Steps to Choosing a Nursing Specialization
Many nurses, once comfortable with the day-to-day practice of nursing, decide that the next natural step is to go the specialization route. The thinking is that nurses who select a specialty will enjoy a higher salary, greater employment demand, and career-long job security than those who don’t. The US Bureau of Labor Statistics reports that registered nurses earn a mean wage of $68,910 annually, while nurse midwives earn $92,230; nurse practitioners earn $95,070; and nurse anesthetists earn $157,690. Not all specialties guarantee increased earnings—a parish nurse, say, is typically unpaid—but the niches that demand additional training, certification, and experience that’s in short supply almost always do.
However, not everyone agrees that specialization is the best approach to navigating a nursing career. “Some nurses start out interested in pediatrics, ER, or labor and delivery, but most don’t,” says Donna Cardillo, RN, MA, a nursing career coach (www.donnacardillo.com). “Many nurses feel pressured to choose a specialty and feel deficient in some way if they don’t. That’s an old, outdated model. Most of us used to work in one specialty our whole career. It’s not like that anymore. We’re going to work in many different specialties and work settings. It’s common to weave in and out of specialties all the time.”
Cardillo believes the health care landscape has changed and so has the job market. Jobs are moving out of hospitals to alternate inpatient settings—long-term care, inpatient rehab, subacute care, and long-term subacute care.
“New nurses have to think more about the opportunity itself—the support they will get and the opportunity to grow personally and professionally, rather than ‘choosing a specialty,’” says Cardillo. “But they also have to think about opportunities outside of the hospital. For example, if interested in pediatrics, consider pedi long-term care, pedi home care, [or] pedi rehab.”
Regardless of whether you pursue a specialty or a good opportunity, as Cardillo advises, it turns out that the steps are very similar. It means thoughtful consideration, energetic career exploration, and possibly pursuing more education, certification, and on-the-job training. Here are three simple steps to specialization, plus the career stories of three nurses in some of today’s most popular specialties.
One of the best online resources for nurses considering a specialty is at www.discovernursing.com, which is sponsored by Johnson & Johnson. They offer a comprehensive Find Your Specialty quiz that starts with your education and skills (current or projected), then goes on to your favorite work roles and preferred work environment. Here are some representative questions and possible answers, slightly modified for brevity:
Q: What are you good at?
A: Tech savvy; good communicator; strong leader; compassionate; calm
Q: When it comes to your patients, the best way you can help them is:
A: Face-to-face; managing, training, or teaching nurses; doing research, writing, or advocating
Q: When mingling with colleagues, how do you join the conversation?
A: I lead it; I usually listen at first; I listen
Q: At work the perfect pace for you is:
A: Slower; steady; faster
Q: Your ideal day at work is:
A: Pretty much the same; slightly switched up; completely different
At the end of the test, you’ll get a top recommendation for a specialty, plus two alternatives. Each one is described in detail and includes a list of advanced training, educational degrees, or certifications required to practice. Finally, there’s a profile of a successful nurse in that specialty to give you a sense of what’s required to find satisfaction on that career path.
After self-exploration, it’s time to do some workplace exploration. Nurses get a great deal of first-hand knowledge of various categories of nursing as they do their rotations during nursing school. If you pay careful attention to your “gut level” reactions—to medical-surgical, pediatrics, obstetrics, or critical care—you will discover which specialties appeal to you at a deeper level. You may want to explore additional specialties through internships, externships, temporary assignments, or PRN work outside your regular work duties.
If an actual, in-the-field trial is not an option, consider going online to learn about other categories. At www.discovernursing.com, there is a database of 104 nursing specialties that you can access in a variety of ways. The specialties cover the gamut, so there’s something for everyone: 34 are outside hospital settings, 68 are research connected, 37 are managerial, and 92 are patient-facing.
One of the best parts of this database is that you can filter it by health care setting, degrees/certifications required, and job characteristics, so you don’t have to wade through all 104 specialties. The site will “curate” the ones that match your specific requirements.
One of the key factors that nurses consider when choosing a specialty is employment demand. Many associations survey their members about employment and publish results. Say that you’d like to be an OR nurse and know that the Association of periOperative Registered Nurses (AORN – online at www.aorn.org) reports that the average age of their members skews high, plus a quarter of OR nurses plan to retire or work part-time in the near future. Those demographic factors may increase job demand—or not. You have to dig a bit deeper to find out.
Now that you’ve chosen a few specialties to explore, it’s time to get out there and do some personal sleuthing. You can attend the professional association meetings near you, go to area conferences, or connect with RNs online at nursing specialty forums and at networking and social media sites.
So, when pursuing insights about being an OR nurse, for example, ask nurse leaders what prospective nurses should know about that specialty. Here’s what Deb Cooksey, RN, MBA, MS, CNOR, vice president of nursing at AORN notes: “First, they need to understand that their experience with the patient is very different; it’s very short and concise—probably the biggest difference they would experience. Also, working as part of a team is often a big change; many nurses are used to working autonomously. Another area where there is a significant difference is in how work is done; in Periop, it’s often multitasking but in a consecutive way. That can take getting used to.”
Next up, arrange one-to-one informational interviews with nurses who are successfully working in that specialty to find out more about their individual career path and what they’d suggest to a newcomer. Cardillo recommends asking experienced nurses these questions:
• How did you get started in this specialty?
• What do you like most and least about your specialty?
• What are the most important attributes of a nurse in this specialty?
• What trends do you see in this specialty?
“You’ll get your best information from those in the field, but take it with a grain of salt—that’s another reason why you should speak to four or five people,” Cardillo adds, so that nobody’s opinions weigh too heavily on your decision to pursue a specialty. Make a point to ask each person you interview for the names of one or two other nurses, and if they’re willing to make an introduction or let you say they referred you.
Take a look at your overall career goals and areas of interest, the type of lifestyle you aspire to, your personality and work style, and the time and other resources required to pursue an avenue.
So, for instance, if you think you’d enjoy independent case management but you don’t have funds available to get a business off the ground (and wait for it to grow to support you), maybe that isn’t a good initial specialty.
Then, of course you’ll want to see what offers you get as a way of determining if your job target is actually viable. “Whether a new or experienced nurse, you don’t want to stay unemployed for any length of time,” says Cardillo. “You can continue to pursue your dream job while you’re working. Say you’re interested in pediatrics, but can’t get hired in a hospital on that unit. Maybe you get offered a job on a telemetry unit. You might consider taking that because it’s easier to get transferred into another unit than hired from outside.”
Below, three nurses weigh in on their journey to a specialty, with some advice for other nurses:
RN, BSN, Director of Maternal Child Services, Children’s Hospital at Nevada University Medical Center, Las Vegas
My personal journey
I always knew I wanted to help moms and babies, because of a nurse who took care of me when I had my older child. I went into nursing school with the idea of maternal care but was advised not to specialize early on so I did medical-surgical nursing, then neuro subacute nursing, then I made a full circle back to my passion, a women’s care unit, and realized my love of taking care of women and children. It’s a place where I can leave my footprint and make a difference. We’re a voice for families, making sure they’re taken care of. I’ve been doing this for 23 years. There are so many aspects to this field—antepartum, NICU, women’s care unit, community nursing—it’s so broad so you can really find your niche.
Who does well in this specialty
Nurses with a passion for taking care of mothers and children do best. Follow your heart, and then even on that hardest day when you don’t think you can come back to work, you will. Find a unit that takes in new grads and trains them. Be careful not to take just anything. You want it to work for your goals.
What might surprise you about this specialty
A lot of nurses want to take care of moms and babies, but sometimes there’s disillusion. Having a baby is a dangerous thing. I always say it’s the most dangerous point of a young woman’s life. We triage patients, we have an OR for C-sections. If you work in a birthing center, it’s usually a quiet, beautiful experience. But if it’s high risk, like here at the hospital, you’ll have your fill of adrenaline. The NICU is different still, and so is postpartum.
Also, when I started, if you weren’t healthy you didn’t have babies. Now patients can have diabetes, heart problems, and asthma, and still get pregnant. Their health is compromised and their pregnancy is high risk. Patients come in by ambulance, very ill, and a lot of moms end up in the ICU later—with nothing that’s pregnancy related.
Downside of specialization
If you do specialize early, you may fear layoffs. If you’ve been a NICU nurse for 15 to 20 years, for instance, those nurses have a really hard time getting another job if we have a layoff.
For more information on this specialty, visit The Association of Women’s Health, Obstetric and Neonatal Nurses website at www.awhonn.org.
RN, BSN, Nursing Supervisor, Providence Seaside Hospital, Oregon
My personal journey
I chose ER for selfish reasons—I’m an instant gratification person. In the ER, either we fix them or we send them away. Instant results. We get a go at it, and if they stabilize they go to ICU or another department. When I was in nursing school, I saw a level 1 trauma center in inner-city Detroit. Everything you see on TV—well, that was that place. It was just a one-shift visit, but the next day I applied for a two-year internship. There were 500 applicants and they hired 30 of us. It was a free-for-all, fly-by-the-seat-of-your-pants kind of place, but a great place to learn.
I’ve been in the ER at a small, rural, critical access hospital for 18 years, now as a nursing supervisor. I work two 12-hour shifts; my wife and I are raising four kids and running a coffee business. That’s the great thing about nursing—you can work as much or as little as you want.
Who does well in this specialty
It’s so intense and we’re so busy that waiters and waitresses make the best ER nurses. You know to grab everything you need before leaving the kitchen, then check in on everyone to see how they’re doing and give them the best service possible! The ER is so like the food-service industry. That’s what I grew up doing—waiting tables.
Job search advice for new nurses
Just keep pushing. Introduce yourself to the ER manager and let them know your goal. Tell them, “If you need help, I’m available.” Keep pushing. When you pass them in the hall, ask “When can I work for you?”
ER personnel will respect people who are assertive. If you’re leaning in this direction, start getting your certifications in order and working towards becoming a Certified Emergency Nurse. Get the books and start studying for the test.
For more information on this specialty, visit the Emergency Nurses Association at www.ena.org.
RN, BSN, also known as “The Nerdy Nurse,” Clinical Informatics Nurse, Georgia
My personal journey
After my second year of bedside nursing, I knew that I couldn’t do it forever. It’s backbreaking and emotionally draining. I began searching for MSN programs that would allow me to elevate my career and stumbled upon something called “Nursing Informatics.” When I read the job description, it was like the clouds parted, the sun broke through, the angels began to sing. Most informatics nurses are BSN-prepared. So I decided to pursue the career without the MSN in hand to see if I got any traction; three months later, I was hired. Of course, my technology savvy as conveyed through my blog (www.thenerdynurse.com) were a big help with that. In my day job, I get to do what I love every day: combine technology and health care to improve patient outcomes.
Who does well in this specialty
One of the primary parts of my job is translating the needs of nurses to IT and the needs of IT to the nurses and other clinical staff. Sometimes, when nurses and nerds get together, it can seem like they’re speaking two separate languages. That’s where informatics nurses come in.
Job search advice for this specialty
Informatics nursing has become a hot specialty, and because of this, it can be really difficult to get your foot in the door. I will say that, at minimum, you should be BSN-prepared with at least three years of bedside nursing experience. The MSN credential will certainly be a help, but many organizations also want experience, so try to find some way to get IT or technical experience.
Certifications do command a higher salary. According to the HIMSS 2014 Nursing Informatics Workforce Survey, the average salary for an informatics nurse in 2014 is $100,717, while the average salary for a nurse who is certified in nursing informatics is $121,830.
For more information on this specialty, visit the American Nursing Informatics Association at www.ania.org.
Career advice for any nurse
Read nursing blogs! There are many message boards that are filled with negativity and lots of complaining. If you want to find something more uplifting and connect with people who are really passionate about nursing, then nursing blogs are where it’s at!
Jebra Turner is a freelance health and business writer based in Portland, Oregon. She frequently contributes to the Minority Nurse magazine and website. Visit her online at www.jebra.com.