Nursing career options and specializations
Introduction to nursing
Although nursing is a well-paying, in-demand position, the people who go into this field usually do so for altruistic reasons. They enjoy helping people overcome illnesses or injuries and have often had a caring personality since childhood. Although everyone who pursues a career in nursing is a unique individual, the field tends to attract people with similar values and skills.
Who is an ideal nursing candidate?
People who value relationships with coworkers, patients, and patients’ family members are likely to find satisfaction working as a nurse. Nurses work in high-pressure environments with rapidly changing priorities. Such environments can be stressful, and lack of proper support can lead to caregiver burnout.
Nurses typically value community, service, and the opportunity to work as part of a larger support team.
Nurse typically value community, service, and the opportunity to work as part of a larger support team. Their success relies on cooperation and support from both coworkers and management, with all parties holding each other to exacting standards.
Skills and personal attributes of nurses
Attention to detail is one of the most important attributes a nurse can possess. Patients rely on nurses to give them the right medication, provide important updates to their doctors, and keep them comfortable. Nurses who fail to be accurate and thorough in their work can literally put patients’ lives at risk. Double-checking their work and asking for clarification are some of the ways nurses prioritize patient safety.
The ability to cooperate with a patient’s care team and prioritize patient wellness are critical for success in this field. A nurse in a chronically bad mood creates an unpleasant atmosphere for both patients and coworkers. The ability to remain upbeat and friendly regardless of the situation are therefore key.
A keen sense of ethics and personal integrity are additional attributes nurses should possess, since the job puts both skills to the test.
A keen sense of ethics and personal integrity are additional attributes nurses should possess, since the job puts both skills to the test. For example, a patient may ask their nurse not to share details about their condition with family members. Nurses in this situation need to honor that request regardless of how much pressure the patient’s family members apply.
The profession can put nurses in ethical dilemmas, such as deciding which patient to treat first. Fortunately, nursing school teaches future nurses how to triage patients based on who presents the greatest need.
People considering a career in nursing can expect to be on their feet most of the time. Stress and criticism may also be regular parts of the job. People are rarely on their best behavior when sick, especially those dealing with significant pain or anxiety. Nurses cope with mistreatment from patients without allowing it to affect the quality of care they provide.
What type of people make good nurses?
Nursing typically attracts more extroverted than introverted people, which can make the social aspects of the job easier for them. Common examples of social interactions include teaching patients how to care for themselves at home, communicating with patients about their symptoms, and discussing patient care with other nurses, doctors, and family members. Effective communication skills are also essential when helping patients. People with extroverted personalities tend to thrive on the constant social contact integral to nursing.
Nurses often have an inborn sense of curiosity and the drive to investigate until they arrive at solutions. For example, a nurse practitioner treating a patient with diabetes who is not responding to any of the usual medications to reduce blood sugar may take it upon themselves to search for alternatives. That sense of urgency, coupled with a solutions-oriented personality, serves nurses well.
Nursing pathways
Nursing offers multiple opportunities, from providing basic care as a nursing assistant to conducting in-depth research at the Ph.D. level. A common strategy among new nurses is to earn the minimum educational credential and then accept an entry-level healthcare position.
Taking this approach allows them to work for a while to see if nursing is indeed a good fit. Thanks to the flexibility of most nursing schedules, it is usually possible for nurses to continue working while they return to school to earn more advanced credentials. Combining work with school is definitely manageable, especially when students choose to complete most of their program online.
Certified nursing assistant (CNA)
A certified nursing assistant provides basic patient care, which includes helping patients with activities of daily living. They rarely provide any direct medical care because of their limited training. Approximately 78% of CNAs work in hospitals. Like nurses, CNAs spend most of a shift on their feet.
Total employment
1,450,960
Projected growth (2018-2028)
8.9%
Degree required
High school diploma or GED
The role
A CNA can expect to perform the following duties:
- assisting patients with eating or drinking
- recording the daily amount of food and drink a patient consumes and outputs of urine and fecal matter; reporting significant changes to the supervising doctor or nurse
- repositioning or turning patients who are bedridden to prevent bedsores and blood clots
- assisting patients with using the bathroom, dressing, bathing, exercising, and other activities of daily living
- ensuring that patients take daily prescribed medication and nutritional supplements
- making sure patients receive appropriate daily menu items by reviewing their food allergies, dietary restrictions, and personal preferences
- observing and documenting patient behavior and reporting any concerning changes to the supervising doctor or nurse
- responding to patients who summon the CNA using their call light
How to become
Most states require nursing assistants to complete an approved course and pass an exam before becoming official certified nursing assistants. Upon certification, a CNA’s name is listed on the state’s registry. Although CNAs do not need a license, their name must appear on the state registry before they can accept their first position.
CNA training courses are typically short, with most programs lasting 6 weeks or less. Many long-term care homes offer training as part of an employment offer. People interested in becoming a CNA may also be able to find a low-cost course through their local Red Cross.
Licensed practical nurse or licensed vocational nurse (LPN, LVN)
A licensed practical nurse (LPN) or licensed vocational nurse (LVN) provides basic medical care to patients under the direct supervision of a registered nurse (RN).
Total employment
676,440
Projected growth (2018-2028)
10.7%
Degree required
Postsecondary nondegree
The role
Examples of common duties performed by someone in this position include:
- observing and recording patient behavior and medical conditions; reporting worsening symptoms or an unexpected reaction to medication to the supervising RN
- working as an essential part of care teams to assess patient needs and provide the most appropriate interventions
- recording patient vital signs, including weight, height, blood pressure, body temperature, respiration, and pulse
- supervising CNAs
- completing basic patient care tasks, such as treating bedsores, setting up a catheterization, changing wound dressing, and obtaining body temperature
LPNs may also complete some of the following duties, depending on the level of education they have received:
- reinforcing instructions given by a registered nurse regarding how a patient should be cared for at home by family members
- answering basic questions from patients and family members about the patient’s medical condition
- feeding and caring for infants
- collecting blood, urine, or other types of body fluid for laboratory samples and delivering them to the appropriate person for processing
- feeding patients who cannot feed themselves due to an illness or injury
How to become
LPNs and LVNs must complete an accredited post-secondary education program. Most community and technical colleges offer these programs, which generally take a year to complete. Before practical nursing students can accept employment, they must pass the National Council Licensure Examination for Practical Nurses (NCLEX-PN). Some practical nurses choose to earn certification in a specialty area, such as intravenous (IV) therapy.
With minimal education requirements to complete, CNAs can begin working within a few months and LPNs or LVNs can accept their first nursing position less than a year after starting their training. Those who decide to pursue education as a registered nurse (RN) may be able to transfer credits earned in a career training program to a 2-year or 4-year degree.
Registered nurses
Registered nurses work under the supervision of the patient’s physician to coordinate and deliver their care. They are often the first point of contact for family members, and they are instrumental in providing patients with instruction on managing their injury or health concerns at home.
Total employment
2,986,500
Projected growth (2018-2028)
12.1%
Degree required
Associates or bachelor’s
The role
- supervising LPNs, CNAs, and other healthcare personnel with fewer credentials
- consulting with other members of a patient’s care team and coordinating duties
- helping patients prepare for medical tests or surgery
- adjusting treatment plans based on how the patient responded to previous interventions
- monitoring patients’ diet, physical activity, and medication schedules
- taking vital signs and administering medication
- helping doctors and testing technicians perform diagnostic tests
- helping perform diagnostic tests such as MRIs or blood tests
- monitoring and operating several types of medical equipment, e.g., heart rate monitors
How to become
RNs must complete a minimum of an associate degree in nursing (ADN), although healthcare employers are increasingly requiring a bachelor’s degree for entry-level RN vacancies. After earning their degree, nursing students must pass the NCLEX-RN exam before they can start working. Depending on the employer and position offered, they may also need certification in basic life support or cardiopulmonary resuscitation (CPR). Nursing students can expect to study anatomy, microbiology, physiology, and social and behavioral science in addition to accruing hours under clinical supervision.
Transition programs
Current nurses who have an associate degree and would like to earn a bachelor’s degree should look for schools that offer accredited RN-to-BSN (bachelor of science in nursing) transition programs. The average timeframe to complete a transition program is 1 to 2 years. Transition programs focus on teaching students additional skills and do not spend a lot of time on general nursing education.
Not only are RNs with a bachelor’s degree in much higher demand, but they can also expect to earn a significantly higher salary. According to the American Association of Colleges of Nursing, nurses with a 4-year degree earn an average of $15,000 more per year than nurses with a 2-year degree. Nurses who want to specialize in a specific treatment area or transition to academic research usually earn advanced nursing credentials first.
Advanced nursing
Nurses who want to practice advanced medicine or focus on a specialty area need a master’s degree and additional credentials. There are various RN to MSN education programs which cater to working RNs. Exam requirements and certifications vary by state and specialty. The most common specialties among healthcare professionals with the Advanced Practice Registered Nurse (APRN) credential are nurse practitioner, nurse anesthetist, nurse midwife, and clinical nurse specialist.
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Nurse practitioner
Median salary: $118KSee moreNurse practitioners (NPs) diagnose and treat chronic or acute illness, either independently or as a member of a healthcare team. Many NPs focus on nutrition and lifestyle choices to help patients avoid disease. These professionals can diagnose and treat disease, prescribe medication, and interpret diagnostic testing. Depending on the state, NPs are beginning to replace physicians in primary care settings.
RNs who want to become a nurse practitioner need an active nursing license and complete a graduate degree program accredited by a national agency like the Accreditation Commission for Education in Nursing. NPs also need to pass a certification exam accredited by the Accreditation Board of Specialty Nursing Certification and the National Commission for Certifying Agencies.
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Median salary: $161KSee more
Nurses in this role administer anesthesia to patients about to have surgery. They also monitor patients’ vital signs while under anesthesia and supervise their recovery. Nurse anesthetists may work with doctors, dentists, surgeons, or anesthesiologists. According to the American Association of Nurse Anesthetists (AANA), healthcare providers in this role need the following qualifications before they can practice:
- bachelor’s degree in nursing
- minimum 1 year full-time experience working as a registered nurse in a critical care setting
- master’s degree in nurse anesthesiology from a school accredited by the Council on Accreditation of Nurse Anesthesia Accreditation Programs
- passing score on the Nurse Anesthesia National Certification Examination
Some nurse anesthetists choose to earn certification in a specialty area, such as chronic pain management. Private physicians hire the most nurse anesthetists, followed by hospitals and outpatient care centers.
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Nurse midwife
Median salary: $98KSee moreSome people have the mistaken belief that nurse midwives only work with pregnant women. The reality is that these specialty nurses work with female patients starting in their adolescent years and care for them past menopause. Some specific duties of nurse midwives include:
- caring for newborns
- offering gynecological and family planning services
- providing pre-conception care
- caring for women in postpartum recovery
- treating male partners with a sexually transmitted disease
- supporting women in labor
Nurse midwives can prescribe medication and diagnose and treat disease. Like many advanced practice nurses, nurse midwives tend to focus on wellness and preventive medicine more than treating existing health conditions. After earning a graduate degree, nurse midwives are required to pass an exam administered by the American Midwifery Certification Board. The board also recommends that people interested in training for this career enroll in a school accredited by the Accreditation Commission for Midwifery Education.
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Median salary: $92KSee more
Clinical nurse specialists have advanced training that allows them to diagnose, treat, and manage patients on an ongoing basis. These nurses provide direct bedside care, implement evidence-based interventions, and help drive organizational change.
Licensing requirements and laws regarding how clinical nurse specialists can practice vary by state. Clinical nurse specialists who choose to earn certification pursue a specialty area based on the top healthcare needs of the population they serve. Common examples include geriatrics, pediatrics, and neonatal intensive care.
People interested in training for this career can learn more about the education and experience requirements of their state at the National Association of Clinical Nurse Specialists.
Additional specializations
Below are brief explanations of 6 other types of advanced nursing practice available to nurses aiming to expand their practice:
Travel nurse
Travel nurses complete temporary nursing assignments in areas that have the greatest need. For example, a travel nurse may temporarily relocate to an area recently affected by a natural disaster.
Pediatric nurse
These specialty nurses work exclusively with patients from birth up to age 18. Pediatric nurses work in a wide range of settings and are responsible for teaching patients and their families about caring for health conditions at home.
Obstetrics and gynecology nurse
OB-GYN nurses care for women throughout the duration of their pregnancy while also assisting them with sexual wellness and reproductive health. These types of nurses also support women during childbirth.
Labor and delivery nurse
Labor and delivery nurses remain with pregnant women throughout labor, delivery, and the postpartum period. These nurses act as a go-between for new mothers and the rest of the medical staff. They spend more time with pregnant women and women in labor than any other type of nurse.
Neonatal and intensive care nurses
Neonatal nurses care for healthy newborns, moderately ill or premature babies, and those requiring extensive medical intervention.
Hospice nurse
Nurses with this specialty training work exclusively with patients who are dying or have a terminal illness. The main duty of hospice nurses is to keep their patients as comfortable as possible during their last weeks or months of life.
Conclusion
People and healthcare facilities cannot get by without nurses, which means people studying to receive nursing credentials should never have to worry about being out of a job. The high demand for nurses increases the starting wage employers are willing to pay. Nursing students can feel confident that they will receive an excellent return on investment when they choose this career.
Nurses play an instrumental role in helping patients recover from injury or illness, making them an essential member of any healthcare team. If you are drawn to the medical field and want to make a direct impact on patients’ health, nursing could be the field for you.
There are numerous sites online which provide further information and guidance to a career in nursing. Some provide information on how to seek funding and financial aid, others provide tips on different types of schools.
Accreditation Commission for Education in Nursing
This is the site for the main body that provides accreditation for all levels of nursing programs across the U.S.
Commission on Collegiate Nursing Education
The site for national accreditation for degree-level nursing courses in the U.S.
National Council Licensure Examination
Website for the national licensure for RN qualification. Provides information on preparation and organization for examination.
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