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I don't know what specialty to choose. Help?

Poll - Total Votes: 7
NICU
Psych
ICU
L&D
CRNA
Other (details below)
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I'm in nursing school, and graduating the end of this year. I don't know what specialty to choose, based on my goals and inclinations. I will illustrate my idea job vs. what is available.

My ideal job: Pays well ($150K+/year), can be done remotely and/or only work 50%-75% of the year (I need a minimum of 2 months vacation every year). I enjoy hands on, but don't want anything that is physically detrimental- "backbreaking". I also enjoy mental work or conversation, and challenging work. Variety is good, but not 100% necessary. I also want meaningful work, that I feel good about and excited to share my experiences with friends and family, and that I feel helps me grow as a person.

Some potential nursing specialties:

1. NICU (neonate/newborn intensive care unit): Pros of this I feel it would be really meaningful and deep work, literally "saving babies and cheating death". Also emotionally difficult because babies also die on you, but I feel emotionally grounded, and partly called to do this work because I feel I can handle the hard parts well emotionally. I actually was kind of "looking forward" to learning more about how to best support and comfort grieving parents as an aspect of this job. Another aspect of this job that really appeals is how small and technically more difficult newborns are, for things like IV placements in smaller veins, and everything so delicate. Another benefit to this specialty is the patients weigh so little, it is less physically demanding (though still heaps of walking, standing, moving around, no heavy weight).

2. Psych - The idea I have behind this specialty is ideally I could get to a place (Psychiatric Mental Health Nurse Practitioner, PMHNP, with a Master's degree) where I would do therapy remotely from my own home or anywhere in the world with internet. I would have to start off somewhere else, though, and not really sure where. I currently work as a Registered Behavioral Therapist with autistic people, and I don't care much for the violent aggression I deal with. I don't want to deal with people attacking me. But I would like to help people and I have a larger vision for creating healthy community connections and getting people socializing in person more and away from their devices. I have a lot of passion for psychology and philosophy. I think this would be a really great path but my problem here is I know my goal (PMHNP remote therapist), but not the best path to get there. Most mental health shifts/units I have seen are dealing with potential violence. Strengths of this profession include interpersonal communication and psych medication knowledge, and weaknesses being a lack of acute critical care which translates to being less transferable to other specialties.

3. ICU (intensive care unit (adult)): pros of this are that it is critical care, challenging and rewarding work. Very similar to the NICU only without the specialty of working with small humans. The pros of this are a bigger population with a wider variety of cases/pathologies, and broader applications to many other specialties if I moved to something new. "Former ICU nurse" is great resume experience. I originally was attracted to this because it would be part of the CRNA (nurse anesthetist) path, which requires years of ICU experience before you are allowed to get your Doctorate for the license.

4. Labor and Delivery: I really loved this department as a student, and see it as a potential place to move after having a year of NICU experience, if I don't enjoy NICU. The downside to this choice is less pay ($80K-$100K unless I go management), and more paperwork/filing. But the upside is being a part of the birthing process, which is amazing. Also would deal with death in this specialty as babies and mothers both die here and there.

5. CRNA (certified registered nurse anesthetist): This is the most difficult and long path. Also one of the more rewarding in terms of salary (~$250K/year) and job satisfaction. Basically, you just go around and get people high for surgery, take away their pain and consciousness, and make sure they don't get so high they stop breathing. Very specialized, lots of really cool chemistry and calculation work that I am pretty sure I would love (I'm strong in math skills). But the years of school and just difficulty is daunting, especially as I am 45, and am trying to be more or less retired by 60. I wouldn't finish school until after 50. But I feel like if I had a job like this, I'd be doing it for as long as they'd let me.

Some other "side hustles" I've thought about are nurse educator, clinical instructor, starting a community project. I've also considered having a dual career, where I got say a job at one hospital as a NICU nurse, then did some mental health related work with another facility.
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perceptivei · 36-40, F
I'd say nurse anesthetist is your best bet, if you want to make $150K+/yr. In what state do you live currently?
Dust057 · 46-50
@perceptivei I'm in CA. Where I am, I can make $75K-$80K starting in just about anything, and easily bump that above 6 figures if I put in a little overtime here and there. I made over $60K in my basic no-degree job just by working overtime last year while also going to school full time. The year before that, I did even more OT and came close to $80K. (on a $23/hr job). PMHNP makes over $150K and I could probably swing $150K as a NICU or ICU nurse as well, especially if I did travel nursing.

CRNA is without a doubt the best paying of all the options. But it also costs the most in terms of tuition and time. So it gets to a point where I could go to school for 4-5 more years and come out making more, or I could just work for 5-6 years and retire around the time I would just be getting out of school and starting to pay off all that debt.
perceptivei · 36-40, F
@Dust057 Well, if that's how you're figuring the potential salary, I'd go with whatever gives you the most reward emotionally. I'd say psych as I always thought it was the most interesting, but I've also heard it can be the least rewarding. I don't blame you for not wanting to be around the violence, and psych is pretty depressing, in my personal opinion. If you can handle dealing with babies, then do that or ICU. I couldn't handle seeing little babies pass though.
Dust057 · 46-50
@perceptivei yeah, that's the thing, I think with jobs a lot of them have this "ideal" image we get, like I imagine doing remote work as a PMHNP, having many clients that I talk to a couple times a month and help them through life, dealign with their issues and growing. But the reality is probably more like having clients that just have the same issues over and over and don't grow or adapt and probably really frustrating to see people digging holes for themselves and unable to get out.

I am definitely leaning toward NICU right now, my biggest qualm about it though is that I do eventually want to be doing work that I can do remotely and that is very hands on.
perceptivei · 36-40, F
@Dust057
But the reality is probably more like having clients that just have the same issues over and over and don't grow or adapt and probably really frustrating to see people digging holes for themselves and unable to get out.

Yes.


Do what is most important to you, I suppose. If working remotely means more to you than feeling rewarded from your career, go with the PMHNP.
@Dust057 California and Hawaii are the highest paying states in the country.