6 Questions to Ask When Choosing a Nursing Specialty

Nurses can be found providing health care and leadership in metropolitan hospitals, suburban care facilities, and just about any doctor’s office and clinic in rural areas in between. They’re also working in correctional centers, schools, and patients’ homes. They administer emergency services from ambulances and military bases. They also branch out, working as nurse educators or holistic nursing consultants from private practices.

The nursing field has experienced unprecedented growth in recent years and is expected to continue for the foreseeable future. The Bureau of Labor Statistics (BLS) predicts that U.S. jobs for registered nurses (RNs) will grow 12 percent through 2028, mainly stemming from a rapidly aging baby boomer population that requires a higher degree of healthcare services.

Given the demand for nurses and the diverse range of jobs you can pursue, you’ll have the opportunity to focus on a particular area as you start building experience and refining your practice in the field. As you gain experience, you may want to dedicate your career to a specific type of nursing or patient population. This is where nursing specialization comes in, allowing you to demonstrate finely-tuned skills and expertise in a particular healthcare niche.

So, how will you choose? It turns out, by giving thoughtful consideration to your needs and interests, preferred working style, and potentially, your willingness to go back to school. Salary, work location, and job security factor in too.

1. What keeps you motivated at work?

Every nursing specialty comes with its own unique set of challenges and experiences. By choosing one that suits your personality and interests, you’ll be able to land in a career where you like the subject matter and the work itself. Do you thrive on adrenaline, constant challenges, and fast-paced, unpredictable situations? Working as an emergency nurse practitioner (ENP) may be ideal. Do you have exceptional organizational and communication skills and a high degree of patience? A career as a Hospice Nurse will let you ensure quality end-of-life care to patients and serve as a liaison between physicians and families who are coming to terms with the possibility of loss.

What about your capacity for engagement with others? Some nurses are naturally introverted, meaning that they tend to feel worn out after extended periods of social interaction. They tend to prefer solitude and independence and to listen instead of talk. Finding a nursing position that suits these qualities can be difficult, but not impossible. Take nurse educator, a role that requires nursing knowledge and extensive clinical skills to design and implement academic and continuing education programs for nurses. While those in this occupation typically work in social, educational settings like nursing schools and community colleges, it’s an independent job that allows them to set their pace for interaction.

More outgoing nurses may choose to take on roles like head nurse or nurse manager. While introverted nurses can—and do—make great leaders, these roles tend to require constant interaction with doctors, patients, families, and a range of other hospital workers, as well as the staff of nurses they coach and mentor.

2. What environment do you feel most comfortable working in?

BLS reports that 60 percent of RNs work at state, local, and private hospitals. As for the remainder of professionals in the field, many find work non-hospital settings like physicians’ offices, home healthcare services, and nursing care facilities. Some work in outpatient clinics, schools, public health departments, and industrial job sites. Others perform research, monitor I.T. at healthcare consulting firms, or serve in the military.

Hospital-centered or otherwise, you’ll want to consider how your immediate work environment will play into your career. Some may find an operating room unbearable, where the surgeon, anesthetist, and surgical technician hierarchy reigns supreme. Others may find that a nursing home or hospital’s geriatric wing isn’t fast-paced enough for their needs.

There are vast differences in work environments in terms of pace and the kinds of interactions you’ll have with patients, physicians, and other caregivers. You can only be at your maximum productivity if you are relaxed and feel that you fit in.

3. Would you be willing to relocate?

No? Then you’ll have to choose a specialization that’s in demand where you live. As you get farther outside of cities, you may not be able to practice in certain specialties. Rural areas, in particular, often look for generalist nurses to develop close ties with the individuals and families they serve.

Job and recruitment site ZipRecruiter reports that specialized nursing jobs are widespread in major metropolitan areas known for top-ranking hospitals, medical centers, and nursing schools—naming Boston, Washington, D.C., San Francisco, and Houston, among others. You can also consider cities that offer the highest number of nursing jobs per resident, like Columbus, Ohio and Hartford, Connecticut, as well as Nashville, Tennessee.

4. Have you factored in job security?

While the overall field is booming, in some of the most in-demand nursing specialties, demand is even higher. BLS reports that medical and health services manager jobs, which covers nursing roles in management and administration, will increase 18 percent through 2028. Since advanced practice registered nurses (APRNs) are qualified to perform many of the same duties as physicians, their skills are in particularly high demand as well. Employment for nurse anesthetists, nurse midwives, and nurse practitioners—all types of APRNs—is projected to grow 26 percent by 2028.

Despite the growth across industries, nurses should think seriously about specializations that depend heavily on procedures that aren’t necessary to preserve a patient’s health, such as plastic or exploratory surgery. In the event of an economic downturn or a recession, elaborate procedures that require patients to go under the knife—like liposuction, breast augmentation, nose jobs, and laparotomies, to name a few—tend to be swapped for less costly, minimally-invasive alternatives.

5. How important is salary?

If you’re in it to make more money than the average nurse, aim for an executive position or an in-demand specialty with a high salary potential. Using salary average annual salary data from PayScale, we rounded up the top five highest-paying nursing occupations:
Certified Registered Nurse Anesthetist: $147,603
Psychiatric Advanced Registered Nurse Practitioner: $112,370
Nurse Practitioner: $97,255
Certified Nurse Midwife: $91,517
Adult-Gerontology Nurse Practitioner: $89,832

Remember that you’ll need to balance any financial benefits with your personal needs and interests, as well as the demands your specialization will ask of you. What’s more, you’ll also need to factor in any existing student loans—and the cost of any additional required education.

6. Are you up for any additional education requirements?

Many specialties require no more than an associate degree, including those as sought after as labor and delivery, neonatal, and orthopedic care. From here, every additional step of education will open more doors to more nursing jobs, many of which offer more significant professional opportunities and higher salaries.

Those who pursue a Bachelor of Science in Nursing (BSN) and gain RN licensure have the option to become certified as a medical-surgical nurse. Credentialing for specific patient populations, such as cardiac, geriatric, and diabetic patients, is also an option, as is whoever’s coming through the doors of the emergency room.

APRNs are the next step up, characterized as RNs who’ve completed a Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP). Specialization within the APRN category includes nurse practitioners, as well as certified nurse midwives, certified registered nurse anesthetists, and clinical nurse specialists. Given their more generalized advanced training, nurse practitioners may choose to further specialize in a specific type of nursing, becoming a family nurse practitioner or acute care nurse practitioner, or focusing on gerontology, or pediatrics, among other subfields.

Clinical nurse specialists (CNS), like nurse practitioners, receive graduate-level training at the MSN or DNP level and are licensed to carry out advanced nursing responsibilities. However, clinical nurse specialist training tends to emphasize administrative, research, and program development. While some CNSs would consider providing direct care to patients as the main element of their job, many others focus on patient advocacy, research, and education.

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