The dynamic nursing field now has over 200 sub-specialties, and is adding more daily. Which one will you choose? It’s not easy to decide on a niche to settle in for the long-term, especially when you factor in your evolving self and the breakneck pace of change in the health care landscape. But if done right, the promise of specialization is a nursing career with a healthy salary, plentiful job openings, and greater job satisfaction.

For instance, the most recent occupational employment statistics from the U.S. Bureau of Labor Statistics (BLS) reports that registered nurses earn a mean wage of $69,790 annually, while nurse midwives earn $97,700; nurse practitioners earn $97,990; and nurse anesthetists earn even more at $158,900.

Additionally, the BLS projects that demand for registered nurses will increase an impressive 19% from 2012 to 2022, while the news is even better in some specialty areas. Demand for nurse midwives, nurse practitioners, and nurse anesthetists, the advanced nurse specialties cited earlier, is slated to rise 31%.

But there are other important factors to consider in deciding on a specialty, such as job satisfaction and barriers to entry. Turn-over statistics and requirements for previous work experience or advanced education are some of the big-picture signs to look out for here. But on a personal level, you are more likely to find satisfaction in a specialty that leverages your favorite skills and preferred work role or environment. The challenge of figuring all that out can be daunting. Here are the steps to help you get where you want to go in your nursing career.

Don’t Hurry, Don’t Worry

Once, nurses were pressured to choose a niche early on and stick with it for their entire career, but no more. “We’re going to work in many different specialties and work settings. It’s common to weave in and out of specialties all the time,” says Donna Cardillo, RN, MA, keynote speaker, author, and columnist. She cautions that the whole concept of specialization is outmoded, and advises nurses to instead “think more about the opportunity itself—the support they will get and the opportunity to grow personally and professionally.” Donna herself has explored many specialties in her nursing career, and is still eager to see what’s around the next corner.

Do a Self-Assessment

Check out the online resource DiscoverNursing.com , sponsored by Johnson & Johnson. Perusing this site is almost as good as having a personal career coach by your side, but you can explore on your own schedule and from your own home.

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Start with their five-minute quiz, Find Your Specialty, which asks about education, skills, and how and where you like to work. You will get a couple of niche recommendations based on your answers. From there, you can look over their database of 104 specialties to find out more about these and other possibilities, whether patient-facing jobs in a hospital or outside of it (where hiring is booming in long-term care, inpatient rehab, subacute care, and long-term subacute care). Even if your aim is a research, managerial, or entrepreneurial nursing niche, you’re likely to find something that fits you to a T.

If you want to explore the “nurse anesthetist” specialty, for example, the site reports $98,000 to $129,000 as the average salary, with 22% more jobs projected from 2008 to 2018. It also lists a dozen or so links to helpful resources, including a few professional associations. That’s a great jump-off point for finding experts to talk to, in-person or online, for answers to your specific concerns.

Follow Your Dream

Some nurses go to nursing school specifically to prepare for a certain role in a favorite niche—pediatrics, ER, or labor and delivery, say. Their challenge may be blocking out the voices of teachers, friends, and family who admonish them to do otherwise.

“I always knew I wanted to help moms and babies, because of a nurse who took care of me when I had my older child,” says Lisa Pacheco, RN, BSN, director of maternal child services at Children’s Hospital of Nevada at UMC. She started her nursing career in a medical-surgical unit, though, because she was advised to get broad experience first. She doesn’t regret taking a detour, but her satisfaction soared when she circled back to her passion, a women’s care unit, and “realized my love of taking care of women and children.” For over two decades, Pacheco has explored the many facets of this broad specialty, from antepartum, NICU, women’s care unit, and community nursing.

“Follow your heart, and then even on that hardest day when you don’t think you can come back to work, you will,” she says.

If you don’t feel passionate about any niche area of nursing, that’s okay. Follow your interests, rather than your passion, and see where that leads you. Who knows, you may fall head over heels in love with a niche when you least expect it.

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Alternately, if you have your heart set on a specialization, such as pediatrics, but can’t seem to break in, don’t hold out for your dream job forever. If you’re offered a job in a hospital in telemetry, for instance, “you might consider taking that because it’s easier to get transferred into another unit than hired from outside,” advises Cardillo. Being unemployed for six months or longer is a red flag for many hospitals that require new nurse hires to have recent experience and up-to-date skills, she says.

Try it Out in the Real-World

Sometimes you only know what you like when you see it. So, put yourself in the way of your destiny and fan the flames of your desire with wide-ranging experience in a real-world context. Erik Meyer, RN, BSN, nursing supervisor at the Providence Seaside Hospital in Oregon, wasn’t enthralled with his nursing studies until “I saw a level 1 trauma center in inner-city Detroit…It was just a one-shift visit, but the next day I applied for a two-year internship.”

That rash decision turned out to have real staying power, and he’s served in the ER of a small, rural, critical access hospital for 19 years now. His part-time hours fit in nicely with a busy family life; he and his wife operate a coffee business and care for four young children.

Meyer advises nurses interested in his specialty to be assertive—what some might call aggressive, even—and let the ER manager know you’re ready to help out on the unit when there’s a need. “ER people won’t think that you’re being pushy, they respect that.” To prepare for the time when you get a try-out, start studying to pass the tests for becoming a Certified Emergency Nurse.

Weave Together Your Interests

Two years after starting a career as a bedside nurse, Brittney Wilson, RN, BSN, informatics nurse, social media influencer, and blogger at TheNerdyNurse.com, knew that she couldn’t continue it for long. “It’s backbreaking and emotionally draining,” she explains. She was exploring advanced degree programs when she discovered the nursing informatics niche. “It was like the clouds parted, the sun broke through, the angels began to sing,” she says. The field combines her love of technology with her health care training and experience. Because an MSN degree wasn’t a requirement, Wilson plunged ahead and within three months had a job in hand. Her popular nursing blog was instrumental in showcasing her tech savvy to health care recruiters.

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Consider your hobbies and see if you can combine them with health care to come up with your own unique area of specialization. Want inspiration? Nursing blogs are a great way to become familiar with different niches, learn about the career paths of influential nurses, and connect with people who are enthusiastic about what they do.

Refuse to Choose

Not every specialty requires shutting the door on all others. Jake Schubert, RN, BSN, travel nurse and owner of Nursity.com, an online NCLEX prep course, has found his niche as a sort of “generalist-specialist,” the kind of nurse who can walk into a broad range of nursing environments and succeed.

“When faced with the proverbial fork in the road, I typically pick the route that has the most options in the future,” he explains. “I started my career in the float pool at a major academic medical center and floated to 15 different floors of adult medical-surgical specialties. It gave me exposure to a variety of specialties, nurse managers, and other opportunities in the hospital that I had never even heard of, let alone, considered.”

Schubert learned that he enjoyed the variety and dynamic nature of the work. “Going in with a good attitude and a broad set of skills makes me very marketable. I’m offered a full-time staff position on virtually every unit I work on,” he says. What sets him apart is his ability to embrace the new and relish change, which assure an easy ramp-up and short learning curve on each assignment. “Every unit, hospital, and system is different—so you have to be adaptive, flexible, willing to go with the flow.”

After a few years, Shubert decided to expand his “float” to other hospitals in other cities across the country and became a travel nurse. Travel nursing is a great specialty for people with lifestyle as a major motivating factor in their career decisions. “If you stay too narrow you miss out on a lot,” he says, “People who think of themselves first as nurses” can better weather layoffs or other transitions in this fast-changing profession.

Jebra Turner
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