Choosing a Specialty

TheCommuter, BSN, RN · Feb 25, 2016

I assessed my likes and dislikes. Then I proceeded from there. I like routine, calmness, predictability, and paperwork. I dislike high acuity, snap decisions, too many hands-on procedural skills, ADLs, and a chaotic pace.

Hence, I started my career in long-term care due to the low acuity, predictability, routinized environment, and mountains of charting. After several years I ended up in post-acute physical rehabilitation, which is lower acuity than acute care.

Now I'm in case management and couldn't be happier because it involves no ADLs or hands-on procedural skills.

nutella, MSN, RN · Feb 25, 2016

The other day, I was having a conversation with a girl who has just started nursing school. She is very excited about it, and already seems to be doing well. She has already begun thinking about what type of floors/nursing she would like to do. Although she really seems committed to becoming a NICU nurse one day, she also mentioned that a cardiac ICU and ED are also on her list. She talks about liking fast paced, exciting floors. I can honestly see her in any of these settings.
She seems like she has a lot to offer nursing, and to be completely honest, I'm a bit jealous. Having failed orientation on a cardiac PCU, I just don't know that a fast-paced floor is for me. In fact, I have no idea what would be a good fit for me. To me, I feel I have very limited options, in comparison to her. It's depressing knowing that I probably would not do well in any of the areas she's looking at. I don't see myself as an ICU nurse, since I did not do well in a PCU.
My question is...how do you decide which direction to go, when you have absolutely no idea what would be a good fit?

I think a lot is trial and error when you are a new nurse. If your problem is multitasking, pace, or perhaps your critical thinking skills are not as trained (yet) a less acute setting may be better.

It would be good to make a list of the things that were giving you problems and the things you were good with.

There is also a difference between major teaching hospital and community hospital or small specialized clinics.

There are so many areas - something will be for you.

Perhaps consider mental health nursing, med/surg without tele, office ... but you need to apply and find another nursing job. The longer you wait, the harder it will be to find something.

LadyFree28, BSN, LPN, RN · Feb 25, 2016

I didn't choose a specialty per se, a lot of times a specialty choose me; I have worked in:

LTC

Post-Acute/Acute Rehabilitation SCI, TBI, Trauma

Pediatric Private Duty Home Health/Hone Health Visits

Specialty Ambulatory Care

Medical Day Care

Pediatric Post-Acute Care

Pediatric Emergency (current setting)

...and a dash of PICU (2 months)

Each of the knowledge I built helped my nursing transcend specialties and helped me be able to tailor my ability to be flexible and knowledgable upon any encounter with a pt and their family; it has allowed me to be able to be a resource to the people that I take care of, and even then, I learn something new everyday. With my current reasoning, I think Emergency Nursing currently is a fit for me, but that came after years of working and learning my own practice.

When I got out of school the first time, I ended up taking the first job I could take-as a LPN; they stopped hiring them where I worked, so I kept an open mind where I would land. I ended up working in an Acute Rehab hospital and in Pediatric Private Duty Home Health. Both gave me the ability to think out of the box, advocate, educate, goal set and monitor progress and interventions related to my nursing care; I have dabbled in LTC, Ambulatory Specialty Care, which presented to me assessing without machines, managing goals in a timely manner, in addition to the qualities I listed prior-I used all those nursing aspects as well.

Once I began as an RN, it was like starting over again; I had new information and had to bridge those prospects together; as I mentioned on another thread of yours I didn't do well in an ICU setting-I dusted myself off and got the aspects of what I needed in order to be successful in a very acute environment; almost three years since my "non fit" in ICU, I'm thriving in a Level I Trauma PediER-I make snap decisions, can assess by the seat of my pants, teach, think outside the box, and have all the aspects that have helped me previously at the forefront of my practice-It takes time and experience, IMHO; not everyone out of the front gate can be place in a high paced setting; even with my experiences with SCI, TBI, vents, post-trauma, special needs kids, etc didn't mean anything until I could hone my practice to me and the knowledge that I have and begun to experience.

If you desire to become that ICU nurse someday, learn those basics...even if you start out in a "low-stress" environment; whatever that is, because anything dealing with sick pts, even in LTC, and even at a specialty ambulatory clinic is like manning a Med-Surg unit a lot of times without the advances in technology-only ones eyes, ears, and brain can put you on the path. Take what you need, and apply it to the next specialty wherever you find your fit...it will be to your advantage.

Best wishes.