How did you decide your specialty?

A little background information: I am a second degree BSN student and I graduate in December of this year. I have been thinking a lot about what kind of jobs to apply for since graduation is around the corner. So far, I have done my ob (L&D) and post partum rotations. I work one on one with a preceptor on a cario/neuro critical care unit and have so far worked with her around 250 hours. I will be with her another 225 hours this summer and then again in the fall. I will do my peds and psych rotations in July. We will also get a chance to do a rotation or two in the ER and ICU as well once we take the acute care class in the fall.

Having said all that, I still don't know where I belong. I LOVED labor and delivery but I also love critical care. Should I just bite the bullet and apply for anything and everything for new grads? I know that new grads have some fierce competition and that beggars can't be choosers but I want to be happy where I work (who doesn't?). I am in the Dallas/Ft. Worth area if that matters.

I knew that I wanted to work critical care after graduation and was in neuro ICU in my last year of nursing school. I made good connections and got hired for the unit right out of school - I was a paramedic before I became a nurse and perhaps that helped in some way.

I worked critical care/ICU for almost 10 years and have worked in other areas since including med/surg tele, dialysis, palliative/hospice. I am somewhat adventurous and never considered staying in one spot for longer than 2 years and applied to job I though would interest me.

My advice for a new graduate is to apply to a variety if positions/places as it is very competitive. If you want critical care - there are now some residency programs that hire new grads for those areas without prior med/surg experience. While some are successful, others are overwhelmed. I do not think a nurse has to have 1 or 2 y of med/surg to be happy and successful as a nurse.

I "knew" I wanted critical care, but after first year horrendous experience there (yes, NETY) I found myself working agency in med/surg, ICU, LTC and LTAC, all at the same time. I always loved med/surg, and also always had lingering interest in where all these folks still on vents go after they got off drips. In addition, I wanted a place where I could have way more authonomy and could apply my assessment and clinical knowledge, both being just too good for just too many in my previous jobs. Ridiculously, I found them accepted and sought after in LTC and LTACH much more than in acute. I was wobbling about for a while, then joined LTACH because of high acuity. It is med/surg on steroids, but it suits me perfectly well.

It is ok to want one specialty above others, but IMHO it is more important while in school to figure out where you will not work unless facing your child starving. After that, just be open to opportunities. Even BSN programs do not expose students to 95% of what nursing can offer, sometimes right away from school if you have right previous experience. You are developing as a nurse and person, and just cannot know what your interests/personal needs might be in these proverbial 5 years after school. Seek options to do what you think you will like, but be ready to compromice and do not fix yourself on one option only.

It was the unit that offered me a job. And so few actually enjoy psych patients and individuals with addiction issues that I feel it would be a disservice to leave.

I kind of fell into it. I had interviewed for a few med/surg jobs, but one of my clinical instructors who was part-time took a job as DON at a LTC facility that was looking for an RN for the rehab side (they had just renovated it to accommodate an ortho sx doing joint replacements). I have a long orthopedic hx myself so it was a good fit. About 9 months into it, I discovered a nurse residency position (I was less than a year out of school, so considered a new grad still) in ortho at my dream hospital. The experience I had in ortho gave me a huge advantage and I got the job. I have been there almost 3 1/2 years now and LOVE it.

I was working as an agency LPN, going into various nursing homes, most were hideous and depressing. I needed a better way! Surely there was a better way! Lord pleeeeease show me a better way to make a living than the 16-hour shifts in these whatchamacallits! Then one day, I went to collect my paycheck at the office. The agency admin was desperate for a Med-surg nurse. As I walked past the door, she yelled my name: -----!!! You're Med-surg, aren't you? Am I med-surg?? What kind of question is that?! Of course I am!! You better believe it!! (At the time, I vaguely recalled the terminology, but how else was I going to get the experience? So, I lied. Hey, I didn't kill anybody while I faked it til I made it;)). Been in Med-surg ever since, except for this last year on the regulatory side.

***Do NOT try this at home, folks!! Those were easier times way back then. Nursing has mutated since then! Wait for the offer to be trained!

I found out that I sucked at ICU so I went back to the ER.

For me, it was all about where I felt like I fit in. I never expected to be a pediatric nurse. I actually started this journey sure I would work in adult oncology, or hospice. Took me just a few shifts of clinical in a children's hospital to realize that this was what I was made for. Pediatrics. I love it. :) Good luck!

I started out med/surg.....loved to float so I was exposed to everything from ER to L&D to a locked psych facility. I make my self sound like super nurse! "Fake it till you make it," can be a useful philosophy! (No patients were harmed.) My speciality became out patient surgery because DUH, no nights, no weekends, no holidays.

Every in-house unit I floated to would enter the back of my mind as, "maybe it'd be fun to work here?" There is good and bad to every speciality.

For myself, I loved oncology. That never changed. When I graduated I applied to all various types of positions. Of course oncology was number one but I didn't only apply to oncology positions. I did like L&D, ER, and psych so I applied to positions in those areas too if I was qualified. I also applied to med/surg positions although this wasn't my favorite I knew it would provide a good foundation. Luckily, I got the best of both worlds...a med/surg/oncology unit!

I think a safe bet is to of course aim for those L&D positions but also apply to other units that you like or can tolerate working in for at least a year or two. That way you broaden your chances of landing a job sooner! Hope this helps!

So, a couple of strategies from a current NICU nurse:

1. Shadow if at all possible. In theory, I thought I'd love adult ICU nursing (high level critical thinking, low patient ratios, etc.) It took about two shifts in adult critical care for me to realize that it was not for me. Shadowing allows you to see what nurses within a unit actually do, unlike in school where you learn the theories/patho behind what its done. For example, part of adult ICU is vented patients with code browns--you teachers aren't talking about that when they're discussing ARDS and vent settings.

2. Similarly, you have to think about what you really enjoy doing, what what you don't. I volunteered in an ED where I enjoyed the pace (sometimes slower, sometimes totally crazy) and loved the patho behind all of the cases; I considered ED. However, I've since discovered that even though I like ED in theory, I get really stressed out when I can't start my shift with a definitive schedule and game plan for the day. Therefore, ED probably wouldn't be a good fit for me. Figuring out what you really do an don't enjoy in a professional setting is a process, and it requires some self-reflection. Think about what events in clinical made you happiest, what made you miserable, and most importantly why.

3. Talk to nurses in those specialties. Find out what they love about their jobs, what they hate, and why. I first began looking into NICU because I heard so many awesome things from NICU nurses. Nearly every NICU nurse I met told me "I love this job, I can't imagine doing anything else, and I want to be doing this until the day I retire." The main reason I found people leaving the NICU was because of burnout due to management and unit politics, not the nature of the nursing care.

4. Research. I literally used academic databases to look up journal articles on nursing satisfaction in various specialties, the exact same way you look up articles to write a paper. There are hundreds, if not thousands, of papers on nursing burnout, including papers that look at job satisfaction and burnout by specialty. I think I found the ones I used via Google Scholar. You should be able to access them through your campus network if your school pays for access to the journal article databases, and a handful are free to anyone online. Evidence-based practice, anyone?

Of course I have a bias, but I think you might enjoy NICU. You get the joy/satisfaction of seeing new families achieve milestones together, along with awesome elements of ICU (high level skills, critical thinking, low patient ratio). Unlike in L&D, where soon after birth the couplets are whisked away, you get to care for, nurture, and bond with families over days, weeks, and even months. You can take care of a tiny 2 lb peanut, and four months later experience the joyous 'victory lap' around the unit before the family takes their healthy NICU graduate out the door and into the world. It is also pretty easy to get cross-trained in L&D and NICU (since they generally get floated to one another), so you can have the best of both worlds. But like I said, I'm pretty biased because I absolutely love NICU nursing.