With more than 100 specialties available to nurses, the initial choice of nursing as a profession for most is just the first of many they will make throughout their careers. Whether the profession is facing a time of vacancies and shortages or low turnover and no openings, options are always available for nurses to move from one specialty to another. The profession continually becomes more specialty-focused as nurses hone new skills and move their careers forward, perhaps opting to transition to a new specialty along the way.
Heres what nursing leaders in ambulatory care, case management, informatics and perioperative nursing have to say about who moves where and why, as well as characteristics RNs possess who thrive in these specialties and what they can do to prepare for the transition.
Ambulatory care: Build strong patient bonds
Denise C. Brenner, BSN, RN, CWCW, nurse manager of ambulatory services, Morristown (N.J.) Medical Center, said nurses who transition more easily to ambulatory care have at least two years of inpatient nursing. She finds the experience provides a good foundation to sharpen assessment skills and develop a basic understanding of patients acute conditions and their continuity of care.
Home care RNs also are more comfortable in ambulatory care, she said, since they have been trained to think independently, case manage the patients comorbid conditions and collaborate with multiple specialties to facilitate the patients independence.
Brenner said those interested in moving to ambulatory care must understand the role is not easy. It takes dedicated individuals who are willing to work with patients and their families long term, she said. There is emotional involvement that can tug at our hearts because of the closeness we develop with our patients over time. Reciprocally, the closeness we develop with our patients is quite rewarding and can directly impact the positive outcomes for our patients.
She added ambulatory nurses need to be persistent when following their patients and maximizing adherence to their regimens. It takes patience, compassion and an ethical approach to care, and our awareness of healthcare diversity and literacy are crucial to the quality of care we provide, she said.
In the outpatient setting, nurses often are challenged by the fine balance between patient care and fiscal responsibility, when the patients health coverage often mandates the care nurses are able to provide to them. Many times MMC nurses take on the mission of researching and linking patients to charitable opportunities to access care and treatment essential to improving the patients health status when their coverage does not meet the need, according to Brenner.
She said its helpful when we can link the nurses other experiences to the specific ambulatory area they would like to transition to, and additional education or certifications always help in determining the best fit for the department.
Brenner recommends nurses in ambulatory care pursue case management certification, because it gives them expertise in managing all aspects of the patients needs following hospital discharge and increases their awareness of continuity of care.
Those interested in the clinical aspect of nursing can follow a clinical path as an NP or APN and those more interested in the operations of the ambulatory setting would benefit most from the nursing leadership pathways, she said. There are a variety of different degrees in healthcare administration, community health and public health that help ambulatory nurses advance their careers.
Case management: Follow patients progress
If you like to problem-solve and have excellent critical and creative thinking skills, then case management may be a good career path, said Colleen Morley, MSN, RN, CMCN, ACM, director of case management, St. Bernard Hospital, Chicago. For anyone who ever wondered on a regular basis how the patient fared after discharge, the specialty is definitely for them, she said. Depending on the setting, you can see a patient progress from acute to post-acute through recovery and be a part of that continuum of care.
Morley has worked in a number of settings where the RN case management role varied greatly. In some places, the RN primarily does utilization review and discharge planning with social workers providing support for social issues. In other places, the social worker is responsible for discharge planning and the RN case manager provides clinical support, expertise and runs interference with the payer to expedite services, Morley said. RN case managers also are involved in community outreach to ensure patients and families with clinical questions do not get lost in the call back shuffle.
It has been said RNs with ICU and ED background have excellent critical thinking skills that apply well to the utilization review portion while RNs with med/surg background seem to handle the larger caseload better, she said. But theres really no magic formula or standard for which specialty is best for CM or how many years of experience you need. Case management requires a love of learning, the ability to change and adapt on a moments notice, excellent organizational skills and dedication to the best outcome for the patient, according to Morley. The best person for the case manager role is someone who can think outside the box while staying inside the lines demarcated by the payer/patients resources; one who not only has a plan A or B, but also a plan Q, R and S, just in case; one who can build relationships with community resources and is always learning about what services are available, just in case, Morley said.
Morley recommends nurses exploring CM as a career path shadow a case manager in the setting they prefer. She also suggests they talk with nurses at their local CM professional organization about what they do and how they do it. If CM is available at their workplace, Morley suggests they seek out a few case managers and get together with them.
Certifications are available from a number of organizations, some based on the practice setting of the case manager, according to Morley. She finds the professional organizations for case management to be excellent sources of continuing education at all levels of practice.
Informatics: For the techno-savvy
Nursing informatics is an ever-changing and exciting specialty, but no two days are alike, and some find that appealing, while others find that challenging, said Ellen Pollack, MSN, RN, chief nursing informatics officer, UCLA Health, Los Angeles.
At UCLA, about 20 nurses work in the specialty in roles such as optimization and workflow specialists, analysts, decision support, clinical content, training, service desk, adoption and innovation. They are experienced RNs who help to ensure new technology or enhancements to current technology support patient care and help clinicians function as efficiently and safely as possible.
A challenge, however, is finding nurses who are experienced clinicians, fluent with new and emerging technology, effective change agents and innovators, Pollack said. Nurses who have successfully transitioned to informatics thrive on change, have an interest in continuous learning and possess strong leadership and project-management skills, she said.
We have nurses who have come from a variety of specialty areas which helps ensure our team has a broad understanding of the user experience and our clinicians needs, Pollack said. We also have a few nurses who came from IT backgrounds before becoming nurses and have found a way to merge those two careers in a meaningful way.
Many nurses on the UCLA informatics team started out as super users (individuals who are trained first and serve as resource people in their practice areas), and Pollack suggests nurses volunteer to become super users, if interested in the specialty. That way they can get to know the informatics team and can gain experience implementing or optimizing EHRs (electronic health records) or other computer systems, she said.
She also recommends nurses attend conferences, such as the ones offered by the American Nursing Informatics Association, to network and learn more about the field and participate in committees or work groups focused on optimizing EHR.
One of the participants of our optimization committee will be providing coverage for one of our nurses who is going out on maternity leave, Pollack said. If she wasnt a member of this committee, we wouldnt have had the opportunity to get to know her skills and abilities.
At UCLA, a bachelors degree is required for informatics positions, however a masters degree is preferred, and a number of advanced practice nurses work in IT. Certainly, getting a masters degree in nursing informatics is very helpful, but for those who have degrees in other areas, certification is a good option, Pollack said. Several UCLA nurses are preparing to sit for the ANCC Nursing Informatics certification.
Perioperative: For high-energy nurses
While OR is a highly sought-after specialty, its not one RNs can just walk into, said Marty Higgins, MS, RN, NE-BC, director of surgical services, The Medical Center of Plano, Texas, who has worked in the OR for about 30 years.
Working as a labor and delivery nurse for five years after graduating from school did not prepare her for the OR. You cant pair up with a buddy and become an independent OR nurse, she said. You need a good training program or internship.
OR nurses like to care for one patient at a time, want to be challenged and stimulated and are drawn to the latest and greatest technology, she said. Good nurses in the OR can handle stress, have high energy, can think critically, prioritize, multitask and, basically, never stop, she said, and that could mean it might be a nurse coming from the ED, ICU, med/surg or another specialty.
Preop nurses, on the other hand, must possess great communication skills, because they constantly teach and affirm and reaffirm information with patients and families, and PACU nurses must have excellent assessment skills, according to Higgins. Previous ICU nurses thrive in the PACU setting because they are very comfortable monitoring patients and intervening when needed, she said.
Higgins added well-honed time management and organizational skills are crucial in preop and PACU, because both have high-patient volume and constant patient turnover. The two settings are in high demand with a low RN turnover, because they offer nurses the type of nursing practice they prefer and more regular schedules, even though there is on-call scheduling in the PACU.
Higgins advises nurses interested in periop to spend at least one to several days observing in the setting to make sure they understand what the role entails. It really gives you the best picture of what the OR, preop or PACU involves, and you can see firsthand that the OR really is a different world than anywhere else in the hospital, she said.
Since the PACU requires more advanced critical care skills, new nurses generally arent hired there, and Higgins recommends RNs develop those skills in another setting and become ACLS-certified. Because the preop setting is not as skill-driven, a nurse who has good med/surg skills can transfer more easily to the preop area.
Higgins encourages all of her periop nurses to be working on their bachelors, if they dont already have it. Certification in the field is important, but to sit for the CNOR you must have two years of periop experience, she said.
And she has words of wisdom for all nurses who are hoping to move to any new specialty. Theres nothing like sheer drive in the process of transitioning to another specialty. If you want to move, you can find a way, Higgins said.