How to Choose a Nursing Specialty

As healthcare grows complex, many nurses are deciding to focus their efforts on a particular area of nursing. We sat down with Cheryl Wagner, PhD, MSN/MBA, RN, for a Q&A session about the topic of nursing specializations.

Q: Why would – or should – nurses choose to specialize?

In healthcare today, there’s just so much to know that one person can’t be good at everything. In the same way that physicians have come to specialize, nurses are finding out that it’s impossible to be a generalist. That’s why we’re now seeing careers like nurse administrator or nurse informaticist. But even nurses who work in acute care find it useful to specialize in areas like pediatric nursing or gerontological nursing, because healthcare has become so complex. Within various specialties, nurses can gain very specific knowledge and skills through extra education and certification. And of course, the nursing profession is currently pushing additional education for nurses anyway, suggesting that perhaps the associate degree won’t be adequate for entry level nurses in the near future.

Q: Would an RN’s first job dictate what his or her future specialty might be?

Not always. Sometimes people move around quite a bit before they find their niche. Let’s say you have a nurse right out of school, and maybe she’s placed in oncology, but she finds she doesn’t like death and dying, so she moves to maternity, and that’s not a good fit either, so she moves to orthopedics. You have to find out where your gifts are and what you’re suited for, and once you do, you’ll want to find out more and more about it. For instance, it’s rare that you find nurses seeking extra education in an area they don’t like – it’s almost always connected to something that interests them enough that they want to excel in it.

Q: Should a nurse consider salary potential when choosing a specialty?

I think salary is a really good motivator. People don’t like to go through school again or study for certification if it’s not going to have some type of reward. In many ways, caring for patients and doing a great job is its own reward, but everyone has to come home and put food on the table. So salary definitely makes a difference. I know there are people who actively pursue a specialty known for its high salary potential, like nurse anesthetist.

And if salary is your prime motivator, then you also have to consider where you’ll be seeking work. If you’re going to work at a small community hospital with limited resources, the salary may not be as attractive as at a large medical center. There may also be more limited opportunities to specialize – a community hospital may not be interested in hiring a nurse informaticist, for example, because they just don’t have the budget for a specialty like that.

Q: How does advanced education come into play with a career specialization?

I think the two go hand-in-hand. Let’s take the example of an entry level nurse with an associate degree who discovers she has an interest in pediatrics and really enjoys working with children. Maybe the leading children’s hospital in her area has a strong preference for BSN-prepared nurses, so she goes ahead and gets the baccalaureate degree. But after a while she decides she’d like to move forward and practice on her own – so the next step is an MSN, but it would be with a nurse practitioner focus and also a focus in pediatrics. And then she’s able to practice independently in her state and has her own office where she sees patients – but she decides she needs more education in order to run her clinic as a good leader, and she returns to school for a DNP degree with an executive focus. You can see in this example how education supports a career path.

Q: How does a nurse determine whether she needs an advanced degree or if certification is enough?

While certification is a step in the right direction, I think it can always be enhanced by additional academic education. With certification, usually you get a textbook and study it, and then you take a test, whereas with a degree program, you get the benefit of many different courses, and you take them in a way that will have an impact on your career right then and there. At the master’s level in particular, most courses have applications you can use at your place of employment right now.

I know some nurses favor certification because they feel they don’t have the time or money to invest in a degree. And in some cases, certification can demonstrate that nurses know their stuff in a certain area without necessarily going back for a more academic education. On the other hand, some certifications are starting to require a baccalaureate degree. The certifying organizations are embracing the idea that an associate degree might not be the best entry level education for nursing, and more of them are looking for ways to push that BSN – so they’re saying, for example, if you want to be an oncology nurse, then you need a baccalaureate degree.

Q: Are there any specializations you feel are especially relevant today?

Case management and infection control are very cutting edge. If healthcare organizations don’t have positions in these areas now, they will soon. These fields address top concerns in the industry today, so they really present nurses with an opportunity to grow, keep ahead of the status quo, and develop a niche. I think they’re also likely to command a higher salary. Nursing informatics is also very cutting edge. We offer programs in all three of these specialties at American Sentinel University, and they are all designed to prepare nurses at a high level of competency for the job demands they’re likely to encounter.

Cheryl Wagner, PhD, MSN, MBA, RN, is the associate dean, nursing graduate programs at American Sentinel University.

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