out the support workers. She thought that a bit of military discipline and the ability to grip a situation was what she was after. Not really my style” (Participant E)
Some veterans orientated themselves towards specific civilian roles such as nursing, the ambulance service, or working in an offshore medic on oil rigs. However, although these roles attracted veterans, their previous military experience did not always translate or lead to job offers. In fact, a common message was that employers were not too interested in operational tours, medals, and specific military experiences. Despite this lack of interest in previous military experience, most participants were in employment. A minority of veterans reported job roles that seemed to lead to a concentration of employees who were also veterans, suggesting that military camaraderie and values remained important.
“I do miss, I really do miss the military. I miss I think probably the camaraderie, the friendships that you, the bonds that you kind of develop through some of the environments that you find yourself in... not just. I mean, yes, I think that across the board when you’re in the UK and going through training, and you’re living in close proximity and what have you, you build some strong bonds and friendships and stuff” (Participant C)
Despite the perceived lack of value by civilian employers in participants’ previous military experience, most felt like their previous military role would always shape their identity.
“People used to say what is it like to be a civvy. I say I have no idea mate. I said I am an ex; I am ex-military. I will never be a civvy. And people don’t realise that you carry on being military when you leave, you still identify. And I see myself being an old legionnaire soon, sitting in an old legion if there is any left” (Participant G)
Although participants sought out roles where they hoped that there would be some similarities to their previous military values and that this would continue to form part of their identity. Sometimes the reality was not exactly as expected, values incongruent, or the civilian workplace was too focused upon financial pressures as opposed to the people within the organisation and the quality of the service that they were delivering. On other occasions, the transition into a civilian identity included benefitting from what were perceived as transferable values.
Creative synthesis
As part of a creative synthesis, the above analysis was revised into the following revised themes, the tipping point, adjustment, and progression. The themes draw upon all our experiences but, consistent with heuristic inquiry, are reflected through my personal perspective, learning, and construction of knowledge.
The tipping point
While it is true that I was frightened of leaving the forces, it is equally true that I was scared to stay. There was increasing tension between my values and employment needs compared to the expectations of the military. This felt like a gradual shift in my identity from a sailor who was also a nurse to becoming a nurse who happened to be working in the navy. This tension slowly led to a tipping point where the opportunities as a civilian began to outweigh those in the forces. Most of the people that I talked to shared this experience. On reflection, many of us worked towards this eventuality by developing civilian work skills, professional training, and outside interests that bore fruit in the latter stages of our careers. This served as a cushion during the transition process, and when it did not happen for whatever reason, for example, ill health or lack of opportunity, then the shock of leaving seemed more severe and the adjustment took longer.
I have learnt that, during a military career, it is important to target professional development that includes transferable skills and civilian qualifications. One advantage to serving as a healthcare professional was the scope to exploit opportunities for civilian training, as some of the civilian professional roles were not dependent upon previous military experience, and it felt like it was the skill that was transferable and of value in the civilian labour market more than the person. However, there is a risk that a growing realisation of the value of civilian skills or qualifications might increase the tension or conflict near the time of leaving. For example, I and others began to feel that the value of our skill set had transcended whatever rank or role was being performed in the forces and the military structure. For some, this was evident in the monetary value placed upon our skills and the demand for our services in part-time civilian employment that was more favourable than our military grade. This led to a tipping point, where leaving seemed to be an opportunity to flourish, but staying felt increasingly like a dead end.
Adjustment
With the decision made to leave, there came a period of adjustment. This was a triple whammy of uncertainty about the process of leaving and the starting of new employment, insecurity in the workplace, and a loss of identity. Most people reported a period of adjustment that included increased anxiety or low mood. Some people had been able to develop and perform their future civilian role while still serving and before giving their notice, which may have cushioned them a little from some of the stress of leaving. However, for others, leaving meant a period of deciding how best to make use of resettlement funding for further training and job hunting. There were mixed views about this resettlement process with some finding the workshops, courses, and job fairs useful and others making little use of them. I fell into the latter category and could not work out how to make use of the available funding and courses.
Having spent time during their military careers drafted to different geographical locations with or without their families, most people left the forces for greater stability and security for the future. All participants had invested many years in the forces and had flourished. Leaving was a time of uncertainty that involved navigating bureaucratic processes, a long notice period, and securing civilian employment. This was particularly challenging when it coincided with civilian job insecurity that came in many forms from not fitting in with the team norms, the agreed job no longer being available, problems with emigration, zero-hours contracts, and the threat of redundancy. This was managed by problem-solving strategies to improve the situation that included improving CVs through targeted training and job experience, securing different employment, and trying hard to fit in and to progress within the organisation despite the job insecurity.
Progression
You never sit still in the forces as you are always at risk of being drafted, practising skills, training or working towards promotion; but you never sit still. Everybody learns how to navigate the opportunities this presents and feels the frustration when it does not work out the way we hoped it would, for example, being turned down for a promotion, a wrong draft or rejected for a desirable training opportunity. Everybody learns how to navigate that system, to play to their strengths and to progress. The key is to make yourself invaluable, to become credible, to be dependable, and to fit in.
The importance of this was best represented by one of the early leavers and one person whose career ended suddenly. The former was ambitious and keen to gain a senior role. However, soon after leaving, he was made redundant and learnt the importance of building credibility and networking in the civilian workplace to defend himself against future job losses and to create opportunities. The latter was on a zero-hours contract and trying to gain full-time employment in his chosen field. Again, to develop a full-time role meant being liked and well regarded. Soft skills were paramount in both cases to develop positive work relationships. To achieve this, they both sacrificed work-life balance and played the long game for their careers through self-sacrifice and relationship building in the short to mid-term. When faced with adversity and uncertainty at work, I defaulted to the same strategy which was to sacrifice work-life balance for the team, help as much as possible, and try to build a reputation as somebody who could be depended upon to deliver the task at hand. This resonates with my training experiences in the military; whether it was basic training, leadership training or deployment training, the principal was always the same. The principle was to act in the best interests of the team because a resilient team benefits all the team players.
Everybody felt that they had developed a set of military values that had helped shape their identity and were useful. More specifically, values such as punctuality, smart dress, and working hard were deemed important and associated with being ex-military. Clearly, these attributes are not exclusive to veterans, yet many reported being able to identify other military personnel and being drawn to them, on occasion, either in work or socially. I now see the strengths of my civilian colleagues and my military peers, whilst noticing that these are not mutually exclusive. I have let myself become more distant from my military past and others in this study have chosen to do the same but to greater or lesser degrees. As I focus upon my current work role, performed by me as a civilian healthcare professional who once worked in the military, I realise that being a veteran remains part of all of us and contributes to who we are in a civilian workplace. However, it does not need to exclusively define my civilian work identity, as we all get to shape our future selves, the jobs we do, the way we act, and what we say. This feels forward focused, as opposed to dwelling on the past, and it feels like progression.
Study limitations and strengths
As an insider researcher, I made use of my networks via social media to access participants from a geographically disparate population, which means they had links with the researcher that may have increased the commonality of the findings. Data collection was based upon a single interview. Additionally, two of the participants opted to respond to the request for an interview with a written response to the proposed interview themes. A single interview is an accepted approach to heuristic inquiry with the aim of facilitating the emergence of ideas and feelings related to the phenomenon [20]. This emergence of ideas through dialogue was not possible with the written responses, which means that there was not an opportunity to clarify meaning or to explore ideas with those two participants. Within qualitative research, reflexivity can illustrate how the researcher makes sense of the knowledge they are creating [30]. In this study, rather than avoiding my personal bias, the aim was to make it explicit by including my personal experience and how this informed the analysis of the participants’ experiences.
Discussion
This is the first time that the Transtheoretical Model has been applied to midlife career change for both UK veterans in general and military healthcare professionals specifically. The links between the Transtheoretical Model and military healthcare professionals’ experience of midlife career transition were: the concept of reaching a tipping point that involved recognising a shift in values (Precontemplation/Contemplation); exploring opportunities in civilian environments (Preparation); reaching a decision to leave (Action); adjusting to a new work environment and identity (Action); building new working relationships and civilian work experience (Action/Maintenance); as well as establishing and maintaining credibility as an employee (Maintenance). Of note, at the point of leaving there seemed to be an initial triple whammy of uncertainty about leaving, insecurity in a new job and loss of identity that impacted negatively upon the positive foundation expected from long service and exacerbated the degree of distress experienced when integrating into civilian work roles. This triple whammy may need to be accounted for as a risk factor within the action stage of the Transtheoretical Model.
Membership of reinventive institutions such as the military are typically perceived as a positive and transformative life experience, with the new military professional identity becoming a dominant facet of a person’s social identity [1]. Given that many participants reported a divergence in skills and values leading to the potential for conflict and unhappiness, it seems possible that the perception of the military institution as transformative and life-fulfilling may not be a static construct and could be dependent upon factors such as career stage, military experiences or competing demands from other roles. Neary [3] suggests that, because professional identity can be a composite of different concurrent roles, how people perceive and communicate their professional identity to others is not straightforward. Furthermore, it may be that the military component is a fragile and transitional element to a person’s overarching professional identity that involves becoming a military person, being a military person, and then undoing a military identity dependent upon where a person is in their military career pathway [11]. This study indicates there may be a shift in professional identity towards the latter stage of a military career as people reach a tipping point to a midlife career change.
We all experienced a period of uncertainty when leaving the military and starting civilian employment that led to self-doubt about career decisions and how we were going to manage. Consistent with the idea that new joiners to an organisation experience stress and uncertainty [31], the participants in this study reported that uncertainty in the new workplace and loss of identity resulted in periods of anxiety and low mood. Identity loss may reflect both the experience of a shift in professional identity as we adjusted to the new workplace and the fragility of military identity when leaving a reinventive institution such as the armed forces. In part, this may explain the participants and my struggle with the general adjustment to a civilian role. However, we also experienced additional organisational stressors related to leaving the UK military, as opposed to joining the new civilian organisation, which were navigating military bureaucratic processes and a long notice period. These additional organisational stressors that were related to the process of leaving the military may have presented as an additional challenge and resulted in increased anxiety. I describe this as a triple whammy of uncertainty about leaving, insecurity in a new job and loss of identity.
The recommendations from this study focus upon personal strategies to manage transition, organisational strategies to support the transition process, and future research. At the personal level, most of the healthcare professionals held additional civilian qualifications in nursing, education or paramedical skills. This helped with employability; when this was not the case, there was greater dependency upon the resettlement process and increased civilian employment uncertainty. Thus, it may be useful to develop civilian qualifications earlier in a military career. This approach may help to mitigate uncertainty when transitioning to civilian employment and create less dependence upon a military resettlement process that was reported as ill-equipped for healthcare professionals.
At an organisational level, the tipping point for choosing to leave the military meant that the needs of the service and the needs of the individual parted ways, that is, there was a divergence in values. For some, this came at the end of a contract when participants reached the decision not to extend their contract. In essence, they perceived that they had served their time and were now ready to leave. For others, remaining in the forces beyond their current contract was not an option afforded to them, and their careers ended more suddenly. However, there was a final group who felt that there were greater opportunities available in civilian employment and that their military role/rank did not adequately reflect their skills and qualifications. This group typically pre-empted the inevitable midlife end of the military employment contract. This seems to be a group that the military could seek to retain if suitable roles could be identified that reflect their skills and qualifications. To mitigate personnel making unfavourable comparisons and opting to leave, the military employer needs to demonstrate it values civilian qualifications and clinical skills in a way that is comparable to how it values other characteristics such as management and leadership skills.
This study has focused upon the experience of healthcare professionals transitioning to civilian employment. Their experience sits within the broader context of the military that they are leaving behind and the civilian organisations that they are joining. Further research is needed to understand the perspectives of military and civilian line managers in supporting veterans through a career transition. Careers are longitudinal, it is important to discover how healthcare professionals experience further career changes and the function of their veteran status within that process. In addition, in this study most participants had transferable civilian qualifications. Future research should examine how those military personnel in roles without civilian qualifications, but who have also served lengthy careers, experience transition.
Conclusion
Military healthcare professionals are a unique group of non-combatants who serve within the armed forces. To our knowledge, no previous research has specifically explored the experiences of UK military healthcare professionals, and this is the first study to explore their experience of midlife career transition. My position as a veteran and as an insider researcher has revealed new insights about being a military veteran in a civilian workplace. More specifically, how we experienced a divergence in values away from military service and an explanation for why adjusting to civilian employment impacted mental wellbeing. This is important for both the UK armed forces and for comparable militaries worldwide, because it may affect retention within the armed forces, how veterans prepare for a midlife career change, and how civilian employers support veterans.
Ethical approval
The study was approved by Lancaster University (FHMREC16081).
Informed consent
Informed consent was obtained from all participants.
Conflicts of interest
The authors declare that they have no conflict of interest.
