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 Exploring nursing as a career
Nursing Specialties A common thread of compassionate care, clinical skills and broad-based knowledge runs through the nursing profession. Yet, despite this fundamental commonality, the experiences of individual nurses can vary widely depending on the specialty in which they practice. Nursing specialties continue to evolve as we acquire new knowledge and technology to treat illness and maintain health. Some of the most common nursing specialties are described in the headings that follow. With the exception of the heading “Medical-Surgical Nursing,” the content is reprinted with permission from The American Nurse.
This is the largest nursing specialty found in the hospital setting. Nurses who work in the medical-surgical setting care for a wide variety of adult patients. They work on the general units that you find in every hospital, caring for patients with respiratory, orthopedic, cardiac, neurological, gastrointestinal and many other health problems who are in the hospital for medical treatment or surgical intervention. The demands placed on these nurses are great – they not only care for their patients and administer medications and treatments, but they interact with their physicians and other health care providers to coordinate overall care. The knowledge base of these nurses requires a broad understanding of many different types of health problems and skill with a wide variety of nursing interventions.
“Help, my wife is having a baby in the parking lot!” “This is Anytown Ambulance, we are four minutes out with an adult male victim of a motorcycle crash who is in full arrest.” These and more are phrases heard everyday in emergency departments (EDs) across the country. Emergency nurses have to be ready to deliver care to patients with almost any imaginable physical or emotional problem, and at acuity levels ranging from benign to life-threatening. It’s a specialty full of challenges with very few dull moments. An emergency nurse must have excellent assessment skills, be able to multi-task, and be skilled at technical procedures all while being an assertive patient advocate and providing emotional support to the patient and family. Stamina, a sense of humor and a large bladder are essential characteristics. Emergency nurses also function in many non-ED settings. Telephone advice, poison information, air and surface transport, pre-hospital care, trauma coordinator, pediatric ED, case manager, EMS liaison, urgent care, and injury prevention/community outreach are all subspecialty roles of emergency nursing. Like out nursing colleagues in all specialties, we practice with our hands, our hands and our hearts. Our heads to assess the patient with simple sprained ankle who is actually a victim of domestic violence. Our hands to cut the cord of the baby we deliver in the parking lot. Our hearts to comfort and support the family of the victim of a motorcycle crash.
For more information about
emergency nursing, contact the Emergency Nurses Association at (800)
2GET-ENA or go to www.eng.org
Jean A. Proehl, MN, RN, CEN, CCRN, is president of the Emergency Nurses Association. As a certified registered nurse anesthetist, about 70 percent of my practice is at an ambulatory surgical center specializing in cataract surgeries. I may perform as many as 27 ocular anesthetics a day, which often allow me to combine compassion with science. Recently, a robust, 65-year-old patient who suffers from severe claustrophobia broke out in a cold sweat and turned pale when told that a sterile drape would be placed over his face just prior to surgery. After conducting a thorough pre-op assessment, the patient and I discussed his concerns at length. I assured him that we would provide ample space under the drape so he could see his toes, but his sweating continues. I told him that we would provide some extra oxygen, blowing a cool breeze by his face, but his color did not improve. I promised that I would give him some sedation and hold his hand if necessary.
When the patient arrived for his surgery, he looked like a deer
caught in the headlights! I
started his IV and sedated him with Midazolam, but it barely had an effect.
I gave him Methohexital just prior to his peri-bulbar block.
He tolerated the block well, so we headed down to the procedure room.
I put my arm around his shoulders and once again reassured him that
he was going to be fine. Before
draping his face, I gave him a little more Midazolam.
I turned on the oxygen breeze and held his hand.
In this fashion, the patient was able to tolerate his surgery and
have his vision restored.
I believe it is the combination of compassionate nursing skills and
the art and science of anesthesia that allowed the patient to successfully
complete his surgery. When he returned two weeks later for surgery on his other
eye, much of his fear and anxiety had disappeared. For more information on nurse anesthesia, contact the American Association of Nurse Anesthetists at (847) 692-7050 or go to www.aana.com. Jay Horowtiz, CRNA, is a partner key Anesthesia, Sarasota, Fl. by Patricia C. Seifert, MSN, RN, CNOR, CRNFA Perioperative nurses work in hospital surgical departments, day surgery units, clinics and physician’s offices. Relied upon for their professional judgment and critical-thinking skills, they typically work closely with the surgical patient, family members and other health care professionals by planning, implementing and evaluating treatment of the patients. During surgery, the perioperative nurse may serve as a scrub nurse – selecting and handing instruments and supplies used for the procedure; as a circulating nurse – managing the overall nursing care in the operating room and helping to maintain a safe, comfortable environment; or, with additional education and training, as an RN first assistant – delivering direct surgical care by assisting the surgeon in controlling bleeding, providing wound exposure and suturing. Perioperative nurses also may work as an OR director, managing budgets, staffing and other business aspects of the operating room. Some perioperative nurses may later consider a career in business as a management consultant, clinical educator, researcher or medical sales professional. With advanced education and training, some perioperative nurses elect to pursue the role of a nurse anesthetist. As a manager for cardiac surgical services, staff nurse and registered nurse first assistant, I’ve always enjoyed the flexibility of my perioperative experience – learning new skills, working with new technologies, collaborating with colleagues both inside and outside the OR arena and contributing to the well-being of the surgical patient. For more
information on perioperative nursing, contact the Association of
periOperative Registered Nurses at (800) 755-2676 or www.aorn.org. Patricia C. Seifert, MSN, RN, CNOR, CRNFA, is president of the Association of periOperative Registered Nurses. by
Judy Harrigan, MSN, RN Today there are children attending schools who have complex health needs that would have prohibited their attendance at school just a few years ago; who have chronic illnesses that must be managed during the school day; who are using alcohol or other illegal substances; who are sexually active; who are or will become pregnant or are parenting their own children; who are using violence to deal with differences with their peers and are carrying weapons in order to feel safe; who have potentially fatal communicable diseases; who come to school without breakfast or lunch; whose parents are too exhausted, spaced out or busy to properly care for them; who wear keys around their necks and go home to an empty house every day; and who have no health insurance and only receive their health care in emergency rooms or school health offices. The role of the school nurse has changed extensively in the past 20 years. School nursing practice required comprehensive pediatric, public health and mental health nursing skills. The school nurse practices independently and provide acute, chronic, episodic and emergency health care, assessment of the health status of students, including identification of health problems that may affect educational achievement, development of nursing care plans that must be implemented in the school setting, administration of medications, assessment of the school environment and contributions of health-related information to community-at-large. In addition, school nurses provide health counseling and health education for students and families, advocate for students with disabilities, provide wellness programs for school employees and are involved in program planning, development, management and evaluation. For more
information on school nursing, contact the National Association of School
Nurses, Inc, at (207) 883-2117 or www.nasn.org. Judy Harrigan, MSN, RN, is education coordinator at the National Association of School Nurses, Inc. by
Kimberly Brown, MSN, RN, CEN “Christmas Eve and freezing rain, not a good combinations,” I pondered as I headed through the doors to the ICU. “You have an 80-year-old head trauma on the way,” called out my charge nurse. A gurney steered by two nurses crashed through the doors. I observed Mrs. B., a tall, slender woman, with silver hair matted with blood. Her decerebrate posturing violently shook the gurney. As we prepared to transfer her, I noticed a polka-dot tote bag filled with festively wrapped presents. The neurosurgeon on duty quickly inserted a ventriculostomy. Mrs. B.’s ICP (intracranial pressure) was extremely high. A CT done earlier in the Emergency Department showed multiple inoperable sights of intracranial hemorrhage. The next hour was spent inserting lines, checking vital signs and providing pharmacological and respiratory support. By the time her husband arrived, all of Mrs. B.’s movement had ceased. Mr. B. walked without pausing to her side and cradled her pale hand with both of his. A minister, he had been interrupted in the middle of his Christmas Eve service with news of his wife’s accident. She had been delivering presents to the bed-ridden members of the congregation when the bus from which she had disembarked hit her. They had just celebrated their 62nd wedding anniversary.
Mrs. B. died on Christmas morning.
Mr. B. allowed us to cry with him as decisions were made to donate
her organs and remove life support. I
knew we had done all technologically possible to save Mrs. B.
I also knew that the extra hours on the ventilator gave Mr. B. a
chance to say goodbye to his beloved. I
ached for this man’s loss. However,
I would never trade the privileged place that critical care nursing allowed
me to have in the lives of these two people. For more
information on critical care nursing, contact the American Association of
Critical of Critical Care Nurses at (800) 899-2226 or go to www.aacn.org. Kimberly Brown, MSN, RN, CEN, is a clinical practice
specialist at the American Association of Critical Care Nurses. As clients leave our program for the day, I know that some leave with a sense of renewed hope, others are wondering where to find the will to move on and a few leave angry at themselves and the world. For many, the required program attendance is viewed as just one more thing out of their control. While staff is sometimes the target of displaced anger and resentment, we are the lifelines to reintegration with families, the community and the workplace. The process of recovery from mental illness can be slow, and clients are in need of hope and reassurance. Helping individuals understand the progress often involves changing lifelong patterns is not easy. I can teach them the tools they need, but one of the challenges of psychiatric nursing is helping clients realize that they are the ones who must put those tools to use. I assist patients in developing readiness and plans for follow-up care. There are days when I need to remind myself that working with insurance and managed care companies is an important service I provide for patients, particularly given the complexity and frustration associated with such systems. I serve as a voice for patients in a world that at times seems less concerned about a person’s well-being than about the financial bottom line.
As I prepared to leave work for the day, I hear a knock. I look up to see a man standing in the doorway of my office.
He smiles and says, “Remember me? I wanted to stop by and say
thanks for helping me live life again.”
I do remember him, but gone is the furrowed brow and the sullen voice
of despair. I like to think I
had a part in helping him find the glimmer of hope that is now the sparkle
in his eyes. For more
information on psychiatric-mental health nursing, contact the American
Psychiatric Nurses Association at (202) 857-1133 or go to www.apna.org. Kristeen Watson, RNC, is a member of the American Psychiatric Nurses Association and a certified psychiatric-mental health staff nurse and coordinator of the Intensive Outpatient Program of Behavioral Health Services, Mary Greely Medical Center, Ames, IA. by
Gail Lynn Sims, MSN, RN, CRRN Rehabilitation nursing is a specialty devoted to assisting individuals of all ages and cultural backgrounds to accomplish the tasks of daily living to their greatest potential and return to their premorbid (pre-illness) lifestyle. This specialty offers the opportunity to utilize creative methods in a collaborative environment to deliver holistic patient care. The nurse’s goals are patient-centered and focus on adaptations to disability. The nurse assists the patient, family and significant other to maximize independence using a variety of resources. The role of the rehabilitation nurse beckons us to embrace our own nursing experience and education while engaging in joint problem-solving, critical thinking and judgment with other disciplines. Because we serve a diverse population, our knowledge base must encompass a wide range of diagnoses and clinical challenges. This diversity allows rehabilitation nurses the opportunity to stay current in medical/surgical skills within a specialty field.
Rehabilitation nursing is not a location of practice, but a
philosophy. After 20 years
working in a variety of settings, I had “come home” to the environment
for which I had prepared. I
practiced rehabilitation nursing in a NICU caring for brain-injured
patients. I included dysphagia
precautions, transfer techniques and adaptive methods for bathing, and
taught bowel and bladder management to CVA patients.
I encouraged an 80-year-old spinal cord-injured woman to mobilize in
a brace at home. I taught exercises and adaptive techniques to those with
mastectomies. Rehabilitation
nursing was evident in each of these settings. For more
information on rehabilitative nursing, contact the Association of
Rehabilitation Nurses (ARN) at (800) 229-7530 or (847) 375-4710 or go to www.rehabnurse.org Gail Lynn Sims, MSN, RN, CRRN, a member of the Association of Rehabilitation Nurses, is nurse manager at TIRR LifeBridge in Houston, TX. |
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