Opportunities in Specialized Nursing

For many nurses, the best way to get more job satisfaction and earn a better salary is to get the training for a specialized area of nursing. Here's an overview of some of the most popular nursing specialties, and what kind of training and certification you will need to practice in them.

Critical Care Nursing
Work environment & skills: Critical care nurses, sometimes called “intensive care” nurses, deal with patients who are very sick, who are going through difficult surgical treatments or who are experiencing an emergency. They work in intensive care units (including specialized surgical intensive care units) and emergency rooms. In these environments, critically ill patients need a very high degree of attention from a nurse who knows how to operate cutting edge life support technologies such as extracorporeal membrane oxygenation devices and ventricular assist devices.

Critical care nurses handle everything from wound dressing to monitoring vital signs and administering medications. However, they need to be comfortable handling both these basic jobs and the kind of emergencies that can arise frequently in the high-intensity environment of the ICU, Emergency or postoperative care unit, where decisions must often be made rapidly.

Training & Certification: Strictly speaking, there is no certification required to work as a critical care nurse if you are already an RN. But there are several certifications that can make it far easier to gain employment in this specialty, and which can make you a more effective in critical care. The American Association of Critical Care Nurses (AACN) offers a certification in for critical care nursing in pediatric, neonatal and adult care units. The AACN also offers more specific certifications in cardiac care, cardiac surgery and in clinical nursing for adult or child critical care. The tests for these certificates are tough, but the certification is important if you wish to work in a high-quality facility. Be aware however, that after you get an AACN certificate, you must still contact your state nursing board if you with to officially register in this specialty.

Salary Options: Because good critical care nurses are in short supply, hospitals sometimes often sign on bonuses, reimbursement for relocation or other bonuses. Depending on geographic location, salaries in this specialty range from about $40,000. up to $70,000.

Nurse Anesthetist
Work environment & skills: Nurse anesthetists specialize in giving anesthesia to patients who are being operated on. It’s one of the oldest of all nursing specialties in the U.S., and it’s a very exacting type of practice where certification requires a high level of training. Nurse anesthetists can work not only in hospitals, but in dental offices, obstetrics practices, outpatient surgery centers and other facilities.

As in some other nursing specialties, the rules are not crystal clear in many states on exactly what nurse anesthetists can and cannot do independently. Contrary to popular belief, most states do not actually require nurse anesthetists to work under the supervision of an anesthesiologist. But they are, in most states, required to work with some oversight or “collaboration” with a physician or other licensed healthcare provider.

Given that anesthesia can be dangerous, it would be unusual in the U.S. for a nurse to be independently in charge of keeping a patient “under” on a long, complex operation. Many hospitals do, in fact, have their own requirement that an anesthesiologist oversee the work of a nurse anesthetist.

But a Certified Registered Nurse Anesthetist can operate with relative independence in a small community hospital, pain clinic or physician’s office. They play a very important role in military medical practice and in many public health organizations. The American Association of Nurse Anesthetists currently has almost 40,000 members, who administer more than 30 million anesthetics in the US each year.

Training & Certification: In order to be a Certified Registered Nurse Anesthetist (CRNA), you need to be a registered nurse with not just a bachelor’s degree, but also graduate education approved by the American Association of Nurse Anesthetists’ accreditation council. The education requirement for this specialization is that you must be a licensed registered nurse, have completed a four year bachelor degree (usually in nursing or another science-type subject) and then have at least one year of work experience in an intensive care unit or other acute care type environment. You then need to get an accredited master’s degree in anesthesia education, which can take up to 36 months.

Overall, the training and education of a nurse anesthetist can take anywhere from eight to ten years to complete. (Some nurses go even further, obtaining a Ph.D. to move into teaching, administrative or research positions in this specialty). There is currently a move on by the American Association of Colleges of Nursing to require that only Doctor in Nursing Practice or Doctor of Nurse Anesthesia Practice degree holders be allowed to practice as nurse anesthetists. As this would require all practitioners to hold a doctorate level degree, it would make it tougher for new candidates to enter this specialty. The change is tentatively envisioned for 2015, though it is not clear at present if it will be implemented.

Salary Options: Nurse anesthetists often work quite hard, being on call for operations at all times of day and night and working on weekends. But they are well compensated. An average salary in this specialty is approximately $150,000. per year, making it one of the most highly paid medical practices next to being an actual physician. About 40% of all nurse anesthetists in the U.S. are male.

Oncology Nursing
Work environment & skills: Oncology nurses specialize in helping cancer patients deal with the wide variety of treatments, surgeries, medications and recovery issues that result from the disease. An oncology or “oncology/hematology” nurse, needs first and foremost to have good communication skills and an ability to empathize with patients and their families, who come under tremendous stress when there is a diagnosis of cancer. Pediatric oncology is a large area of practice where a nurse must have a particularly strong emotional makeup in order to deal with very sick children. It is, however, a specialty that is tremendously important today due to the prevalence of many different types of cancers, and one where medical advances are constantly going on.

Nurses in this specialty often spend a good deal of their time working with patients who come into the hospital as outpatients on a regular schedule for chemotherapy, radiation therapy, diagnostic procedures and discussions with the medical team about the course of treatment. Cancer patients who have been admitted to the hospital either for surgery or simply because they have become very sick will have their medications and even protective isolation (for patients with very low white cell counts) managed by specialized oncology nurses and doctors.

Some of the technical sub-specialties with oncology nursing include genetic counseling, radiation oncology, pain management and bone marrow transplantation.

Training & Certification: While it’s not a requirement in most states that a nurse be certified as an oncology specialist to work in an oncology center, the best hospitals and clinics look to hire nurses with specialized oncology training. The leading group in the specialty in the U.S., Oncology Nursing Certification Corporation (ONCC), offers several types of board certification in oncology nursing. There are “basic” certifications offered by ONCC as an oncology certified nurse, a certified pediatric oncology nurse or a certified breast care nurse. Advanced certifications are given as oncology certified nurse, an oncology certified nurse practitioner or an oncology certified clinical nurse care specialist.

To practice as an oncology nurse, an RN needs to get one of these certifications. They are good for four years before a recertification test or a set number of continuing education credits are needed to keep the credential. Two of these advanced certifications, the Advanced Oncology Certified Nurse Practitioner and the Advanced Oncology Certified Clinical Nurse Specialist, require a masters degree in nursing.

Salary Options: The aging of American society has increased demand for oncology nursing specialists, since older people are the ones more frequently diagnosed with cancer. Salaries for oncology nurses vary widely from small local hospitals, where this type of nurse might earn about $55,000., to a very large city hospital where an oncology nurse could get a salary of more than $75.000.

Perioperative Nursing
Work environment & skills: Perioperative nurses help patients through every aspect of being operated on, from the preparation on through the actual surgery and all phases of the recovery. This type of specialized nurse will make sure that all of a patient’s records of diagnostic tests, consent forms and allergies are organized for the surgical team to have easy access to. Some perioperative nurses do not actually participate in the surgery, but focus more on managing the operating room environment - making sure that all equipment is operating properly, providing the surgeon with information on the patient and more. Others, however, do actually “scrub in” for the operation and help the surgeon more directly. Some get certification as a registered “nurse first assistant” to specialize in this type of work.

Perioperative nursing requires good physical stamina, both for standing through long operations and pushing medical equipment around. More importantly, it requires an ability to work well with physicians and other medical specialists in the sometimes stressful environment of the operating room. The perioperative nurse also takes responsibility for handling the patient’s medical care through the recovery process.

Training & Certification: While you need to be a licensed RN to practice perioperative nursing, it is not a specialty driven primarily by certification. Many hospitals have programs designed to develop general practice nurses in this specialty. In larger facilities, you may be better positioned for acceptance into this type of program if you have a bachelor’s degree in nursing. The credentialing institute of the The Association of periOperative Registered Nurses (AORN) administers a test that can give you a certificate in perioparative nursing. A bachelor’s degree is not required for this, but it does have a prerequesite of a whopping 2400 hours of operating room nursing. The group also offers a more advanced certification for Registered Nurse First Assistants. Good luck; to our eyes AORN’s website is extremely confusing.

Perioperative nurses frequently specialize in handling a particular type of surgical cases such as cardiac, reconstructive and plastic, urologic, orthopedic, pediatric or dental, to name just a few.

Salary Options: According to AORN’s website, certified perioperative nurses earn an average of about $9,000. per year more than non-specialized RNs. That would put their median salary in a range of approximately $66,000. per year.

Nurse Practitioner
Work environment & skills: The nurse practitioner specialty came into being in the US the 1960’s, largely to fill a need for basic patient care in areas where there was no physician available. The specialty has expanded and developed a number of subspecialties. And while nurse practitioners sometimes operate their own free standing practices (unlike a physician’s assistant, they do not need to be associated with a specific doctor in all states), many provide high-end nursing care in hospitals nursing homes and other facilities. Overall, the nurse practitioner is seen as the first touch point for patients coming into the health care system. In many clinics, the nurse practitioner will handle many basic medical issues that don’t require a physician.

The most common jobs done by NPs include prenatal care and planning, diagnosing problems like high blood pressure, interpreting lab tests, assisting in minor surgeries and giving critical care to patients who come in with acute problems. Some states also allow nurse practitioners to prescribe a limited number of drugs for patients. In addition to clinics, NPs can be found working in many schools, nursing homes and veteran’s administration facilities.

Training & Certification: Certification is fairly standardized on a national basis. The American Nurses Credentialing Center and American Academy of Nurse Practitioners both provide certification for NPs in specialties including pediatrics (and subspecialties such as pediatric critical care), psychiatry and mental care and occupational medicine. This type of certification, which virtually always requires a masters degree and in some cases requires a doctoral degree or post-master’s certificate, is required to practice as a nurse practitioner in every state. A variety of certifications are also available for nurse practitioners who want to specialize in acute care, geriatrics, holistic medicine or other areas.

Licensure is a bit more complicated. Nurse practitioners are generally licensed by individual states to practice. Because NPs often provide a level of care that comes close at times to medical practice, states tend to regulate them very closely. There are significant differences in what various state nursing boards require for an NP to become licensed and wide variations from state to state on what procedures they are allowed to perform.

Salary Options: Nurse practitioners earn an average of about $65,000. per year in the U.S., though some who work in the neonatal or surgical unit of a large hospital can earn up to $85.000.