Mid-forties : Looking for a Specialty to Grow Old In

[Nurse Beth]

Hi Nurse Beth,

I am in my mid-40's and only have 6 years of nursing experience which is mostly in acute care. I am thinking about my future a lot, especially my old-age, but would like to go into a specialization which I could grow old in. Knowing that I am not getting younger, and is fairly new to the field, I would like to make sure that the area I would be choosing is a best fit for me. Which area do you think is advisable for me to go into considering my age and the background I have? I am thinking of signing up for a continuing education opportunity either in ICU, Nephrology or High Acuity Nursing. What other factors do you think I should consider in choosing right?

Thanks very much!

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Dear mid-forties,

It's wise to be considering your options now. Here's some ideas, maybe you'll see something that appeals to you.

I see a lot of mature nurses going into Case Management. It's 0900-1700, mostly weekdays. There's Infection Prevention, and Informatics. I'm mentioning non-bedside roles as down the road you may want a less physical job.

Telephonic nursing is a new, growing field.

Dialysis still gives you patient contact, but it's not as demanding as typical bedside nursing. There's pre-op or admission nursing, where you interview patients before surgery, and provide patient education. GI Lab, interventional nursing, any kind of clinic work can also provide patient contact but is not quite as heavy as floor work.

How do you feel about nursing management? It's not physical, but it is stressful. Every hospital has a Palliative Care nurse (or more), and there's Quality and Risk Management. House Supervisor can be a great, challenging role if you're cut out for it.

Your choice depends on your educational level (the higher, the more options), your skills and passions, and the opportunities available to you.

Best of luck. I hope I got the brainstorming started for you!

Nurse Beth

[tinyonern]

Be very, very careful if you go the insurance company route. It isn't physically taxing, but mentally it can be so stressful!! There were quotas, time constraints and an overall horrible work environment. This was at one of the largest companies. There were about 15 people in my group, and last I heard, only one or two were still with the company. Everyone else had quit to go elsewhere. Several "quit" under severe duress. Several of my friends went to another company and are very happy.

I loved in-pt. psych, but it can be physically taxing and dangerous.

12 hr shifts in general can be hard on your body (although I know lots of people who like them).

Best advice I can give, no matter what you chose to do, is keep yourself in good shape, and do what you can to stay in good health. Good luck!

[PANYNP]

When students have asked for advice about switching specialities, I've suggested that they find a 1-day conference or refresher in an area in which they are interested, and "go native".

Act as though you belong, and you may pick up nuances about the specialty, even if you don't at first understand all the jargon.

Many years ago I did this when I was considering a physical mobility-driven change from Adult ICU to NICU.

I learned just enough at the NICU conference to frighten myself back into my own comfort zone.

A few years later, I tried this approach with a palliative care conference, and found a new home.

[Mr Pitstop]

This is exactly the topic I have been looking for. My comment is long, but I would really appreciate some input. I posted it in another area; Nursing Student, so I will post it here. Thanks in advance.

Hello all, I am fairly new to the site and this is the first thread I have posted. In fact I am new to nursing, which leads to my topic. I am asking for input about two separate nursing disciplines, which I have been offered a position. I appreciate your reading this and giving your input since it is a long comment.

After graduating as an RN in the AAS program (Associates Degree) and passing my NCLEX, I am working in a nursing home setting as a charge nurse. I hate it! Be that as it may. I have been offered two new positions:

The first is as a Reassessment Nurse for a reputable health insurance company. Let me be clear, this is NOT a home healthcare nurse position. What it entails is performing UAS Assessments for New York State, at the patient's home, and can be described as assessing whether or not a home care patient's needs are being met, for instance; whether the caretaker is able to efficiently care for the patient; if there is food in the house; is there heat, air conditioning, adequate leisure, sleeping arrangements; if the environment is infested with bugs or rodents; the stage of disease, illness or pressure ulcer; are the meds being distributed properly and timely; the performance of the home healthcare nurse...and assessment in that nature. It also includes 6 month follow-ups (follow up from hospital discharge) and assessing whether a patient should be placed in a nursing home (LT) as well as collaborating with all other disciplines to propagate a stable plan of care. A boat load of computer work.

There is no detail that includes IV therapy, catheters, wound care, enemas etc., in fact, there is no need for a stethoscope. Here's the pros and cons from my perspective:

Pros: Wear regular clothes, 9-5 Monday thru Friday weekends off; starting salary 81,000/year ($40.00/hr) plus overtime (time and 1/2; $60.00/hr) after 11 cases per week; full benefits with moderate cotribution, 401k (company matches up to 6%), PTO (paid time off) 29 days per year; 3 to 5% pay increase per year available; bonuses for exemplary performance.

Cons: Travel time and expense; I live on Long Island (Suffolk County, Long Island is the only place in the world you live ON and not in) and cases are primarily in the 5 boroughs, office is in Manhattan, near WTC 19th floor (Tribeca);The company will pay for all travel occurring after the first case and until the last including tolls and MTA card, so getting to and from my home care cases or to the office is on me (approximately $3,500 per year); hard to continue BSN program (unable to get "clinical classes" in, can possibly use my PTO), 9-5 M-F and only leaves weekends for extra work to repair limousines and transmission overhauls (extra 30k/year) or, for instance, take on a job at a doctor's office; NO hospital experience what-so-ever.

The other position is as a med-surg nurse on a telemetry floor at a prominent university hospital, the same at which I attend school. I don't think I need to explain the position detail, you know what it entails. Pros and cons:

Pros: Hospital position, 3 and 4 day work weeks (80hrs per 2 weeks); easy to finish school; no travel time, I live literally 2 miles away; overtime available at time and a half (extra day per week); night position 7pm-7am, time to work another job (not much time to sleep, though).

Cons: Less pay, base pay $77,000/year ($37.00/hr); must work every other weekend; vacations are given as per seniority (which means my vacation will be in November or February); 6-8 sick days per year, 3 week vacations but not consecutive (so the same as above); health insurance comes from the ACA Exchange, so it costs a lot with a high deductible; and anybody who is a med-surge nurse knows what a *******' pain in the ass it is! No need to elaborate.

So that is the deal. I am fortunate to have two positions available after having NO positions available for some time. Many of these may be seen as pros and not cons or vise-versa. There is one more caveat, I am no spring chicken. After working for 25 years in the automotive business as a technician, humping cylinder heads and automatic transmissions, I have successfully reached the age of 48. I am in very good physical shape but I don't know if I have 20 years of med-surge in me; the reassessment nurse position has potential for management positions, so I thought I might just add that.

Any input will be appreciated and I am anxious to hear about your own experiences. Until then...Fuhgeddaboudit

[Terridts]

Please help...I am so confused. I am 46 and will be graduating with an ADN in 9 weeks. My focus thus far has been hospice; however, at this point I am totally confused since other areas interest me as well. I completed 2 years into a BS in Psychology prior to switching to nursing, thus I am very interested in the social work component. I am fairly healthy and strong, but I'm definitely feeling my age in my joints at times. I really don't know which area to pursue. I am drawn to Hospice, pediatrics and psych. Any feedback would be extremely helpful and appreciated!