How Do I Change Specialties?

[JunkFoodJunkie]

Morning! Long time lurker, here. I'd appreciate some feedback from this amazing community. To;dr: How do I change my specialty?

I have been working home hospice as a case manager for about a year and a half and have year of acute care (tele/med-surg) experience prior to this. Though I absolutely love my patients & families and feel the work I do is important (minus the endless paperwork, ugh!), I cannot stop looking at job sites and dreaming of another specialty.The fact is, as much as I enjoy what I do, I can not see myself doing this full time for the rest of my working life. I'm also fearful that I've lost so much knowledge and skills (though I've gained "soft" skills) that I will have a difficult time transitioning back to acute care when it's time.

I always felt I would thrive in an emergency department, or would find the focus in an ICU stimulating and have been applying for positions along these lines that either offer a training program or don't specifically ask for in specialty experience. I have received one phone interview where the interviewer determined I did not have the required experience, but encouraged me to apply for a Tele position to gain more floor time. I did so, and followed up with a thank you email to the recruiter.

What types of certifications, classes, memberships should I be pursuing in order to be considered with no direct experience? I have BLS and NIH, but hate to spend the $$$ on ACLS and PALS if an employer offers them, kwim? Other than autonomy, pt education, follow through, and problem anticipation what skills can I highlight to let recruiters know that I haven't been resting on my laurels forever? Any other suggestions?

[TheCommuter, BSN, RN]

Since you are interested in the ER and/or critical care, my advice is to start in another area of the hospital that is somewhat 'easier' to be hired into, such as med/surg, telemetry, stepdown, or progressive care.

Work in one of these areas for a year before attempting to transfer to the ICU or ER. During that year, attain certifications for ACLS/PALS on the hospital's dime.

Good luck to you.

[nutella, MSN, RN]

I think it will be difficult to get hired directly into ER or ICU - the pace in hospice or home hospice is very differently (though the documentation part very overwhelming at a lot of places...) plus not all hospice places operate the same. When I worked as a hospice and palliative CM I maintained all skills and even expanded somewhat - but this is due to the fact that the agency combined palliative with hospice care, giving me a lot of room for all my skills.

I think the suggestion to go to med/surg first is a good one. You can brush up on skill you have not learned or you have not mastered fully. At the same time you get a feeling for the hospital.

[JunkFoodJunkie]

That's not what I was hoping to hear. :-(

I'll just keep applying and crossing my fingers for the ones that look like they provide training. I'll also keep applying for Tele.

Once I'm back in the hospital, how do I go about letting the ED know I'm for them, without upsetting the unit that hires me? Any certs I should work on while I get my additional year of bedside to show interest and self-learning toward my goals?

[ED Nurse, RN]

That's not what I was hoping to hear. :-(

I'll just keep applying and crossing my fingers for the ones that look like they provide training. I'll also keep applying for Tele.

Once I'm back in the hospital, how do I go about letting the ED know I'm for them, without upsetting the unit that hires me? Any certs I should work on while I get my additional year of bedside to show interest and self-learning toward my goals?

If you want to do ER or ICU, you need ACLS. I wouldn't pursue your CEN or CCRN with no practical experience- what's the point? You can keep applying or do what other suggestion and work in another area of the hospital- you can't always start out where you want.

[nutella, MSN, RN]

Look at your resume critically and see if it is written in a way that sticks out and shows your skills pertaining to ER/ICU nursing. Also, a well written dynamic cover letter is helpful!

If you go to med/surg first, do not tell them that your goal is ER - the manager will not be interested in training you if you do not want to stay. Other nurses may not react favorable to your desire to leave that floor asap. I would not reveal that your dream is critical care or ER and focus on getting a handle on floor nursing. Make sure you can handle high acuity and fast pace without losing it, being discouraged, or complaining because all of that will backfire when you apply to transfer to ER or ICU.

Not all hospitals will pay for you to go for ACLS - if they are already full with all the other nurses who need it for their position. You can do it outside of the hospital with an ACLS approved provider (AHA) but you would have to pay for it. I did ACLS through my employer but later on when I switched to acute dialysis had to pay privately to get re-cert. I still did it because it made me more marketable plus I felt that this was a great skill to have.

When you work in med/surg and your hospital offers IV certification or similar, that may be helpful. But it is really your reputation that will be the strongest predictor in getting to a different area. Be pleasant under stress, collaborate well, play nicely all around ...

Good luck!

[JunkFoodJunkie]

Thanks for the advice. I'll keep applying and plan for another year bedside.

[TheCommuter, BSN, RN]

I'd appreciate some feedback from this amazing community. To;dr: How do I change my specialty?

We moved your thread to our Nursing Career Advice forum with the goal of amassing more replies.