A career in the nursing profession affords various opportunities by care setting, specialty, role, and type of nursing. Many of these options are a function of which specialty you choose to pursue. Nursing is unique because, for the most part, you can switch specialties and care settings relatively easier than you can in medicine. And you can do so many times over throughout your nursing career.
For example, you might be an Emergency Department nurse and then decide to work in Critical Care or Ambulatory Care. With proper orientation and onboarding, you can explore all areas of health care that draw your curiosity.
How to Choose a Nursing Specialty
As a new graduate nurse, selecting a specialty may be daunting. There are many “specialty” quizzes and decision trees out there (none of which are evidence-based). Additionally, you are likely getting bombarded with opinions (the lowest form of evidence) from friends, classmates, and faculty — which is pretty much just as effective as asking someone for a meal recommendation without qualifying whether you even have the same taste!
You may have heard old nurse tale of the need to work Medical-Surgical nursing (Med-Surg) for a year before you can pursue other specialties, or that you need to have experience in acute settings before ever considering ambulatory care.
These old nurse tales are, for the most part, falsehoods that should not be the main influence on your decision making for which specialty you initially pursue. This article will share some ways to frame your decision to enable you to make an informed and personal choice that will launch your nursing career on a great trajectory (and the best one for you).
The process of choosing a specialty entails aligning three things: your gut, your passion, and your mind.
Your Gut: Clinical Rotations in Nursing School
Although professional, licensed experience post-graduation is very different from the experience you get in school during your clinical rotations as a student. This experience can help you get a sense of the areas that resonate with you the most.
When reflecting on your clinical rotations, try to remove the preceptor variable (because it can be truly variable) and focus on the actual care delivery, the work flows, and the patient populations.
When doing so, you should consider these two questions:
- Did the patient population, diagnoses, and treatments interest and stimulate me, and could I see myself interacting with them every day?
- Did the routine of the care fit my personality (i.e the pace, environment, interdisciplinary team, ratios, acuity)?
These reflective questions help you think about the preliminary feelings you had as a novice in the environment. This is how to identify your gut feeling for where you might want to focus your professional time and work in hospitals.
For example, in nursing school I rotated through the ICU and ED in my last semester. Those were the only two areas where I felt excited, challenged, and where I went above and beyond for assignments. I read more, researched my patients extensively, and I was sad leaving the units at the end of the clinical day. My gut was telling me critical care nursing was the place for me.
When I interviewed for nurse residency programs, I only focused on critical care and ED areas, and it turned out to be an amazing choice. If I had instead relied on advice from my faculty, I likely would have worked Med-Surg first and risked being unhappy because it was not what my gut told me I enjoyed.
Your Passion: Tapping into Your Personality
While your gut gives you a raw sense of where you might want to focus your specialty search, your personality gives you more insight into your passions. There has been some insightful research done on how personality aligns with nursing speciality. The authors found that personality was not highly correlated to specialty choice but rather with burnout and stress.
Ultimately, your personality assessment should dig into what makes you happy and what fulfills your soul. If you can align happiness and fulfillment you will love your nursing specialty.
As a profession, we must rid nursing of the specialty stereotypes we see, hear, and perpetuate. Despite popular belief, detail-oriented nurses make for great ED nurses, and I know some lovely operating room nurses who really do enjoy interacting with patients. These are traits that have been tied to specialties by those who are not fully aware of all the nuances of the work in those areas.
When thinking of your personality, try to focus on things that give you energy and that you’re passionate about beyond nursing. Do you like routines or adventure? Do you like surprises or planning? Can you remember details for long periods or do you love to wing it and learn as you go?
You can also think about how you make decisions in your life and what you were most drawn to during school. If you enjoy autonomy and working alone, you may not like the team environment of an ICU or ED. If you love fast-paced environments and action but also love influence and politics, you may like the Community Health setting.
Research the settings and obtain insights about your personality from a Myers Briggs, DISC, or even your significant others, friends, and family. Then compare those insights to those identified when going with your gut.
Your Mind: Finding the Never-Ending Challenge
By now, you’ve likely narrowed your search down to a few areas of interest. Your gut and your personality have connected the dots, and it's time for that last assessment: tapping into your mind.
Professional growth and satisfaction come from being challenged and learning for as long as possible. If work becomes mundane, it can lead to boredom, which is ultimately correlated to burnout. So, for your new review of the specialties you may consider, you need to think about both the subject matter and the mental challenge of the work.
This is going to be different for everyone. It’s important to understand that no singular specialty is any “smarter” or “better” than another. They are different.
Many times in the “eat-your-young” culture that nursing is fighting, we assign higher intellect to critical care and less to settings such as mental health or ambulatory clinics. This is not an evidence-based worldview. Each setting has extremely complex and stimulating dynamics that require all nurses to be extremely intelligent.
To tap into what makes your mind buzz, you need to think about the care you will be delivering and assess whether you feel excited and challenged by it. Use the following areas to assess your mental stimulation for a given specialty.
- Do the medications, calculations, and assessments excite me and make me want to learn more?
- Do the diagnosis and treatment interventions seem challenging and drive me to want to be an expert?
- Does the patient population present enough diversity of situation to make each day stimulating?
- Could I do this every single day for 12 hours, fie days in a row on nights and still wake up on day six to be excited about another overtime shift? (Okay, maybe this is extreme, but most of the time can and should be possible!)
Bringing It All Together
Start with a wide net and use your gut to narrow your search down to a few specialties. Take those specialties and research them through nurses actually working within them. Compare their stories to what you enjoy as a person.
Then, narrow your list a little more and think about the intellectual stimulation and career growth you will experience there. You should narrow it down to two or three specialties you might interview for within a new grad residency program. Use these interviews to make your final decision.
There are other things to also consider related to specialty, but they are not as tied to long-term career satisfaction. I have listed them here for consideration in your decision making process:
- Pay differences
- Shift types and hours
- Work environment
- Job market
At the end of the day, your gut, passion, and mind need to thrive… and all the rest will follow.
Education Requirements for Nursing Specialties
One of the great things about the nursing profession is that you can enter many specialties without additional formal education beyond what was required to become an RN. In fact, changing specialties can simply be a matter of being trained and precepted on a unit within the specialty.
For example, if you were to decide to pursue a position in the ED after working in the CVICU, the process could be as straightforward as working with the unit managers to facilitate that switch and training. It may, however, be more difficult in some health care facilities or health systems that require formal programs to formally switch specialties or units.
Each specialty within nursing has its own specialty certification, aside from the certifications required to work within the practice. These are exams that you prepare and sit for, not dissimilar to the NCLEX. The purpose of these certification exams is to validate and confirm your expertise as a practicing nurse in your specialty.
After a year or so of practice, you may be ready to sit for specialty-specific certification exams. You can usually take a practice exam to test your knowledge and readiness, either in a study book or online with the certifying organization.
For example, an ICU nurse can acquire enough critical care nursing experience and become certified as a Critical Care Registered Nurse (CCRN). It’s not uncommon for nurses to receive a compensation differential for becoming certified. In one study, certified nurses earned 9% more than non-certified nurses. Additionally, 90% of nurse managers would hire a certified nurse over a non-certified nurse (everything else equal). It also helps demonstrate that you are committed, knowledgeable, and passionate about caring for your patients.
Many of the certifications suggest that you practice for a few years before sitting for the exam. There are fees to take the exams, and some only allow retesting a few times in a given year. However, this is a completely personal decision.
For example, I sat for the Certified Emergency Nurse exam after one year of practice. It was suggested that a nurse practice for three-four years before taking this exam. I passed, barely, but became certified on my one-year anniversary of working as a nurse. By studying, learning from clinical mentors, and taking care of a wide variety of patients, you can accelerate your learning exponentially.
Additional Specialty Certifications
Most specialties require additional certifications for preparation to safely care for the patient population. These are typically easy to obtain or may be a part of hospital onboarding and training programs.
For example, if you work in the Emergency Department, you will be required -- at minimum -- to have BLS (Basic Life Saving), ACLS (Advanced Cardiac Life Saving), and PALS (Pediatric Advanced Life Saving) certifications.
Some facilities, such as trauma centers, will additionally require TNCC (Trauma Nurse Core Curriculum), MAB/CPI (Crisis Prevention Interventions), or ENPC (Emergency Nurse Pediatric Curriculum) credentials.
Each specialty typically has some combination of “alphabet soup” you will need to complete in order to learn and be prepared for anything that might happen within that patient population. You can find a comprehensive list of required certification based on specialty here as well as an extensive list of nearly all possible certifications here.
In some areas there are nurse education requirements to work in more advanced roles. For example, OR nurses can take classes to become a First Assist. Acute care nurses can learn to be PICC nurses or on the IV team. You can even learn to be a Dialysis nurse or a Wound & Ostomy Care Nurse. Even if you find your specialty doesn't necessarily have a formal nursing program, you can always inquire about extra certifications or courses to enhance your practice.
Common Specializations that require further formal education are:
- Wound/Ostomy Nurse - Certification Program or Master’s Degree
- Clinical Nurse Leader - Master’s Degree
- Clinical Nurse Specialist - Certification Program
- Nurse Practitioner - Doctoral Degree
- Legal Nurse Consultant - Certification Program
- Certified Diabetic Educator - Clinical hours and Master’s Degree
- First Assist - Certification Program
- Nurse Educator - Master’s Degree
- Nurse Informaticist - Master’s Degree
To find out which certifications are available and what various specialties require, click here.