Are nurses pigeonholed?

jjjoy, LPN · Mar 23, 2007

Generally, within an acute care setting or clinic setting, once you have a few years of experience, it shouldn't be too difficult to switch between specialties. For other types of nursing roles (school nurse, public health nurse, occupational health nurse, case management...), many jobs PREFER certain experience but don't require it. It's more a matter of being a quick learner and being there ready to take a job when someone needs a nurse and can't easily find someone who already has a strong background in that area. If you're persistent and motivated, you should be able to find varied opportunities as a nurse.

Still, most people would recommend getting a few years experience in acute care since that experience is what most employers are looking for when they hire a nurse. And if you work outside of acute care for several years, even if in long term care or home health care, hospitals will be reluctant to hire you because they'd worry that your skills weren't sufficient to handle more acute patients. Though, with persistence and a refresher course, one could probably eventually get back into acute care.

While there are a wide variety of jobs that nurses are technically qualified for, many of the alternate directions nurses can take DO depend upon at least a few years of clinical experience in a related area. For example, to be a research nurse in oncology, they'd want someone with a few years experience with oncology patients. What kind of experience? It could be outpatient chemo, but how do you get the outpatient chemo positions? By having a year or two on an inpatient oncology unit.

Same thing for legal nurse consultant. You'd need experience in specific area to really be qualifed to give an "expert opinion" on the nursing care in question.

In those places that will hire nurses into positions without related experience, you have to ask yourself how comfortable you are with that. For example, home health care generally wants nurses with a few years inpatient experience since they'll be working on their own in the field. However, a desperate agency might hire a new grad and put the responsibility on you to gauge your ability to handle it.

This is just my perspective on it. Let's hear what others have to say!

llg, PhD, RN · Mar 23, 2007

I think your post was great, jjjoy. As you said, while there are lots of varied options in nursing, most but the most basic entry-level positions require relevant previous experience. So, people CAN switch specialties or roles, but they may have to take a step back or down to get the relevant experience required. Also, many roles require an advanced education and/or certification -- which is the responsibility of the individual nurse to get in order to qualify for those positions.

Bottom line: There are lots of interesting and rewarding career paths within nursing and lot of good opportunities. However, the nurse must make an effort to travel along those paths -- invest in additional education -- invest in getting relevant clinical experience -- establish a track record of success within the profession -- establish a good professional reputation -- etc. if he or she wants to be able to take advantage of many of those opportunities. They don't come automatically when you get your license.

RN34TX · Mar 24, 2007

I have to say that if nurses do get pigeonholed, and I've seen many who are stuck in one area or another, it's because those particular nurses pigeonhole themselves, not others doing that to them.

Many just plain don't want to take the necessary steps involved in moving on and evolving their career. I bring patients up from recovery every day to the med/surg floors and so many of those burned out nurses say to me "You're so lucky. How did you get a job in the recovery room?"

Although they seem genuinely interested at the time, most aren't going to take the steps to move on. They don't want to hear me tell them that they need to move to ICU for a couple of years and get some ICU experience. They want me to tell them that I just sit there until the patient wakes up and then I take them to the floor and that you don't need any special training or experience to do my job. No big effort involved in a nurse moving from med/surg to recovery room.

That's what they want to hear.

I've run into this mentality my entire nursing career. When I graduated from LPN school, despite being told that there were few hospital jobs available for LPN's, I was determined to be a hospital nurse, not a home health or LTC nurse like so many LPN's get steered toward out of sheer tradition and habit.

When I got that first hospital job while working in LTC, my co-workers would be like "Oh how did you land that job as a new grad?" When I told them that there were still opeinings, out came flying the multitude of excuses: "Oh I can't work evening or night shifts...oh I can't do weekends", etc. so trapped in the nursing home they stayed, even though they hated the job they were in.

When I outgrew my med/surg role and needed to move on, I knew that I needed to get my RN in order for this to happen.

You also have to be able to swallow your pride and be the new kid all over again if you want to switch gears in your career, and this is another big problem for many nurses who stay trapped in one area.

Some that I work with get to be great experts in their area, sometimes to the point of being arrogant and so full of ego that it would kill them to be the new kid again. Those new grads they like to make fun of for making silly mistakes or the nurse on the other shift who forgot to do this or that.....well those expert nurses will be the ones making the mistakes and fumbling around if they moved to another specialty and their pride and ego just couldn't handle it, so they stay where they are, burned out and miserable.

Moving from long term care to med/surg to ICU to recovery has made me feel like a new grad so many times over I feel like I'll never become an expert at much of anything.

But.... I still keep trying to find my place and have learned a lot along the way that I take with me to each new area I work.

This is not to say that someone can't be happy working in LTC or med/surg floor nursing, because I've seen some that seem perfectly content where they are.

I'm referring to the ones who are burned out and miserable, but won't do anything about it and just try to make others around them miserable as well.

Tweety, BSN, RN · Mar 24, 2007

Good advice above. Hard work and a desire to advance your career will pay off. llg's point that it's not going to happen automatically is a good one. You have to want it, earn the qualifications and go after it. That's the bottom line for me.

Trauma Columnist · Mar 24, 2007

And I echo all the above posters: your advancement and opportunities for new adventures are not automatic, you earn them just like anything in life.

Good luck - really the sky is the limit.

I too started as an LPN, realized quickly that more education opened more doors, got my ADN, practiced for 8 years, the hospital went to Magnet status and I realized again I was limited, so went back to school for a BSN and then MSN and oops, realized that I didn't like management so went back to school for a clinical nurse specialist.

jenni82104 · Mar 30, 2007

Thank you all for your replies!

CRNA, DNSc · Mar 31, 2007

I can tell you that opportunities are what you make them. I started as an ADN-RN- worked Newborn nursery and then midnights L&D. Earned my BSN before the advent of online completion programs. Transfered to ICU for experience to earn my Masters in Anesthesia to become CRNA. Went on to earn a doctorate in Nursing- still teaching RNs to become CRNAs. Hard work, willingness to change and learn and not being afraid to give up some short-term perks for long-term accomplishments will create opportunities in directions you haven't even considered yet!!!!!!!!!!!!!!! Good Luck

incublissRN, BSN, RN · Apr 4, 2007

There is awesome advice in this thread! I graduated last May and worked on a cardiac medical unit. Hated it and switched to cardiac recovery 5 months later. Felt like I had just graduated all over again. It was a steep learning curve but after I made it to the top of the hill I had found my niche. I'm sure I will get tired of this eventually and switch to something else. I love learning though and am willing to work hard to get to where I want to go.

Amaind · Apr 6, 2007

I am very glad to have found this thread. I am a student and will graduate with my BSN in exactly a month. I have an interest in Pediatric nursing and have been offered a very nice position with a very reputable children's hospital in Indianapolis. My worry is that once I get into the job I will find that it really isn't for me and that it will be difficult to transition back to adult care. It's all very confusing. As a new grad, I find that there are so many opportunities that I want to try them all!!! I truly enjoyed almost all of my clinical experiences with the exception of maybe one or two.

Has anyone here transitioned from pediatrics to adult care? I'd love some input? I too have the fear of becoming pigeonholed.

Thanks!