How did you decide your specialty?

[Irish_Mist]

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.

[adventure_rn, MSN, NP]

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.

[NOADLS]

What pays the most and requires the least amount of work.

[Maevish, ASN, RN]

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

Hahaha! That made me laugh cause I did the same thing with ER. Hate it, but god bless an' all

I still don't think I've found my "area" yet, but ICU has been good to me over the years as has PACU, post partum, and oncology. Good thing about nursing is that, if people are willing to train you, you can do pretty much anything. I'm more type B so I don't do days in ICU (or anywhere) unless I'm staying over to be the resource nurse. Night people and their personalities suit me better. While I'm kind of over ICU, it's still interesting and there's always something new to learn (as in all areas of nursing) and since I'm a traveler I can't go to a floor I don't have a background in anyway.

Good luck! Sounds like you're getting more training than I did my whole first year (counting orientation!)!!

xo

[HeySis, BSN, RN]

I think the best thing about nursing is that by the time you retire, you may have accumulated several "specialties". Most high acuity areas it takes awhile to become competent, then it takes several more years to become an expert. (read a study that says you have to do a job for 5 years before you can really have seen it all and be an expert). But over a career of 40 years or more... you could become expert at many different things.

I also think that sometimes you don't decide your speciality. You just start, and if you don't like it you give it the proper amount if time and move on, eventually you'll find what you love for the time of your life you are in.... and that may change.

[Irish_Mist, BSN, RN]

Thank you, ALL of you, for the wonderful feedback. It has been very helpful! :)

[Irish_Mist, BSN, RN]

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'm actually of afraid of doing pediatrics. I LOVE kiddos so much that seeing them sick, abused or neglected would break my heart and I wouldn't handle it well emotionally. I am doing my pediatrics rotation at Children's Medical Center Dallas in July and I'm so nervous about it.

I know I wouldn't hate it. Don't get me wrong. I care a great deal about my patients but it is easier for me to "separate" myself with the adult ones.

[BSN16]

I like blood, guts, trauma. I originally wanted ER. but...between the 3 hospitals here there was ONE ER opening in the entire city. I didn't even get an interview. then i ended up in ICU :)

[whichone'spink, BSN, RN]

I fell into my current specialty by accident. I was just looking for a change because I was sick of working on a telemetry floor. Not because I didn't like the specialty, but because of other stuff like crappy schedules, short staffing etc. When I go this job, I took it mainly for the consistent set hours. I have come to like my current specialty for the most part. I think what I like most is the crowd control aspect and family visitation restriction. Major headache gone that way. I swear we must be one of the last hold outs that restrict visitation, and I hope it stays that way.

[bgxyrnf, MSN, RN]

I entered the field with every intention of becoming a NICU nurse. Every project that I did in nursing schools was directed toward infants and pediatrics.

However, when I graduated, I didn't have the latitude to be picky and I took the first job that was offered... working med-surg which was the last thing that I wanted to do. About a year into it, a position opened up in the ED and it was offered to me. Despite being unprepared, I accepted it

Over the years I have come to realize that the ED is the best place for me though I've been considering some specialty roles such as house resource nurse. Recently I started working in the ICU as well and I really don't care for it though I intend to continue on with it for the foreseeable future.

It turns out that working with kids is not my cup of tea. It's not that I'm not good at it or that it intimidates me, it's that it breaks my heart. It's easy for me to remain clinically detached with adults; it's very hard for me with children... especially since my own kid has had a variety of serious health issues.

[Wrench Party]

I like the heart and all the things that can possibly go wrong with it; so cardiology/cardiothoracic stepdown was a no-brainer. I love me some chest tubes and VADs. Also, my CT stepdown floor is the ???/*** overflow of the hospital, so we get everything from oncology, to medical, to cardiology, general surgery, renal, ortho/trauma, sickle cell crisis, milder neuro issues because we can handle:

drains/Woundvacs

epidurals

PCAs/PCEAs

protective precautions

PICC lines

all fun drips (pressors, heparin, insulin, nitro, Tikosyn, bivalirudin, Lasix, I'm sure I forgot others)

transplants

and on and on.

One night, I had a fresh lung transplant out of the ICU, an ortho/trauma dude pre-op for surgery who was under C-spine precautions, CHF'er on Lasix drip and a POD2 CABG with Woundvac, chest tubes, PCA, and some other attachments. Fun!

[NurseCard, ADN]

Thirteen years in as a nurse, and I don't even have one set specialty. I've done med surge, psych, long term care, home health, adult day care, and I'm getting ready to go back to med surge, full time!! It's been one adventure after another.

[A&Ox6, MSN, RN]

What pays the most and requires the least amount of work.

This is so you, NOADLS. I love that the persona is so consistent.