THERE ARE DOZENS OF CAREER OPPORTUNITIES IN NURSING, ranging from direct-care in pediatrics to working in skilled nursing facilities (SNF). Experienced nurses may also consider working for health care agencies, opening the door to opportunities to work on different floors every week. But, figuring out which floor to work on as a recent graduate can be trying. Meanwhile, nurses working positions in units may want a change and feel uncertain about which specialty is right for them. By following the tips in this article, you can work through the requirements for different units and care settings and find your ideal specialty in nursing.

Before You Start, Know a Few Things About Finding Your Nursing Specialty

Finding a nursing specialty is not something you should take lightly. While stereotypes exist, like only nurses with a Type A personality work in critical care, it is important to not rule out your career opportunities. Instead, use personality tests and traits as guidelines, not rules to what will and will not garner your interest. In addition, personality tests and traits are filled with exceptions, reflecting their susceptibility to variations in personal preferences, explains Laura A. Stokowski, RN, MS, via Medscape. Rather than focusing solely on such tests, you need to know some background information about nursing specialty selection.

Your Nursing Specialty Does Not Have to Be a Forever Choice

Nurses may choose to work in one nursing specialty for the entirety of their careers, but that is not a given for today’s nurses. You can change specialties at will, assuming you have completed any necessary training and experience requirements to apply for a position in a different unit.

Finding a nursing specialty is not something you should take lightly.

You Have the Right to Test the Waters in Different Specialties

Even the best-laid plans for figuring out your nursing specialty may come up short when you start working. So, it may be better to test the waters by working in different specialties until you find your favorite place.

Pay Will Vary

Wages will also vary from care level to care settings. As explained by the Bureau of Labor Statistics (BLS), RNs can make up to $73,980 in government positions, $70,590 in hospitals and $60,950 in nursing care facilities, including SNF units. However, these statistics only consider full-time nurses, so nurses working part time may make more hourly than reported to the BLS.

Some Units May Have Strict Experience Requirements

Depending on the unit, you may need to meet certain experience requirements prior to applying.
For example, consider the following breakdown of duties and experience required in these units:

• Psychiatric Care – Nurses may be required to complete additional mental health training, including recognizing the signs and symptoms of substance abuse, mental health disorders and training to manage aggression or hostility.
• General Medicine – Nurses working in General Medicine may work in Med-Surgical (Med-Surg) floors or General Medicine, which both refer to catch-all floors where individuals who do not meet criteria for admission to critical care or specialty units are admitted. Nurses in these units may have higher patient-to-nurse ratios as well.
• Med-Surg – This unit is comparable to General Medicine, but it may include individuals who have been transferred from other acute-care areas, including surgery. Vital signs may be taken more often, medications must be administered, including IV medications, blood may be given and more.
• Neurology – This is the unit where individuals suffering from traumatic brain injuries (TBI), stroke or other neurologic conditions may be admitted. Nurses must have a detailed understanding of how the brain functions, as well as the ability to identify neural deficits before they become severe.
• Nephrology – Nephrology may include transplant units for organs of the endocrine system. Nurses should understand the role of neutropenia, immunosuppressive therapy and intensive monitoring of vitals, intake and output, and long medication lists.

Other units, like pediatrics, geriatrics, skilled nursing and plastics, may also have detailed requirements for nurses. Since these requirements and duty lists may vary heavily between employers, check with your prospective employer for applicant requirements.

10 Steps to Find the Best Nursing Specialty for You

1. Start with a Simple Consideration, Time
   Time is not just money; it determines when and how often you will be able to work. When selecting your nursing specialty, make sure to ask yourself these questions:· What Time, Read “Shifts” Do You Prefer? Specialties may not always have openings, and openings may vary by shift as well. Determine which shift, day or night, you would prefer working.· Are You Open to Working PRN (As Needed)? Your willingness to work extra shifts is an integral component in finding your nursing specialty. Depending on your facility, you may be required to work X overtime hours, so check with your employer to find out what shift and overtime requirements may exist.· Do You Have Other Obligations That Impact Your Schedule? This may include working a second job, continuing your education, religious obligations and caring for friends and family members.
2. What Was Your Favorite Rotation During Nursing Clinicals?
   Make a list of your favorite rotations during clinicals in nursing school. Your list indicates areas you may enjoy and find exciting. Rank these areas from most to least enjoyable. Selecting your top three choices, create a list of pros and cons to working in each area. This will help you isolate and figure out which unit is right for you.
3. Are There Any Areas That You Dislike?
   While you may have listed areas you disliked during clinical rotations, it is important to consider areas you may feel uncomfortable in. This can be a catch-all list that details health care facilities you dislike or specialties. The key to creating a truly workable list is being hyper-critical of different care areas in your personal list. In fact, you can burn the list once you finish it and know which areas are simply out of bounds.
4. Never Underestimate the Value of Working General Medicine or Med-Surg
   Recent graduates may not want to work in General Medicine or Med-Surg, but these floors are often stepping stones to landing a job working in critical care. Do not discount the experience and learning opportunities in these units.
5. Ask About Shadow Opportunities for Areas You Are Interested in Pursuing
   Depending on the facility, you may be able to shadow current staff members in units or care settings you find interesting. This will give you an in-person, real-time account of what happens throughout the shift, your responsibilities and an opportunity to meet prospective co-workers.
6. Do You Enjoy High-Energy Work?
   Define high-energy units. These are areas where the workload of staff members can become extreme at times, including the need to make life-or-death decisions to provide the best care possible. High-energy units are areas, such as the emergency department, critical care, intensive care units and post-acute care units (recovery rooms). You need to have the ability to think fast on your feet and respond immediately.
7. Do You Follow Logic and Reason When Faced With Major, Immediate Decisions?
   The argument for using logic and reason in making nursing decisions extends across all specialties, but it can serious ramifications for nurses in acute care units. Critical care nurses should be able to quickly assess and identify possible health problems and respond at once. In other words, nurses who need extra time to figure out health problems, especially recent graduates, may benefit from honing these skills in a less-intense care setting.
8. Can You Multi-Task Easily?
   Acute care usually involves a lower patient-to-nurse ratio, so one nurse may care for two or three people at once. However, this means nurses will need to perform continuing assessments with greater frequency and scope than in other, non-acute care units. Meanwhile, nurses in lower-level care settings, like General Medicine, may be responsible for caring for six or more patients, requiring additional time management and multi-tasking skills. As explained by Scrubs Magazine, you should not pick a unit based on your competitiveness or ability to do things in nursing school exclusively, and this goes back to your ability to self-manage your time working as well.
9. Do You Have Additional Experience in Certain Care Areas, Like Working as a Nurse Tech or Aide During Nursing School?
   Experiences in nursing school and in previous employment positions can also play into your selection of a nursing specialty. List any and all additional experience you have in certain care areas. This may include working as a nurse tech or nursing assistant during nursing school, volunteer experiences or even experiences relating to past family health visits.
   Write down what you enjoyed about these experiences, and take this into consideration when selecting a specialty.For example, nurses with experience in SNF units due to an ailing family member may have both positive and negative emotions relating to SNF and residential care facilities. As a result, it is important to identify such emotions and use them to make the best choice for a career. Essentially, negative experiences may increase the emotional stress associated with working in a specialty and lead to greater risk of burnout and additional disappointment in selection.
10. Remember Your Physical and Mental Limitations
    Everyone has limitations, including the most active and healthy nurses. If you have had previous health problems, consider choosing a specialty that does not exacerbate those issues.
    For example, you may want to find a care setting that uses lifts and transfer-assist devices for those in your care. If you have serious physical limitations, you may also consider applying to work in capacities that are often overlooked in nursing, like working for health insurance companies or becoming a nurse educator. The same holds true for nurses experiencing mental health issues as well.Face it: being a nurse can be stressful and taxing. So, remember your emotional state too. If you grow upset easily, you may want to consider finding ways to relax and re-energize yourself between shifts. Keeping a healthy emotional state is critical to being able to provide the best care to those in need, and failure to tend to your mental health may lead to unhealthy choices, ranging from addiction to anger. Furthermore, maintaining your emotional, mental health is of great importance when working on high-energy, critical care units.

What Else?

There are different requirements and duties nurses may have for different units. In pediatrics, nurses may need to provide bottle feeding of infants or children, but assisting with meals is also a skill seen in geriatrics and skilled nursing facilities. Nurses may need to complete Pediatric Advanced Life Support (PALS) courses or additional training to provide care among different age groups of children.

Meanwhile, the ability to perform thorough assessments of both cognitive and physical health is essential to working in every other unit too. Of course, some areas, like psychiatric care, may require an additional level of understanding for certain health conditions, like depression versus hypertension.

Ultimately, you need to think about what areas you enjoy and have the right education for, including necessary, annual training, like Bloodborne Pathogens or Advanced Cardiac and Basic Life Support (ACLS & BLS).

If you have the right education and training for the units you are most interested in, apply. The worst thing that can happen is you get to go work in another area or facility until you get the experience and training needed. Most importantly, you need to work in a nursing specialty that makes you happy and leaves you with a sense of accomplishment and resolve. This is key to how you, the health care professional, can work to improve your mental health.

In fact, mental health among nurses is a hot-button topic in the state of the health care industry, so the next blog post will focus on how nurses can stay energized and keep a “clear mind,” pardon the pun, when working in this exciting and oft-stressful career.

Additional Sources:
medscape.com/viewarticle/838732_2
bls.gov/ooh/healthcare/registered-nurses.htm
scrubsmag.com/nursing-your-piece-of-the-puzzle-choosing-a-nursing-specialty/
bls.gov/iag/tgs/iag623.htm

About Mike Kansa