Chapter 5
Choosing a Nursing Specialty
Developing a Career Path
Few nurses actually plan their nursing career aside from graduating nursing school and finding their first nursing job. A nursing career seems to evolve from circumstances and opportunities that just happen – not from deliberate planning. Downsizing may force you to explore a different type of nursing. Openings within your hospital may give you a chance to branch into a new specialty. However, you probably don’t have a master plan – a career path.
A career path is a plan that states a goal and enumerates the tasks necessary to reach that goal. You had such a plan when you first thought about becoming a nurse. The goal was to become a licensed nurse. You selected a nursing school, identified and completed prerequisites, and then passed each course required for graduation. You prepped for the nursing boards, you passed, and you became a licensed nurse.
Nurse recruiters are noted for asking, “Where you do see yourself five years from now?” They want to determine if you have a career plan and whether or not the position you are interviewing for provides a stepping stone toward reaching your career goal. Some candidates simply fake a response to make it sound as though they have a well-thought-out master plan for their career, ensuring that the open position is the next step in their career plan.
Consider asking yourself, where do you want to be in five years? Your answer may surprise you. You might want to pursue emergency nursing, legal nursing, or nursing informatics. These are just a few of the many nursing opportunities that are available to you, which you’ll learn more about later in this chapter. Each area of nursing has its own requirements – many of which are not standardized – but they usually follow a traditional career path from novice nurse to expert nurse.
Your initial career goal was to become a professional nurse. During the novice stage, you acquired the know-how to perform nursing tasks through learning from preceptors and from your own experience. You followed rules and had little responsibility for the outcomes of your task. As an advanced beginner, you learned more sophisticated rules and practices and you were able to prioritize tasks based on importance. You formed the foundation for making nursing decisions and accepted responsibility for those decisions. You problem-solved with little assistance from more experienced colleagues.
Next, you became a proficient nurse, using the wealth of experience as the basis for your nursing intuition. You made calculated decisions that produced an effective result. You finally became an expert nurse able to perform all nursing duties fluidly with most actions performed unconsciously based on your broad library of experience. You respond to most clinical situations, including those with critical outcomes, as routine.
Novice nurse to expert nurse provides the framework for you career path. Suppose you set your goal on becoming a nurse practitioner. Explore the requirements – educational and experience -- to attain that goal, then develop and execute a career path. Once you’ve completed the basic educational and licensing requirements, focus changes to the novice-nurse-to-expert-nurse framework. Regardless of your nursing experience, you’ll start off as a novice when you enter an area of nursing that is new to you and you need to work through each stage before becoming an expert nurse. You may move quickly through each stage if you are an expert nurse in a complementary field of nursing such as going from medical-surgical nursing to cardiac nursing. However, expect a slower transition if you are moving to a completely different type of nursing such as to legal nursing or nursing informatics where your skills are not directly transferable.
Consider developing an ultimate career path. Do you really want to continue providing bedside care when you are in your 50s or 60s? Bedside nursing takes a toll on your body as you grow older. There will likely be a time when you can no longer provide quality bedside care to patients. This doesn’t mean you need to give up on nursing. Bedside nursing gives you a wealth of skills that can be transferred to many other areas of nursing as you’ll see later in this chapter. Developing an ultimate career path helps you build the experience and educational requirements to move to areas of nursing aside from the bedside.
Obstacles to Change
Remember your first clinical experience in nursing school? You had butterflies in your stomach. There was a sense of excitement of the unknown challenges that lay before you. You probably were on your “A” game. The spark and excitement probably left you years ago as you became the expert nurse. You know what to expect each day and even the unknowns become routine. There is little excitement and no butterflies in your stomach. Changing to a new career path in nursing rekindles the spark that makes nursing exciting again – new challenges, new learning opportunities, and new ways to care for patients.
If there were no obstacles, what different area of nursing would you explore? Give an honest answer, then investigate obstacles that really stand between you and your dream – and determine how to eliminate those obstacles by going around them or breaking them down. Begin your investigation by reviewing a general description of the job. You’ll find the more common ones in this chapter. Then look at actual job postings at healthcare facilities around your area. You’ll notice what you think might be job requirements are listed as optional: nice to have but not a requirement. You’ll find listed educational and professional certification requirements.
Assume you can meet all requirements with a little work on your part such as returning to school or sitting for the professional certification exam. Make a list of the requirements. Check off those requirements that you meet. Identify what you need to do to satisfy the remaining requirements and investigate how to go about it. Finally, develop a strategy for fulfilling the unmet requirements.
Assess Your Current Nursing Career
Nurse managers use SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis to assess the effectiveness of nursing operations such as a unit or division of the healthcare facility. You can use SWOT analysis to assess the current status of your nursing career. Begin by dividing a piece of paper into fourths – upper left, upper right, lower left, and lower right. Label the upper left as Strengths, upper right as weaknesses, lower left as opportunities, and lower right as threats.
List your strengths in the upper left portion of the paper. Be sure to consider your education, certifications, leadership roles (for example, serving on committees, functioning as a preceptor), nursing experience, and non-nursing experience (that is, your previous career).
List your weaknesses in the upper right portion of the paper. Be honest and list items that you see are or could be weaknesses. For example, you may have an associate’s degree in nursing and healthcare facilities in your area prefer or require a BSN. You might hold an LPN (licensed practical nurse) license, which may limit your choice of employers. The distance between your home and local healthcare facilities may also be a weakness, especially if the nearest healthcare facility is a two-hour drive one way.
List what you see are opportunities in the lower left portion of the page. Opportunities might be to transfer positions within your current healthcare facility. Your healthcare facility may offer incentives to continue your nursing education. Your family situation (for example, having an empty nest) may give you the chance to refocus on your nursing career. You may have developed a strong network of former colleagues and friends who can “open doors” to new employment opportunities.
List threats to your nursing career in the lower right portion of the page. For example, healthcare facilities in your area may be merging or closing down, placing you at risk for termination. Your healthcare facility may be phasing out LPN or associate’s degree nurses and require you to obtain an RN license or BSN within a specific timeframe to maintain your employment. You have new family obligations (for example, caring for an elderly parent) that place limitations on work performance. You’re getting older and working the floors is taking a toll on your body. You are the sole supporter of your family and changing jobs is too risky. You and your new boss are not hitting it off well.
Your goal is to take advantage of your strengths and opportunities while minimizing your weaknesses, as well as preparing a strategy for handling threats to your nursing career. For example, stay with your present employer while you go back to school for your RN or BSN, taking advantage of your employer’s tuition reimbursement policy. Doing so strengthens your weakness and places you in a better position should your employer phase out LPN or associate’s degree RNs. Likewise, if you find yourself in a nurse specialty that is in low demand, you can use your network of colleagues to move to a high-demand nursing specialty within your organization.
Changing Nursing Specialty
Time for a change? If so, then anxiety is likely holding you back from making the move because change means you’ll face new challenges – and the risk that you may not be able to meet those challenges. The risk of failure is a strong roadblock to exploring new areas of nursing. A nurse executive once commented, you know when it is time for a new pair of shoes but you may not know if the new pair is a fit until you try them for a few weeks. The same is true about changing nursing specialties. Should you give up a job that you’ve mastered? What happens if you fail at your new specialty? These aren’t easy questions to answer.
It is usually best to change specialties within your current healthcare facility for a number of reasons. First, you are a known quantity. You’ve proven yourself as an excellent reliable nurse who provides quality care for your patients. Even good candidates from outside the organization still must prove to management that they are reliable and provide quality patient care. Next, you can use your network of colleagues to explore the open position before you apply for a transfer. You’ll learn what it is really like to work on that unit for that manager. You won’t find this information if you accept a position elsewhere until you’re on the job.
And most important, you know from other employees who transferred how Human Resources and management handle situations when the “new shoe” isn’t a fit. Technically, Human Resources will probably tell you that you are on probation for the first 90 days on your new job. You can be terminated at will at any time during that 90-day period. Practically, this may not occur unless you were a marginal employee in your current position or you made grave errors in your new position. If the organization terminated employees following a transfer, it would send the message “don’t transfer from your current job.” This simply doesn’t help the organization. A better approach is to acknowledge that all “new shoes” don’t fit. Sometimes you can go back to wearing your “old shoe” – that is, they purposely hold off replacing you until everyone believes that the “new shoe” is a fit. Other times, you might be offered a position that is comparable to your old position – “another pair of old shoes.” That position, maybe on a different unit, different shift, or in the float pool – but a position that is practically identical to your old position. You are unlikely to find such consideration as a new employee in another healthcare facility.
You’ll need to meet the job requirements for the new specialty even if you are transferring within your organization. One of the toughest requirements to meet is the “3 – 5 years of experience” requirement. You have to solve the chicken or the egg problem. How can you get experience if you don’t have experience in the specialty? Here’s a technique that might work for you. You likely have job skills that are transferable to the specialty – starting an I.V., administering I.V. medications, assessing patients, admissions, discharges. Ask the specialty unit manager in your current organization if you can float to the unit whenever they are short. That is, pick up a shift outside your current position. In this way, you can get a feel for what it is like to work on the specialty unit while helping out the manager. Show that you are willing to learn the specialty. The current staff is likely to help you get up to speed. If both you and the unit manager feel you are a fit, then you become the ideal candidate for the next opening – and the 3 – 5 years of experience may no longer be a requirement in your case because you’ve already been cross-trained.
Don’t be cocky thinking that you are an expert nurse in the new specialty – you’re not. You have a wealth of experience but that experience is in a different specialty. Some experience is transferable and other experiences are meaningless in the new specialty. You still must work your way through the novice, advanced beginner, and proficient nurse stages. Don’t let your pride get in the way of learning your new specialty.
Realize that changing specialty is a major life change that may be stressful. You are moving from being an expert at one specialty to being a novice who has to learn the new specialty by going back to school, reading nursing books about the specialty and taking directions from nurses who could be your younger sibling or your child. You need to ask your colleagues for help – something you don’t do often in your present job. This may not come naturally, but there is a high risk for failure if you don’t ask for help.
Changing specialty is a family decision, in many cases for both your work family and your home family. Family members can be supportive by helping you objectively explore the pros and cons of the move. Also consult your bargaining unit representatives, if your current or future position is a bargaining unit position. The bargaining unit representative can speak to you about your rights based on the bargaining contract and past practices of your healthcare facility setting realistic expectations for the transfer. For example, you might be at the top of the clinical ladder. Changing specialty could place you back on the first rung of the clinical ladder and affect your pay.
Consider a nursing specialty change when your present nursing position is no longer challenging, when your new patient begins to look like the hundreds of patients that you’ve cared for over the years. There is a risk that the quality of your care may be unintentionally lowered. Don’t change specialties to avoid conflicts in your current position. It is always better to the leave your position on a positive note because the “new shoe” may not fit and you need the support from your current management to go back your “old shoe.”
Is Management for You?
Nurse management is challenging and is more than just being the boss. The nurse manager has total responsibility for the operations of a unit(s). This includes: estimating needs, planning to meet needs, and executing that plan. Each unit has a license for a specific number of beds within a specialty, such as medical-surgical beds. The flow of admissions and discharges dictate the number of patients on the unit at any specific time. The nurse manager must meet the needs of those patients based on standards of care defined by The Joint Commission and state and federal regulators. The nurse manager must determine resources (personnel and material) and policies and procedures to meet those needs.
Success is usually defined by staying within budget; passing audits by The Joint Commission and state and Federal regulators; having an excellent customer service rating; and providing a safe and stable working environment for staff. All of these must be accomplished without you – the nurse manager – performing patient care and support services yourself.
Some experienced nurses see nurse management as the next logical step in their nursing career because they’ve already handled the day-to-day challenges of bedside nursing and possibly managed a shift as a charge nurse. You know the problems of providing quality care on the unit – and you have a few possible solutions to rectify those problems that you can implement if you became the boss.
Other experienced nurses see nurse management as a lose-lose situation. Everything that goes wrong on the unit becomes your problem to solve. Upper management usually doesn’t want to hear about your problems and your staff simply asks you, “What do you want me to do?” You have to deal with staffing issues: staff who don’t show up for work; staff who don’t want to follow work rules; staff who are just waiting to be terminated. Upper management orders you to keep within your overtime budget while some staff create situations where they get paid overtime. The nurse manager seems to always be the bad guy.
Consider the following before accepting a nurse manager’s position:
–Healthcare facilities typically require nurse managers to hold an MSN degree although they may accept a nurse with a BSN degree who is working toward the MSN degree. Will you recoup the expense of an MSN degree?
–Nurse managers don’t receive overtime pay.
–Staff nurses can forget about their job once they are off shift. Nurse managers have 24/7 responsibility for their unit(s).
–Experienced nurses who are at the highest salary scale may take a pay reduction by becoming a manager when considering the loss of overtime and pay differential.
–Some healthcare facilities may not permit you to return to a non-management role once you become a manager.
–Nurse managers usually lose their bedside nursing skills because they don’t provide bedside care. This may limit career opportunities in the future.
–Nurse managers are usually not part of a bargaining unit. The nurse loses protection of the bargaining unit by becoming a nurse manager.
–Nurse managers are expected to fix all problems on their unit – even those that are nearly impossible to fix.
–Pay increases for nurse managers may not be as frequent as staff nurses who belong to a bargaining unit.
The nurse manager is no longer seen as a colleague – you’re the boss. You hire new staff. Approve transfers. You write annual evaluations. You discipline staff. You’re the person who says “You’re fired!”
Nurse management is a good experience as long as you are a “take charge” person who is well-organized, likes dealing with people fairly, doesn’t take failure of others personally, and feels a sense of accomplishment when your staff provides quality patient care. Understand there is little glory in being the nurse manager when compared with the overall responsibility for patient care and for your staff.
Successful nurse managers can rise to a director’s level within the healthcare facility where they are responsible for managing a major function within the organization such as the acute division, infection control, emergency department, and staff development. A nurse manager may also become the chief nurse administrator responsible for all nursing in the healthcare facility. There seems to be a trend where directors and administrators jobs require a Doctor of Nursing Practice (DNP) degree.
Agency Nursing
An agency nurse is a nurse who works for an organization that supplies nurses to a healthcare facility to supplement the healthcare facility’s own staffing needs. The agency nurse does not work directly for the healthcare facility but performs the same duties as the healthcare facility’s own staff nurses.
An agency typically has a contract with the healthcare facility and may or may not have a contract with you. The contract with the healthcare facility specifies the hourly or daily rate that the agency is to receive from the healthcare facility, which is typically much higher than the healthcare facility pays its own staff nurses. However, as an agency nurse you receive a fraction of what the agency receives from the healthcare facility.
The agency is responsible for your performance and certifies that you are competent to perform the tasks assigned by the healthcare facility. The healthcare facility is responsible for educating you on the healthcare facility’s policies and procedures and for orienting you to the facility and to each unit.
You will fill out the traditional employment forms for the agency and provide the healthcare facility with a copy of your nursing license and health record. It is likely that you’ll go through the healthcare facility’s orientation process including a probationary period. However, you are not terminated if you don’t successfully complete orientation or the probation period because you work for the agency and not the healthcare facility. The healthcare facility simply tells your agency that they no longer require your services and the agency sends another nurse to fill that spot.
There are benefits for working for an agency:
–You have the opportunity to work for different healthcare facilities.
–You get exposed to different specialties and patient demographics.
–You don’t get involved in the internal politics of the healthcare facility.
–You are an earner for the agency not an overhead expense. Agency nurses bring in revenue for the agency whereas staff nurses are seen as a necessary expense for the healthcare facility. You have leverage to negotiate your compensation with the agency because without you – and the other agency nurses – the agency won’t make money.
–You may be able to create your own schedule.
–You may receive higher pay than if you were an employee at the healthcare facility. However, higher pay may reflect that the agency isn’t providing you with benefits.
And there are drawbacks being an agency nurse:
–There are usually no paid sick days or holidays. If you don’t work, then you don’t get paid.
–Work may or may not be consistent depending on the agency’s contract with the healthcare facility. There are contracts where the agency supplies full-time nurses for a period of time (for example, three to six months). Other contracts are on an as-needed basis. That is, you get called only if regular staff is unavailable. Agencies usually don’t pay you to stand by.
–Agencies usually don’t offer any benefits. Any benefits that are offered to you are likely at a higher amount then if you worked for a healthcare facility.
–You’re considered an outsider in the healthcare facility. You don’t get the same treatment by the healthcare facility as they treat their own employees (for example, no parking discount, training).
–You may be prohibited from being an employee of the healthcare facility for six months to a year after you leave the employ of the agency even if you don’t have a contract with the agency. The healthcare facility’s contract with the agency usually specifies terms under which the healthcare facility can convert an agency nurse to an employee. In some cases, the agency wants the healthcare facility to pay the agency an amount equal to one year’s salary of the agency nurse. This makes it too expensive for the healthcare facility to hire you. And some agencies don’t tell you about this clause in the contract until you apply for a position at the healthcare facility.
–You’re always starting over unless your agency places you in the same healthcare facility for a long time period. You have to continually prove yourself to the staff and manager.
–You are unappreciated and seen as a hired hand. There are no rewards (that is, promotions, bonuses) even if you are a star performer.
–Some agencies may send you out on jobs that are outside your experience in an effort to bring in revenue for the agency.
–You will probably be required to provide your own malpractice insurance.
It is critical that you are totally honest with the agency about your experience and skills because the agency places you on assignments based on what you tell them. You never want to be placed in a position where there are surprises. An agency nurse is considered experienced and able to provide quality patient care with little orientation to the unit. You’ll need to be told where things are, not how to perform the job.
Agency nursing isn’t for new grads or nurses looking to change specialties. There is little opportunity for training and nurturing. Agency nurses are expected to hit the ground running, otherwise the healthcare facility may tell the agency that you are not right for their position. The agency may then place you in a more appropriate position in another healthcare facility or not call you for assignments.
Travel Nursing
A travel nurse is a type of agency nurse, except a travel nurse usually relocates to various parts of the country to work rather than working within the vicinity of their home. Some healthcare facilities bring in travel nurses when there is disruption in their current staffing such as having to rapidly train the current staff; staff-wide illness (flu); or when labor negotiations with nurses may lead to a labor strike.
A travel nurse should be an expert nurse with the confidence to handle any situation with minimum orientation to the unit. During a labor strike there may not be anyone at the healthcare facility to provide a good orientation to the unit. The agency nurse must be a self-starter able to find supplies and anything else needed to provide quality patient care.
There are advantages to being a travel nurse:
–You have the opportunity to live in different parts of the country.
–All travel expenses, room, and board are paid by the agency.
–Many agencies offer a bonus for completing a contract.
–Travel nurses receive premium compensation rates.
–You decide your schedule.
–You are in a state of constant change, living in different housing (the agency selects your housing), different communities, and working in different healthcare facilities. You may have a different charge every three months.
–Each contract has a different rate of pay.
–There is inconsistency of work to consider as you depend on the agency to find your next assignment. You may be out of work once your present contract is fulfilled.
–You are constantly away from family and friends living in unfamiliar surroundings. Packing and unpacking every three months.
–There is the challenge of meeting state licensing requirements for each state where you work. Typically, the agency assists you in meeting these licensing requirements.
–You may not have benefits – and benefits that are offered may be less than those offered to employees at a healthcare facility. No sick days. No holidays.
–You may be working in a hostile work environment especially if the current nursing staff is on strike.
–You are treated as an outsider.
–There is a higher than normal stress environment because you must constantly adapt to change (that is, new healthcare facilities, new policies and procedures). Change also brings with it a higher than normal chance of making errors.
Whether you are a travel nurse or a local agency nurse, it is crucial that you deal only with a well-established agency. The agency is representing you to healthcare facilities just as much as you are representing the agency. Smaller unestablished agencies are prone to two considerable problems. First, the agency may lack the depth of nursing experience to fulfill contracts, resulting in inexperienced nurses (inexperienced outside their specialty) being assigned to a healthcare facility. Cash flow is the other issue. There is usually a gap between when the agency receives payment from the healthcare facility and when the agency has to pay you. Well-established agencies have the financial resources to finance this gap. You get paid even if the agency hasn’t received payment from the healthcare facility. Smaller agencies may not be able to finance payroll – you’ll get paid when the agency gets paid.
Home Healthcare Nursing
There is an increasing trend to provide healthcare in the home to avoid extended stays in a healthcare facility. Some patients prefer the comforts and convenience of home by having the healthcare team come to them rather than by remaining extra days in a healthcare facility. Insurers find home healthcare less expensive than the most costly care given in a healthcare facility.
A home healthcare nurse plays a pivotal role in treating a patient at home. Typically the nurse is the first member of the healthcare team to visit the patient at home to make an assessment of the patient’s needs. The assessment determines if home healthcare is the appropriate level of care for the patient and determines the support level that must be provided to maintain quality care at home. The goal of a home healthcare nurse is to identify health issues with the patient, diagnose problems, administer medication, and coordinate care with the practitioner who oversees the patient’s medical care.
Usually the home healthcare nurse works for a home healthcare agency or a division of a healthcare facility that provides home healthcare services. Based on the nurse’s assessment and the practitioner’s orders, the home healthcare agency assigns other members of the home healthcare team to perform specific levels of care required by the patient. For example, the nurse may determine that the patient requires 24-hour 7-day a week care by a certified nursing assistant. The home healthcare agency then assigns CNAs to shifts at the patient’s house. Specialty nurses such as a wound care nurse may be assigned to treat and monitor wounds.
You’ll need bedside experience – not for new grads -- and be able to work independently to become a home healthcare nurse because you’ll be caring for a patient in the patient’s home with little or no support. For example, you’ll be expected to draw blood, provide Foley catheter care, and provide tracheotomy care all within the home. You must bring all necessary supplies with you and perform all tasks without assistance. Although this can be challenging, home healthcare nursing provides a degree of satisfaction not found in bedside nurses since you develop a care plan, execute the care plan, and know that your effort was a key factor in restoring the patient’s health.
There are advantages to being a home healthcare nurse:
–You make your own schedule. You determine when you visit your patients each day.
–You teach patients how to care for themselves.
–Improvement in the patient’s health is primarily because of the care you give to the patient.
–You get to use nursing skills that you may not use in the healthcare facility.
–You bond with each of your patients and their families.
–You take control of the situation based on your critical thinking skills
There are disadvantages to being a home healthcare nurse:
–You are on your own. There is little or no support.
–There is a lot of driving in all weather. You’ll visit four or five patients per day and they may not live near each other. You’ll use your own car.
–Your day is not over after you leave the patient. You have to provide detailed documentation, usually using computer-based software, on each visit. In some situations, 50% of your job is paperwork.
–You are always going into a stranger’s home and the home may not be in a safe neighborhood.
–Expect to be on-call several days a month.
–You may still have to work weekends and holidays.
Case Management
A case manager is employed by a healthcare facility to coordinate patient care among healthcare providers, insurers, other healthcare facilities, and resources that are available in the community. The goal is to ensure that the patient receives the most efficient and cost-effective level of care based on widely accepted medical protocols. Some case managers are also utilization managers whose goal it is to make sure all the assets of the healthcare facility are in use. For example, the case manager may refer the patient to the healthcare facility’s home healthcare service rather than to an outside home healthcare agency. Still other case managers focus on discharge planning, ensuring that the patient has proper follow-up care that will prevent the patient from returning to the healthcare facility for the same diagnosis shortly after discharge.
Case management is a critical factor in providing quality, cost-effective care because the case manager bridges the gap among care providers. They have an in-depth knowledge of the healthcare system. Each care provider has a defined scope of practice. For example, the primary care practitioner diagnoses and treats common illnesses and may refer the patient to a surgeon if the patient’s condition warrants it. Once surgery is completed and the surgeon determines that the patient has recovered, the surgeon discharges the patient from care and refers the patient back to the patient’s primary practitioner. However, the patient may require additional services such as rehabilitation, home healthcare, or need to be seen by another specialist. The case manager steps in to ensure there is continuity of care – and that care is acceptable to third-party payers.
Case managers work very closely with the patient, the patient’s family, the patient health insurer, and practitioners to make sure that quality patient care doesn’t fall through the cracks in care providers. Case managers also identify care paths that are least costly to the patient yet provide quality care. For example, the case manager may arrange for a patient to receive step-down care in another healthcare facility which is more cost-effective than in the patient’s primary healthcare facility. Likewise, the case manager may arrange rehabilitation services when the patient arrives home rather than sending the patient to a more costly rehabilitation facility.
There are advantages to being a nurse case manager:
–You ensure that patients receive quality care without duplication of tests and treatments.
–You reduce unnecessary medical expenses.
–You help patients and their families navigate the medical system.
–You learn the business rules surrounding medicine and health insurance.
–You are an advocate for your patients by discussing each patient’s case with insurers, practitioners, and healthcare facilities, and by directly arranging for patient care.
–You can work for insurers and healthcare facilities or work privately.
–There are no evenings, nights, weekends, or holidays.
–You develop your own contacts to provide continued patient care.
–You work with all disciplines.
–You are well-paid since you help the healthcare facility bring in reimbursements. You know the ins-and-outs of third-party payers.
–You use a wide array of interpersonal skills.
There are disadvantages to being a nurse case manager:
–Some patients may feel that you are being intrusive and working for insurers to make sure that they pay the lowest cost in lieu of receiving quality patient care.
–Patients may also feel that you are working for the healthcare facility to make sure that they receive the highest reimbursement while performing the least amount of patient care.
–You may find yourself working for the betterment of the healthcare facility rather than the patient since you are employed by the healthcare facility.
–You may have 28 or more patients to manage.
–You are the bearer of bad news to the patient, the patient’s family, and practitioners. You tell the patient and practitioner that the patient must be discharged to another healthcare facility or to home-based care due to the healthcare facility’s policy, and you relay reimbursement limitations of the patient’s health insurance. They may feel you are throwing the patient out of the healthcare facility.
–You are focused on costs vs. benefits. You have to prove that the extra expense is beneficial to the patient.
–You work at a desk focused on the phone and emails to get your job done.
–There are a lot of politics, business, and law involved in case management. These can get you in trouble if you do not adhere to them.
Nurse Practitioner
A nurse practitioner is a nurse who has completed advanced studies and passed licensing boards that permit the nurse practitioner to make medical diagnoses, order medical tests, and prescribe treatments and medications to patients. The nurse practitioner may or may not be able to work without a collaborative relationship with a physician depending on state regulations. The nurse practitioner’s practice is restricted to a specialized area of medicine such as family medicine. Additional training and licenses are required for the nurse practitioner to practice in another specialty.
A nurse practitioner can function as a nurse. However, it is important that the scope of the nurse’s practice is well-defined when hired by the healthcare facility. The nurse is hired as either a nurse or a nurse practitioner — not both. In a nurse’s role, the nurse works within the scope of a nurse and follow orders written by a practitioner. As a nurse practitioner, the nurse works within the scope of a practitioner — not a nurse.
The nurse practitioner takes on the same responsibilities as a physician. You diagnose the patient and order treatment. You are solely to blame if you’re incorrect. You may face malpractice claims and civil lawsuits if you incorrectly order the wrong medication or the wrong dose or overlook a serious medical condition. You can’t say, “I followed the doctor’s order” because you are the practitioner.
There are many advantages to becoming a nurse practitioner:
–You have autonomy because you take on the role of a physician in many settings.
–There is no bedside nursing. The nurse practitioner assesses the patient and writes orders that are carried out by the medical team.
–The nurse practitioner has full responsibility to identify and treat the patient.
–You may have a flexible schedule depending on your practice setting.
–Your work is less physically demanding.
There are also drawbacks to becoming a nurse practitioner:
–There are typically more opportunities for nurses than nurse practitioners, since one nurse practitioner can care for many more patients than a bedside nurse.
–There is increased competition for nurse practitioners since many nursing schools offer nurse practitioner programs.
–There can be bias against a nurse practitioner by the practitioners and by patients. Some practitioners see nurse practitioners as competitors who have less medical training than physicians yet are expected to perform the same tasks as physicians — reducing the need for physicians. Some patients refuse to be seen by a nurse practitioner and would rather be seen by a physician because they feel the nurse practitioner is unqualified to provide care.
–There is no residency program. Physicians must complete a three- or four-year residency program working under the mentorship of an experienced physician before they can work independently. Nurse practitioners have no such programs and therefore may lack that mentorship.
–The nurse practitioner may be assigned tasks that the physician doesn’t want to perform such as being on-call 24/7, hospital rounding, and follow-up assessment of patients.
–You may not recoup the expense associated with becoming a nurse practitioner when you consider tuition, nurse practitioner compensation, and the increased professional insurance coverage that you need.
Flight Transport Nurse
A flight transport nurse is an exciting career choice because you mix the fast pace of the emergency department with the thrill of airlifting critical care patients from the scene of an accident or natural disaster to the nearest trauma center. You are responsible for the care of the patient during the flight under the direction of a practitioner. Flight transport nurses are also involved in transporting more stable patients by air between facilities.
Flight transport nurses usually have years of experience in a trauma center, have worked as critical care nurses, and may have worked as paramedics in the field. You must be in very good physical condition and be able to quickly board and off-board the aircraft in less than ideal locations such as car accidents. You’ll be expected to carry emergency equipment and operate hoists used to lift the patient aboard the aircraft. Advanced Cardiac Life Support (ACLS) Certification, Pediatric Advanced Life Support (PALS) Certification, and Neonatal Resuscitation Program (NRP) Certification are necessary, along with the completion of nationally recognized trauma programs. These include: Transport Nurse Advanced Trauma Course (TPATC), Basic Trauma Life Support, and Pre-Hospital Trauma Life Support (PHTLS).
There are advantages to being a flight transport nurse:
–You are a first responder where your skills save the lives of critically injured patients.
–You work independently and are able to apply critical thinking to save lives.
–You learn to intubate, insert chest tubes, read x-rays, insert central lines, and learn to identify and treat life threatening problems.
–You are trained to handle any emergency condition in the field.
There are disadvantages to being a flight transport nurse:
–There are few jobs. Level I trauma centers usually have flight transportation services although in some states the state police provide such services due to the cost of aircraft maintenance.
–You work under dangerous conditions. There is always the risk of an air crash since the aircraft typically lands in areas other than airports (for example, highways or fields).
–You have minimal backup. You are the primary care giver and you must work within the confined space of the aircraft.
–There is limited growth potential other than returning to bedside trauma care. It is also difficult to change employers since few hospitals require a flight transport nurse.
Nursing Informatics
In nursing informatics, nurses take an active role in maintaining a healthcare facility’s electronic medical records (EMR) system. The nursing informatics nurse documents clinical workflows; modifies the EMR system to conform to existing workflows; writes training materials; trains staff; and oversees the implementation of the EMR system with the clinical staff. In doing so, the nurse directly interacts with all levels of administration and the clinical team in addition to the management information systems (MIS) department and vendors who supply the EMR system.
Nursing informatics requires formal computer training that focuses on systems analysis, database analysis, project management, and other aspects of computer science. Although the informatics nurse won’t be programming the EMR system, the nurse will be applying the EMR system to meet the needs of the healthcare facility. In some cases, this means adjusting the clinical workflows to meet requirements of the EMR system. In other cases, the nurse will use computer programs supplied by the vendor to modify the EMR system to conform to the healthcare facility’s clinical workflows.
You’ll probably require a BSN degree or an MSN degree focused on nursing informatics and several years as a staff nurse. Although the informatics nurse performs many of the same functions as an MIS systems analyst (non-nursing), healthcare facilities tend to prefer nurses in such a role because nurses have a broad knowledge of clinical operations and can easily identify the needs of the clinical staff.
There are advantages to being an informatics nurse:
–Every healthcare facility requires informatics nurses because Federal regulations require healthcare facilities to use computerized medical records.
–You use analytical skills to incorporate clinical workflows into the electronic medical records system workflows.
–You use your critical thinking skills to problem-solve with an EMR system.
–You can implement your own ideas to streamline clinical workflows throughout the healthcare facility.
–You become directly involved with all levels of administration and staff in the healthcare facility.
–You make the EMR system work for the healthcare facility and the clinical team.
–You train the clinical team on the use of the EMR system.
–You may be able to work from home.
–You may have a flexible schedule; however, expect to work long hours when you are on deadline for releasing an update to the EMR system.
There are disadvantages to being an informatics nurse:
–You must translate tedious regulatory requirements into clinical workflows that are incorporated into the electronic medical records system.
–You tend to get blamed by administration and the clinical team when the EMR system doesn’t work as they expect it to work.
–You are expected to fix all EMR system problems – problems that only the vendor can fix. The vendor can take months and years to make fixes.
–You have no contact with patients or with the clinical units.
–You will perform hours and days of tedious testing at your desk prior to releasing updates of the EMR system to the clinical team.
–You are blamed for delays in implementation that are beyond your control.
–You are likely to have difficulty explaining what causes problems with the EMR system because few members of administration and the clinical team understand the technical aspects of the system.
–You can lose your clinical skills.
Hospice Nurse
A hospice nurse cares for a patient who is in the final days of their life. Your goal is to make sure the patient and family members are comfortable and that all needs are met. You provide a blend of patient care and education explaining to the patient and the patient’s family what is happening. Not all nurses are cut out to work hospice, primarily because all your patients are terminal. Nothing you do will save their life.
You’ll work either in a healthcare facility that provides inpatient hospice care or provide at-home hospice care through a hospice agency. Many hospice patients are not geriatric patients. Many patients are middle-age and some hospice patients are children.
There are benefits to being a hospice nurse:
–You make a difference in the lives of your patients and their families.
–You advocate for your patients and families.
–You help the patient and family understand the end-of-life process.
–You help to bring a painless (as possible) death to a patient.
–You develop sensitive communication skills.
–You stay abreast of clinical skills such as pain management.
There are disadvantages to being a hospice nurse:
–All your patients are terminal. You build a bond with your patients – and then they pass away.
–The constant stress of facing death daily is difficult to balance with your personal life.
–On-call for home hospice patients requires you to travel distances to patients’ homes at any time.
–There is too much to do when multiple patients require your services at the same time.
–Providing care in the last stages of life in the home environment with little or no support can be unpredictable. You don’t have immediate access to supplies and the clinical team as you would in an inpatient hospice setting.
–There is a high risk for burnout.
–Conflict of roles may occur when the employer has you performing roles other than that of a hospice nurse, such as that of a case manager.
Infection Control Nurse
An infection control nurse is responsible for preventing the spread of infections in a healthcare facility by monitoring admissions, lab results, and daily assessments of patients to identify potential risks for infection. The infection control nurse is usually on-call to answer inquiries from staff nurses and practitioners about situations related to infection such as the proper handling of suspected infected samples.
Healthcare facilities are required to report results of this monitoring to regulatory authorities. This is also performed by the infection control nurse. If there appears to be an outbreak of infection, the infection control nurse implements measures to identify the source of the infection and contain, treat, and monitor the affected area of the healthcare facility. On an ongoing basis, the infection control nurse makes rounds on units, educating staff on infection control prevention methods and observing if those preventive measures are being properly implemented. The infection control nurse also coordinates with vendors on the proper procedures for sanitizing vendor equipment.
There are advantages to being an infection control nurse:
–You are the first responder to identify and contain infections within the healthcare facility.
–You play a critical role in keeping patients and staff safe from hospital-acquired infections.
–You gain a vast knowledge of infectious agents and how to prevent the spread of infections.
There are disadvantages to being an infection control nurse:
–Most of your time is spent in your office gathering and reporting statistics about infection.
–At times you are more of a coordinator between regulators and the healthcare facility rather than actively preventing infections.
–Staff may see you more as an “inspector” looking to catch their errors rather than as a colleague in a mutual effort to prevent infection.
–You will lose your bedside nursing skills.
Military Nursing
Military service offers the opportunity for nurses to gain a unique experience that can be transferred to civilian nursing. Military nurses work in military hospitals and may be deployed to the field in times of conflict to care for soldiers who are ill or wounded. Nurses provide the full breadth of nursing care in the military – trauma care, urgent care, acute care, primary care, and rehabilitation. Care is provided in military installations both abroad and in the United States.
You’ll need to pass a background check that results in security clearance so you can be deployed around the world. You also must have no felony convictions, pass a physical, and meet age requirements. You’ll need at least a BSN to be a commissioned officer with some experience as a nurse. You need to be a United States citizen; although nurses who are legal residents of the United States may also be eligible. You also have to agree to be a military nurse for at least three years.
You may choose to be an active-duty nurse or a reserve-status nurse. An active-duty nurse is full-time and can be deployed anywhere at any time. A reserve-status nurse is a part-time nurse (after the initial active-duty period) and usually participants in military functions on one weekend per month and for two full weeks per year. However, the reserve-status nurse can be called up for active duty at any time during an international conflict.
The U.S. Navy Nurse Corps services both the Navy and the Marines. At times you may be deployed at sea on a ship. The Air Force offers the opportunity to become a flight nurse. Expect a vast cultural change once you join. The military is highly structured and follows a very formal process. You are a soldier first, then a nurse.
Expect a long work week especially in MEDCEN (the United States Army Medical Center), which are large military hospitals.
You may qualify for an educational loan repayment program. Read the fine print and don’t assume full loan repayment. You may be responsible for interest payments and any taxes associated with the educational loan repayment.
There are advantages to becoming a military nurse:
–You are a commissioned officer.
–You may be able to continue your nursing education at the expense of the military.
–The military usually employs cutting-edge medical technology that you’ll be trained to use.
–You get to travel, although not as a tourist.
–Usually you have a 30-day paid vacation annually.
–Nurses may command an entire military healthcare facility. There are disadvantages to becoming a military nurse:
–Military nursing may be unpredictable because the military assigns you to a job and decides where you are going to live during a deployment period. You may be away from your family for 12 months or more.
–You may be called into harm’s way treating soldiers who are involved in armed conflicts around the world.
–Avoid joining under enlisted (non-officer) status. Enlisted nurses are usually assigned as hospital corpsmen with a civilian nursing license – not as a nurse. There is usually little free time to continue your nursing education and the pay is low.
–Don’t believe everything the recruiter tells you. The recruiter cannot guarantee you anything once you join the military.
–Commissioned officers pay for their own food, uniforms, and have other out-of-pocket expenses not incurred by enlisted personnel.
–You’ll need to join as enlisted personnel if your academic credentials are no higher than an associate’s degree and the same is true if you have less than an RN license, and you won’t work as an RN. Officers must be an RN with at least a BSN.
Nurse Educator
A nurse educator is an experienced nurse who is responsible for developing curriculum and educating nurses on nursing-related subjects. Education takes place online, in the classroom, using computer-based simulations, and in the clinical setting. Schools of nursing employ nurse educators as faculty members in pre-licensing and post-licensing programs. Healthcare facilities employ nurse educators to develop and implement nursing orientation programs, annual competencies, in-service training, continuing education, and provide remediation as part of disciplinary action.
You’ll be updating curriculum based on current regulatory requirements and translating the curriculum into training material, online courses, classroom presentations, and clinical training — and you’ll be teaching in the classroom and clinical setting. You’ll implement testing procedures that identify if nurses are able to understand and implement curriculum. You’ll also develop remediation for nurses who fail.
Schools of nursing and healthcare facilities typically require a nurse educator to have completed an MSN (master of nursing) degree, hold board certification in their specialty, and have several years of experience in their specialty. Healthcare facilities may accept a nurse who is working toward an MSN. You must be a leader and be comfortable speaking before groups of strangers. Good presentation skills are critical to the success of a nurse educator. You should be well-versed in the use of presentation software since you are expected to create your own presentations.
In a healthcare facility, you may be responsible for clinical education for a division of the healthcare facility or for a number of clinical units. You’ll be expected to make sure that the clinical staff has completed all necessary training, and you must provide documentation to support your findings should regulatory authorities audit those units.
Schools of nursing usually offer part-time teaching positions, referred to as ‘adjunct.’ This is worth exploring as a way to see if you like teaching. You’ll be responsible to teach either a lecture or clinical course for an academic term. Pay is minimal. There are usually no benefits. If you like teaching, then you may want to consider working as an adjunct and keep your full-time nursing job.
There are advantages to being a nurse educator:
–You mentor new and current nurses.
–You keep your nursing skills current and provide training that keeps other nurses current with their skills.
–You help correct clinical problems.
–You have no work on weekends or holidays.
–Usually you work a day shift except when in-service training is scheduled for off shift (healthcare facilities).
–Schools of nursing require a minimum number of classes to teach (for example, 24 credit hours), specific office hours, and committee assignments. You work during the academic year (that is, 10 months).
–Nurse educators in healthcare facilities typically have broad responsibilities to create and maintain training for all clinical staff, including managers, and advise on facility-wide policies and procedures.
–Nurse educators in healthcare facilities may also serve as mock auditors surveying clinical units prior to regulatory audits.
–You have autonomy in both schools of nursing and in a healthcare facility as a nurse educator.
–You have minimal patient care. You directly supervise nurses during in-service training (healthcare facility) and clinical rotation (schools of nursing).
There are disadvantages to being a nurse educator:
–Schools of nursing may offer lower salaries compared with a clinical nurse who holds an MSN.
–Schools of nursing may require faculty members to perform research and publish frequently to maintain employment. Expect to work during school breaks and vacations without additional compensation.
–Your assessment may determine if a nursing student becomes a nurse or a current nurse continues employment due to possible incompetence.
–You’ll be expected to manage multiple assessments (for example, orienting multiple nurses, teaching classes, performing in-service training, and preparing curriculum) simultaneously.
–Minimal patient care can lead to you to lose your nursing skills.
–The job requires a lot of prep work.
–You are fully responsible for patient care during clinical rotations in pre-license programs (schools of nursing).
Legal Nursing
A legal nurse assists the legal system in interpreting medical records; helps attorneys interview clients related to medical issues; and collaborates with the legal staff on strategies for legal actions related to a client’s medical condition. No advanced degree is required although you should hold a Legal Nurse Consulting certificate and have several years of staff nurse experience. Experience in nurse management is a plus.
A legal nurse consultant typically participants in personal injury cases where the nurse reviews medical records, treatments, and other technical aspects of the case and compares it to standards of practices. The nurse then advises attorneys whether or not actions of the medical team conformed to standards of care. The nurse’s assessment provides a foundation for building a case, formulating deposition questions, and determining if cases should be settled or go to trial.
There are part-time and full-time opportunities for a legal nurse consultant. The nurse participates in interviews with clients, conducts medical literature searches, identifies a timeline of care, educates the legal staff on medical issues, and may serve as an expert witness during a case.
There are advantages to being a legal nurse consultant:
–If you work as an independent legal nurse consultant:
○You set your own work schedule.
○You can keep your clinical nurse position.
–If you work on an in-house staff:
○You receive a regular salary and benefits.
○You have regular working hours — no weekends, plus holidays off.
○It’s possible you receive a bonus
There are disadvantages to being a legal nurse consultant:
–If you work as an independent legal nurse consultant:
○You must constantly market yourself to attorneys.
○Your clinical nursing employer may frown upon your legal nurse consulting activities.
○You must always be available to be deposed by your attorneys and the opposing party’s attorneys.
○You will likely have to testify in court and be held responsible for your testimony.
○You must meet with potential clients (that is, attorneys) without pay to sell your services.
○You may wait to be paid after providing services. You don’t get a regular pay check.
–If you work on the in-house staff:
○You receive no overtime pay.
○You have no flex time. You are expected to work normal business hours.
○There are few full-time in-house staff positions available.
Forensic Nurse
Forensic nurses work with patients who are involved with the court system either as a victim or as a detainee. Some forensic nurses respond to emergency situations providing care to crime victims, such as victims of rape, abuse, domestic violence and neglect. These nurses collect evidence that can be used in investigations and criminal trials. Another type of forensic nurse works in jails and prisons providing first-line medical care to detainees. There are situations when the forensic nurse also collects evidence when providing first-line medical care, should the detainee become a victim within jail or prison.
You’ll need the emotional stability to work with victims immediately after they have been traumatized and be able to work within the jail and prison systems if you provide care to detainees. You must have good nursing skills as a staff nurse and be trained and certified to collect evidence. The legal case against a perpetrator depends on correctly gathering evidence from the victim.
There are advantages to being a forensic nurse:
–You directly comfort crime victims in their time of need.
–You collect evidence that is key to building a case against the perpetrator.
–You typically work for a government agency such as the Sheriff’s department, although some forensic nurses work for hospitals that are designated trauma centers.
There are disadvantages to being a forensic nurse:
–You are on-call and respond to either the scene of the crime or at the trauma center.
–Your patients are either crime victims or detainees who are incarcerated.
–You may work within the jail or prison system daily where your safety is a concern if you care for detainees.
Utilization Review Nurse
A utilization review nurse ensures that care provided to patients is covered by third-party payers and results in the cost-effective treatment of patients. The utilization review nurse is assigned several patient care units in a healthcare facility. The utilization review nurse monitors and works closely with the patient’s case manager, treatment team, and third-party payers to be sure treatment conforms to third-party payer’s guidelines and that treatment is supported by pre-certification where required and documentation of need and results.
The utilization review nurse also follows up with third-party payers to address any denial of payment. The goal is for the utilization review nurse to take action that ensures payment from third-party payers is received in a timely manner both as care is being provided and for care that has previously been provided by the healthcare facility.
You’ll need several years of bedside nursing and need to master the business of reimbursements. In addition, you’ll need excellent verbal and written communications skills, be comfortable using electronic charting software, and be detailed oriented. You’ll need to interact with the case manager, treatment team, healthcare facility administrators, and insurers.
There are advantages to being a utilization review nurse:
–You are on the first-line to prevent financial losses to the healthcare facility by making sure that requirements of third-party payers are met prior to treatment.
–You recommend changes in procedures within the healthcare facility to ensure every opportunity is taken for reimbursement.
–You are the person who provides additional information to convince insurers to reconsider denial of payment.
–Your skills are transferable to other healthcare facilities and health insurers.
–You don’t work weekends or holidays.
–There is potential to work from home.
–You get to work independently.
There are disadvantages to being a utilization review nurse:
–You may feel like the person in the healthcare facility who denies care to the patient because you transmit requirements for reimbursements to the case manager, treatment team, and the healthcare facility’s administration.
–You work in an office and review charts all day. There is no patient contact.
–You lose your bedside nursing skills since you provide no patient care.
–You must learn the details of reimbursement requirements for many third-party payers.
–You will potentially have a heavy workload.
Telehealth Nursing
A telehealth nurse is hired by a health insurer to assist patients over the phone by answering health-related questions, assessing the patient’s needs, and directing the patient to the proper level of care. Telehealth nursing is also used to help chronically ill patients manage their diseases. The telehealth nurse is a triage nurse and not a replacement for a practitioner. The goal is for the patient to efficiently receive medical help.
The telehealth nurse should have several years of bedside patient care experience and experience in the emergency department as a triage nurse. You’ll need to be comfortable communicating with patients over the phone, asking pertinent medical questions that help to direct the patient to the proper level of care or providing home or over-the-counter remedies that will address the patient’s immediate needs.
There are advantages to being a telehealth nurse:
–You work independently.
–You don’t work weekends or holidays until you agree to be on-call during those shifts.
–You have the possibility of working from home.
–You assist patients and address their immediate medical needs.
There are disadvantages to being a telehealth nurse:
–You make recommendations without seeing the patient.
–You lose your bedside nursing skills.
–You are unable to perform a complete assessment (for example, vital signs).
–The patient may feel your recommendations are in the best interests of the insurer and not those of the patient since you work for the insurer.
School Nursing
Public and private schools, including colleges, are required to have a nurse on staff to respond to general health issues and accidents. The school nurse typically maintains medical records of students and staff; administers or oversees administration (actually performed by the student) treatments ordered by the practitioner, such as inhalation treatment for acute asthma or insulin injections; and performs triage. In some instances, the school nurse also teaches health related classes.
School nurses may require a special state certification. You must like working with children of all ages, including high school students. Each age group has their own unique needs and challenges. And you must like working with parents. You’re the person who notifies a parent when their child has taken ill in school and must care for the child until the parent arrives at the school.
There are advantages to being a school nurse:
–You work during the school day and school year and are usually off during the summer months and during inclement weather.
–There are no weekends, holidays, or evenings.
–You may receive tenure after three years of work, depending on the school district.
–You may have the same schedule as your school-age children which eliminates the need for after school childcare.
–You work relatively independently.
–You directly help children and their parents.
There are disadvantages to being a school nurse:
–You are limited in the care that you can give to students. Some states limit you to performing first aid.
–You lose your bedside nursing skills.
–You have no support since you are usually the only school nurse on duty in the building.
–Dealing with some parents can be challenging.
Cruise Ship Nursing
If you like cruising, then you may want to explore becoming a nurse aboard a cruise ship. Cruise ship lines frequently require onboard nurses to have emergency department experience to assist the ship’s practitioner in managing onboard emergencies. The small cruise ship medical team provides first-line medical care to passengers and crew once at sea. Typically, cruise ship nurses sign a contract for several months (for example, 6 months). The contract is likely renewable by either the nurse or the cruise ship line at the end of the contract period. Staff may take off a couple of months between contracts.
You are expected to have at least three years nursing experience in emergency medicine or acute care since you are expected to handle all first-line medical care, along with the medical team. You’ll be expected to work the clinic from 8 a.m. to 11 a.m. and from 3 p.m. to 6 p.m. and be on-call outside clinic hours. Depending on the cruise line, you may have a private cabin and will have free food and uniforms. You are paid twice a month (usually) in U.S. dollars. Federal taxes are automatically deducted for U.S. citizens and residents. You will have out-of-pocket expenses purchasing items from the crew shop.
There are advantages to being a cruise ship nurse:
–You’ll have time to visit ports-of-call when the ship is at dockside.
–You can take shore excursions at discount prices when space is available.
–There are crew activities onboard (for example, parties, tournaments).
–There is usually a crew gym and crew bar.
–You can use the onboard spa and hair salon at discount prices.
–You and your family may take advantage of discount cruises, if available.
–You are one of the ship’s officers.
There are disadvantages to being a cruise ship nurse:
–You are not on a cruise and have limited or no access to passenger accommodations.
–You may not choose your assignment. Assignments to specific cruise ships are made based on business needs.
–You may have to pay a per-minute fee for Internet access even if you bring your own computer.
–Cell phone service is usually available onboard but international roaming rates apply.
–You can make long distance calls at your expense.
–There is no guarantee that you’ll be offered another contract.
Medical Sales Representative
Medical device and pharmaceutical manufacturers employ nurses to represent their products to the medical community. The medical sales representatives visit practitioners in private offices and in healthcare facilities to explain the technical advancement of products that can improve the quality of patient care. The goal is to make direct or indirect sales. Direct sales are when the medical sales representative places an order. Indirect sales occur when the medical sales representative influences the decision to use the product, such as a when a practitioner prescribes medication that was presented by the medical sales representative.
Nurses usually make good medical sales representatives because the nurse has the clinical background to relate how the product actually helps the provider take better care of the patient. Nurses are particularly successful when describing products that are used by nurses such as wound care products, syringes, and IV catheter products.
You must have excellent communication skills and have a confident outgoing personality to walk up to a stranger (perhaps a practitioner) and tell her how your product will improve her practice – and she may have little or no time to listen to you. You’ll also require a good sense of business, which is not normally found in bedside nursing. Your job is to sell your products.
There are advantages to being a medical sales representative:
–You create your own work hours as long as you meet your sales goals.
–Your compensation is based on performance. Generally, the harder you work the more money you earn.
–You develop professional relationships with healthcare providers.
–You have autonomy to run your own territory and “your own” business within the organization.
–You have the feeling of accomplishment by selling products that can change a patient’s life
There are disadvantages to being a medical sales representative:
–There are risks of layoffs due to the volatility of the industry.
–Unrealistic performance expectations may lead to termination if you fail to meet your sales goal.
–There is a trend by firms to decrease financial incentives for meeting or exceeding sales goals.
–You limit growth within your territory because your focus is on price rather than quality that requires a higher startup cost.
–Consolidation and mergers of competitors limits your employment opportunities.
–There can be too much company politics focused on the bottom-line and not on patient care.
Nursing is a unique profession. There are many different opportunities available to a nurse. If you find yourself pigeon-holed into one nursing specialty, you can always move into a more interesting specialty by taking a few courses then honing your new nursing skills into a fully competent nurse in your new specialty. The challenge is to move outside your comfort zone and test the waters in a new specialty.