How to find your niche?

[lifelong]

I am confused and a little nervous. My ACNP director has mentioned to think through where I want my last clinical to be...in hopes of landing a job. Right now, I am not sure where I want to land, but trauma, hospitalist and neuro are high on my list. I just finished a hospitalist rotation and loved it although I am pretty sure they will offer 75-80K when I get out (most hospitalist/NP are employees of hosp in my neck of the woods and have little negotiating power-not sure why). I made 82K last year as a bedside RN (22 yrs. exp).

My next clinical is with infectious disease (hosp & office) and my third clinical is with Neurology which is fine however, it's mostly outpatient, I have never worked outpatient before. So I am a little nervous about going there. Although, the offices is 10 mins from my house and having no travel would be oh so nice. I think this gal's pretty cool, so I might have a great experience coupled with less hassle.

My problem is right now I don't know what/where I want to work after graduation. Everyone I talk to says "it will come to me" or "my clinicals will help with that". It's not happening like that and I find it frustrating.

I still have 5 months to go, certification exams and feel pressured into thinking where I want to work. Heck, I am trying to wrap my arms around my final coming up and starting round two of pain - next quarter. I've looked for books about finding a niche, parachute colors all that stuff...but no luck and the Divine Intervention I was hoping for is letting me down at the moment in that category. I guess She's working on my others areas.

I need strategies besides my clinicals to determine how to find where my niche is. I have only worked ICU in a hospital setting, I did a little stent in LTC as an educator (didn't care for it), and Home care (during a transition period in my life - thought life was greener). Other than that...it's been ICU in the hospital (SICU, CVICU, Neuro ICU). I am 42 and can pass the adrenaline baton on easily.

My wish list would include: no weekends/holidays/call...so does that mean I have to do office work? Does that eliminate me from trauma/hospitalist/neuro, I don't know. I mean it's a wish list right? I could work them...I just prefer not....but doesn't mean I won't or wouldn't consider it.

I know I like a variety of things (range of diagnosis, tasks such as rounding, OR, procedures)...and toyed with getting a First Assist after graduation.

Any of you guys go through this, what processes did you go through, any thoughts about how I can proceed? It's exhausting thinking about this without some objectivity. Thank you for any suggestions.

[traumaRUs, MSN, APRN]

Gosh - I was right there when I graduated 2 years ago with an adult health CNS. My nursing experience is all ER except for 2 years in ICU. Most of my clinical time was spent in the ER where I worked and a surgical practice. I had great experiences both places. However, the surgical practice didn't have openings and the ER Medical Director didn't want mid-levels (I knew this going into clinicals). I ended up in a nephrology practice. Is it my niche? No - I like my job but don't love it. However, for now it pays the bills and I'm getting some great experience. I do have call once per month on the weekend for 12 hours on Sat and 12 hours Sunday. Call is kinda a misnomer too - I have to round on our hospitalized pts at two hospitals 55 miles from home. (Fortunately, I get mileage).

I'm also starting a second job in August - 2 days a week for a total of 8 hours in occ health at a large foundry. So...I am exploring other options.

My advice? Get the most varied experience in school that you can. However, don't count on getting the job of your life from that experience. Just like when you first became a nurse: there is no problem changing jobs if you find that its not a good fit.

Good luck.