What kind of nurse are you?
April 6, 2014 3:43 PM   Subscribe

I graduated nursing school almost two years ago and got a job doing inpatient acute care nursing on a telemetry floor. I basically have that down now and I'm clear I don't want to be this kind of nurse forever. Part of the appeal of nursing is there are, supposedly, a million different kinds of jobs nurses can do. So what are they and how do I get into those jobs?

I'm interested in both hospice and ER but live in an area where it's pretty hard to get into those specialties without having previous experience with them. But I"m also open to other kinds of nursing too, I just don't even really know what those things are!

I like teaching a lot. I like collaborating with physicians and other providers. I care about the underlying causes of poor health and health inequalities caused by poverty and racism. I like direct patient care. I like feeling smart and fast on my feet. But I also like the emotion side and feel pretty good about my empathetic listening skills.

I don't want to do this job forever because it is really really exhausting and stressful, but at the same time fairly rote. It is oddly both boring and stressful. I feel I have little power to make a meaningful difference for people, and idiotic organizational politics and the occasional annoying person in leadership often make my day to day suck. I don't like sitting in an office full time, but would probably like to do that some of the time eventually because floor nursing is exhausting after a while and it might be nice to have a balance.

I want to have good benefits.

So, are you a nurse or do you know a nurse who does a kind of nursing you like? What is it, and how can I get into that speciality?

posted by latkes to Work & Money (21 answers total) 11 users marked this as a favorite
I am admittedly not a nurse yet (starting school in a month), but what about something in public health? From what I understand that involves a lot of teaching, working with under served populations, and addressing underlying causes of poor health. If you got a government job it would probably have good benefits as well .. But I will let some experienced nurses chime in!
posted by queens86 at 3:57 PM on April 6, 2014

My first nursing job was hospice, it's not the easiest job to get as a new grad but like many things if there's a will there's a way. If you can do some prn home health that may help you for hospice work, the vast majority of hospice care is performed at home. I went from hospice case manager to hospice admissions and now work at a large hospital as a palliative care nurse. It's awesome and I could never ever be a floor nurse now, I'd end up sending everyone to hospice! I guess I was willing to start prn, work on call and do whatever they needed at first to get my foot in the door. I recently met a nurse who spends her days flying all over the country performing education on using rectal tubes, so hooking up with a company that makes medical supplies could be another unique job opportunity.
posted by yodelingisfun at 4:00 PM on April 6, 2014

You can review medical records for a medical malpractice law firm part time. You can work in insurance.

I'm not a nurse, but I used to work at a law firm and there were a lot of nurses working there part time.
posted by discopolo at 4:07 PM on April 6, 2014

My first job was on a telemetry floor and the bulk of my experience was on medical telemetry floors. I work in outpatient cardiopulmonary rehab and love it. I have had this job for eight years. I get to know my patients well because it's a 12-week program where patients come three times a week. I never work weekends or holidays.

If you want to get off of floor nursing I would recommend transferring to ICU and getting a year or more experience there. Your odds are better at nailing a more cushy job if you have ICU experience. Some options after that:

GI lab -- patients are sedated but better hours

cardiac rehab

cath lab

special procedures (interventions besides cath lab)

employee health nurse

posted by Fairchild at 4:12 PM on April 6, 2014

Nursing education might be a good fit for you. The requirements for this vary by organization (in the large academic medical center I worked in, nurse educators had to have a master's degree; in the community hospitals I've worked in, a BSN and a few years of on-the-floor experience were fine). Some nurse educator jobs are structured so that you are required to work at least one shift a week on the floor; others are more desk jobs. Some places have senior nurse/assistant manager jobs that are more focused on education.

Whatever the details are, the job typically includes developing and delivering education to other nursing staff. This may be done in a formal classroom setting, in an on-the-unit inservice, and sometimes one-on-one.
posted by jeoc at 4:15 PM on April 6, 2014

My mom was an R.N. and has done a huge variety of things. She worked for senior services reviewing home care recommendations, she worked in a hospital, in a clinic, and did home care. She also did some of the legal type stuff that discopolo mentions.

You might also consider all the many types of clinics there are out there... orthopedics, cardiology, pulmonology, lab work including specialty clinics within clinics like amiodarone, Coumadin, etc., OB/GYN, infectious disease (fascinating stuff!), forensics, sports medicine (also fascinating!), anesthesiology, dermatology, ophthalmology, pediatrics, pain management, psychiatry, radiology, nephrology etc.

Every specialty needs nurses. If you want something in your current area, flip through the yellow pages and see who is hiring in a specialty that interests you.

I'm a medical transcriptionist and I have typed for providers of nearly all those things I listed. The way to refresh my own career is to find a new specialty. I typed for a teaching hospital that included a million things, then switched to cardiology (boring! all those smokers who refuse to quit! same lecture 50 times a day, ugh!), and now I'm doing orthopedics (people recover and stop coming back! Yay!).
posted by AllieTessKipp at 4:21 PM on April 6, 2014 [2 favorites]

My mother is a nurse in a cardiology practice. She's refreshed her career over the two decades she's been a nurse by changing specialties (from internal medicine to cardiology) and now she's working on becoming an NP.

From talking to her, I think she currently spends most of her time sitting at a desk doing paperwork and being on the phone; she did more hands-on patient care when she was in internal medicine. On the other hand, both settings let her get to know her patients very well over time (albeit more so in internal medicine, where they multiple generations from the same families as patients).

She works quite closely with the two or so doctors she primarily works with, although this can be a good thing (making herself indispensable to the doctors she works with has helped her career during organizational shake ups) and bad (less variety = getting tired of the same frustrations and minor interpersonal issues that inevitably come up).

As for avoiding organizational frustration and annoying leadership, you might have slightly better luck in a smaller clinic setting, but my impression is that the trend is for more and more clinics to become part of hospital and multi practice groups. And of course, even when my mother worked in a practice owned by <5 doctors, organizational frustration and annoying leadership existed- access didn't necessarily translate to the ability to make a difference.
posted by MadamM at 4:36 PM on April 6, 2014

I started out in tele, went to the float pool, did a stint in the Cardiothoracic ICU and had my last clinical gig in home care/visiting nursing. I'm now (back to my first career) in industrial engineering/systems redesign, but doing it in the healthcare industry.

If you like both teaching and direct care, visiting nursing might be for you. I gotta tell you, patients don't remember a damn bit of the teaching they get as inpatients and it can be very rewarding actually reaching them on their terms in their environment. Socioeconomic factors are a much larger issue when you're in the pt home also. Medicaid/care pts seem to get d/c'd sicker and quicker, and visiting nurses pick up that slack. Lots of autonomy, but terrible documentation requirements.

But as my intro implies, I also recommend trying different things, any things, often.
posted by klarck at 4:40 PM on April 6, 2014

I'll also second nursing education. Like cardiac rehab, education can be very small departments and can be difficult to get into. Another option is case management. Case management can be stressful as can some of the other options I listed above. Nothing is as stressful as floor nursing so I think anything is better. Community health may also be an option. I always wanted to be a school nurse but in my area they tend to hire LPNs.

Networking is important. Even in nursing it can all come down to who you know. A friend I went to school with recommended me to my current boss. Always maintain professionalism at all times. Introduce yourself and be friendly with other departments in your hospital.
posted by Fairchild at 4:52 PM on April 6, 2014

Is direct patient care a requirement? I know nurses who've transitioned to training roles, IT roles with EMR implementations, and nurses who pursued advanced degrees to do research. I know one nurse who's now the COO of a hospital system. (Actually, I know doctors and other allied care providers who've followed similar paths.)

If direct patient care is a requirement, then you're looking at a smaller (but still interesting!) set of career paths.
posted by 26.2 at 4:53 PM on April 6, 2014 [1 favorite]

You might be interested in care management. At our institution, there are basically 2 kinds of care manager RNs--one kind does almost exclusively telephone work with patients who are at high risk of hospital admission (they check in with them periodically to help with adherence or a variety of issues from "why am I taking this medication?" to "do I need to go to the ED?", and then if they're admitted, the nurses follow up with them very closely after discharge to make sure that the visiting nurse services show up, that they have their meds and understand how to take any new ones (and stop anything that they're not supposed to take anymore), etc. etc. Those folks rock, and at our hospital they cut our high-risk readmission rate by about 2/3 in less than a year, so there's no question they're making a difference.

The other care manager RNs I know work in my practice and are basically managers of patients with chronic illnesses--they do outreach and education for patients with uncontrolled diabetes and asthma, as well as triage and some other direct clinical tasks like blood pressure checks. They are awesome.

Seconding network, network, network with other RNs. If you don't work at a big hospital system, you might think about trying to get into one even as a floor nurse, since often the unions require that jobs be posted internally first and so the more interesting jobs get snatched up by internal candidates quickly.
posted by The Elusive Architeuthis at 5:22 PM on April 6, 2014

My mom was a nurse for a long time. She worked on the ICU floor, the CCU floor, she was a charge nurse, she did nurse education, and her last job was phone triage for a doctor's office.
posted by Ms Vegetable at 5:31 PM on April 6, 2014

My mom is a psychiatric nurse and I worked on the psych unit for a few years. It is such rewarding work. You hear horror stories in the news and exaggerations/out right lies from film and tv - but mostly people in short term psychiatric units just need a break from everything going on their life and a helpful shoulder to lean on. Even your more stereotypical psychotic patients just need some help and kindness. Psychiatric nursing is more compassion and empathy than drawing blood/titrating doses. It's helping people help themselves when they need it most. My mom's favorite saying is "nobody chooses to wake up in the morning and be schizophrenic." There are a lot of people whose realities are far harder than my own - and if there was anything could do to make their world easier, then I would with a smile. Some days are harder than others, but I still think it was the
Most rewarding job I've had. It does require A LOT of patience and good work/life separation. You need to be able to compartmentalize and not take the day home with you - but I loved doing it.
posted by Suffocating Kitty at 6:37 PM on April 6, 2014 [4 favorites]

ICU nursing
Procedural areas like interventional radiology, cath lab, endoscopy
Outpatient areas like infusion centers, dialysis, clinics
Rehab nursing, psych nursing
Public health, labor and delivery
Risk management, quality improvement, nurse recruiter, clinical educator
Electronic medical records
Research associate, clinical trials nurse
The key to any of this is to start doing more stuff right where you are: get on committes and do projects, be a perceptor and charge nurse, make posters, help review policies, create a journal club, get certified, go to lectures, do a medical mission, volunteer at a free clinic...will all help clarify what direction you want to go in, and help you network.
And a year of ICU nursing opens alot of doors.
posted by SyraCarol at 6:59 PM on April 6, 2014

Add home dialysis nursing to your list of options to look at. I'm not a nurse and I don't know any nurses on my personal time, but I am a dialysis patient, so I've known many nurses over the last several years.

I suppose there are two categories of home dialysis nurse: one who administers regular dialysis to patients in their homes (usually those with means or really good insurance), and one who manages the self-care home dialysis patients in the clinic. I have experience with the latter only.

A home dialysis nurse deals with training new home dialysis patients and their caregivers on their chosen modality, then supporting those patients long-term as they do dialysis at home on their own. You would develop long-term relationships with your patients. The healthiest ones you might only see once a month during clinic appointments with the doctor and other staff. There is a downside - you'd be on call for them 24/7 for emergencies, troubleshooting, and concerns. You'd also often have to deal with some of the logistics of the monthly supply ordering/delivery process when things don't go perfectly between the patient and the supply company.

Look into it. I've had three home dialysis nurses at different clinics (two for peritoneal dialysis, current one for home hemodialysis), and a good one can feel like a lifeline connecting me to all the resources I need to get the best treatment I can.
posted by WasabiFlux at 7:34 PM on April 6, 2014

Transplant coordinator/case manager. It's out of the hospital, involves a lot of patient contact and education. For solid organ transplant most nurses seem to have either an ICU background or a a strong grounding in the specific organ. For stem cell transplant some oncology experience is important.

Good luck to you, wherever you land!
posted by SLC Mom at 7:36 PM on April 6, 2014 [1 favorite]

My friend is a nurse who worked in the cardiac care unit. She would assist with heart transplants, stents etc. I know she worked all over the hospital before she ended up there. Now she works for Silver Chain (not sure if you have that in the States) which involves caring for patients at home who need after care but not enough to necessitate a hospital visit. It involves driving all over the place.

Other friends I know who are nurses and wanted to make more money ended up going into medical sales. This requires medical knowledge to speak to doctors etc. One sells titanium rods to orthopaedic surgeons and requires her to be present during surgery as she assists the doctor with the best way to put them in. She makes a lot of money, but also does a lot of hours. Apparently the more attractive females tend to get a fair bit of business. Heh.
posted by Jubey at 8:26 PM on April 6, 2014

I have overseen and executed the implementation of an EMR. Don't do it. Just stay away from it.
posted by 517 at 9:17 PM on April 6, 2014 [2 favorites]

I do high risk antepartum nursing with some floating to L&D and post partum. Our unit also automatically gets the high risk post partum mothers after they've delivered regardless of whether they were high risk while pregnant (e.g., maternal temp during delivery). I absolutely love my patients. The politics of a very large hospital...not really.

The unit is considered acute care; we get some interesting stuff along with the run of the mill. I work the night shift, so we also start inductions that are then transferred to L&D. Without a doubt, the most difficult aspect of my job is having to deal with the fetal demises that come through. We take them up to 20 weeks (after that L&D gets them).

L&D is a different animal. I will never get tired of the privilege of being one of the very first people to welcome a new soul into this world. But I would be lying if I said that those few minutes are the most stressful at the same time. I think the day you're not afraid -- or at least highly cautioned -- is the day you've become too lax and aren't paying attention. Once the baby is born, you instantly have two patients that require almost continuous assessment and monitoring. It's also much more physically challenging than I ever thought possible. Additionally, we are required to chart every 15 minutes once the Mom has an epidural.

Post partum is pretty low key. Lots of ibuprofen, colace, painkillers. Lots of teaching. The babies have their own nurses, so you're primarily there for the mom. Maybe some antibiotics, help with breast feeding. Also finger sticks for blood sugars if the mom requires and possibly magnesium protocols for pre-eclampsia patients.

These are really broad overviews of the different mother/baby units and I'm sure I've left a lot out, but this should give you an idea of what goes on. Also, it should go without saying that there is an insane amount of charting that has to be done. Both regular charting, as well as fetal monitoring.
posted by dancinglamb at 1:12 AM on April 7, 2014

I can tell you that a lot of nurses start out in Telemetry and burn out on it due to the stress.

The next easiest places to get jobs are Med/Surg and in Elder Care homes. The issue with med/surg is that the folks rotate in and out so frequently, you may only see those folks once, and by the next shift, they're gone.

Elder care is growing and a lot of people plain don't like it. When Husbunny was a nurse, he liked it because it was the same folks every shift, and in many cases he worked in Memory Care, so the folks weren't even physically ill. He would get calls from EVERYWHERE asking him to hire on. So pretty much in demand all the time.

I studied to be an ER nurse (didn't get too far into it.) I like the fast pace, you see a lot of different things and you make an immediate difference. You may have to get a couple more classes and certify, but I think it's worth it.

Some folks like L&D, or neonatal care, again, certify for that.

Another job Husbunny had was case management. 100% administrative, reviewing care plans in a nursing home.

Another job was telephonic nurse. He sat in a call center, and called asthma patients for an insurance company. He was to check in with them to help them manage their chronic illness. They have nurses for diabetes, heart disease and other chronic illnesses. Bonus, since he called across state lines, he had nursing certificates in 30 states, the company paid for that.

You can also return to school for an MBA and become a nurse administrator.

You can study more and be a Nurse-Midwife, or a Nurse-Anesthetist.

What's interesting to you?
posted by Ruthless Bunny at 7:03 AM on April 7, 2014

First - I think the Johnson and Johnson campaign may have more data for you.

I am not a nurse, but I used to hire registry nurses as a staffer for a hospital - and work professionally with nurses in my current job. When I staffed for a L1 teaching hospital, I had a core group of travelling nurses under contract that I placed on different floors every shift. So, I might put someone on Labor and Delivery one night, then the next day they'd be working in the ED/ER. I also always had to hire people from a registry. Working with a registry, you can also make yourself available for things like private nursing stints. Oh, and one of my colleagues was a LVN who staffed part time; my boss was an RN who had moved into education and administration.

I don't think anyone recommended the military, including the reserves? You'd be looking at the Army, Navy, or Air Force. I know a lot of great ex-military nurses -- and a friend of mine's father has had a fantastic career serving as an Army nurse, and will retire with a great pension. He currently runs one of the clinics at one of the Army's largest bases, and the Army paid for him to get a doctorate. They also have a program to pay back loans for certain specialists with BSNs. The Air Force has a flight nursing component that looks really exciting. Obviously, the benefits can be stellar for the service member, and for your family. Your salary is not huge but bear in mind you get paid BAH - basic allowance for housing, and if you decide to make it a career for life, you can retire after 20 years and then start a whole new career.

Community colleges in my area are always looking for good instructors. You can make good full-time money (but not necessarily as much as you would make working full time with overtime pay in a hospital ... on the other hand, the hours are better and you have a great community of practice). One of my friends moved from full time to adjuncting - so right now, she just works with vocational nursing students in the clinical portion of their training. She has a masters in health care administration and is working on her NP; she's working for an orthopedic hospital. So, she's not bored! I do not believe you need a master's, especially as an adjunct.
posted by mitschlag at 8:30 AM on April 7, 2014

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