How do you Choose a Specialty?! Torn between CRNA and CNM.

[carmelite]

Hello!

I've been planning on eventually obtaining an advanced practice degree from the moment I began considering a nursing career, and have spent a ton of time trying to decide which specialty to pursue. At this point, I have 8 months left until I graduate from my ADN program, and I'd like to get some kind of handle on my goals.

Can anyone speak at all to how they made a decision about what they wanted to do, and whether or not they regretted that decision and why?

Have you all found that your personality type correlates with any particular career pretty closely?

I realize, BTW, that many would advise just practicing as an RN and feeling out different areas of nursing for several years. There are a few reasons that I'm in a bit of a hurry to specialize, but they basically all boil down to financial drivers.

Here's a little background on me:

I will be 35 years old when I graduate from my ADN program and will have at least $20,000 in school debt. I am a single mother to a 4 year old little boy, and my own mother (who is in her early 60's) was diagnosed three years ago with CIDP and is now disabled and requires financial support. I am lucky to be blessed with 3 amazing siblings who are helping me to get through school and will be contributing to supporting my mother, but I am determined to pay my family members back and be a source of support in my family rather than a drain on resources.

So, given the financial pressures, I feel it would behoove me to try to move pretty quickly into the area of nursing that I ultimately choose to specialize in. I know that many grad programs require RN experience in a certain area prior to admission, and I'd prefer to start getting that experience ASAP. In other words, I'm hoping not to hang out on med-surg for a few years before I get a job on L&D, ICU, ER, or whatever. I am a good student, and have maintained a GPA above 3.5 throughout my schooling, which leaves a lot of choices open to me. I am also currently working PRN as a CNA on a med-surg floor.

So, the two specialties that appeal to me the most, so far, are CNM and CRNA (although I've dabbled with the idea of working as an FNP in the ED or as a PNP at times). I have to admit that the major driver in my interest in CRNA is the financial and lifestyle benefits. My financial needs are pretty high (once again, family that needs support), and I loooove the idea of having abundance in that area for the first time in my life, and being able to help and give. I also really like the idea of having time to spend with my son and in pursuing other interests besides nursing, such as travel and reading and gardening. I've never been the kind of person who is happy focusing on only one thing for very long. I have a ton of interests and passions and am perennially curious. The advantage of a CRNA career, as I see it, is that I will have the time and money to pursue a life outside of work (after the requisite misery of finishing the brutal education, of course), which is very important to me. On the other hand, I feel bored every time I visit the OR. The pace is just too measured, and when I hear people describe CRNA work I feel no spark of interest. Monitoring a bunch of numbers and data is just not super stimulating to me. Then again, I suspect I may not really be seeing what makes this career so stimulating to so many people. CRNA's do have a really high job satisfaction rate, after all.

On the other hand, the most fun I've had in nursing school has been the time I've spent in the ER. I love the somewhat frenetic pace, the culture of teamwork, and the variety of experiences and skills required. I love interacting with different people and having to think on my feet. I even really enjoy encountering people who are high or experiencing psychiatric issues (thus the interest in PNP). My concern with working as an FNP in the ER is that the pay is lower and the hours are longer and there is less vacation than there is when working as a CRNA. In addition, I hear rumors of burnout, and I fear that the joy and stimulation I get from interacting with others may turn to bitterness over time if my workload is consistently too high. I have experienced some of this as a CNA. Initially I really loved working on a med-surg floor and getting to interact with all of the patients. These days, I drag myself in to work a lot of the time. It's just so hard to keep up with the workload and still provide good patient care. I end up being annoyed by the people that I used to feel compassion for.

The most fun I've had in class, so far, has been my OB classes, and becoming a CNM was actually my initial goal in pursuing a nursing degree. I loooove birth stories and videos, and can get myself all wound up about inappropriate cesarean rates and other OB issues. Discussing birth gives me all kinds of warm fuzzy feelings and feelings of passion. I love the idea of supporting women through pregnancy and delivery. I am about to start my OB clinical rotation too, so maybe that will give me a better idea of what it is like to actually work in that area. My fears around midwifery, though, are related to the heavy workloads that I hear can be common. I know myself well enough to realize that I won't be happy working more than 40 hours/week on a regular basis, and I have never been capable of sustaining sanity with any kind of routine sleep deprivation. I am a single mother as well, and want to be available for my son. I would have to try to find a Midwifery position that doesn't require too much call time, and I'm afraid that would limit my choices too severely.

So, any advice from CNM's or CRNA's? Or just general advice on making these choices?

Thank you!