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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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dancingtongue · 80-89, M
Two things stood out to me: 1. The only one you don't really discuss the cons of is NICU and 2. you would really like a mental health situation where you could get people to interact more socially with fellow humans rather than their devices, yet here you are in social media asking advice from total strangers, trolls, and bots about one of the biggest life-changing decisions of your life. My advice: trust your gut, and it seems to be saying NICU.
Dust057 · 46-50
@dancingtongue you’re right I forgot to mention downsides and there are some. Biggest one is that working with infants you are very specialized and don’t have the adult population experience. But really I don’t mind that so much, there are plenty of babies to keep my hands full!
Dust057 · 46-50
Oh and you’re totally right about the irony 😂 but I am also discussing these things with the offline people in my life❤️
dancingtongue · 80-89, M
@Dust057 Good, and I didn't mean to suggest totally excluding online advice; just be judicious in your evaluation of it. You seem to have an entrepreneurial side to you. Have you looked at the opportunities in home care and hospice care for the opposite end of the market spectrum? I don't mean the nursing homes that are sweat shops at minimal wage with heavy lifting involved (although Hoyer lifts are supposed to be used). It unfortunately is where most of my health care experience has been lately while taking care of first my late wife, and then my late partner. First, I was struck by the apparent market for part-time caregivers -- particularly those with some nursing credentials -- at fairly high hourly rates through websites like care.com. We had one who had retired from her corporate administrative job, gotten a CNA certificate, who was excellent. She was cherry picking her patients, caring for those not yet ready for Assisted Living or hospice care, helping them make the transition. The other one I encountered who impressed me was a young woman with her eyes on a career in financial planning but was working as a "broker" for various Assisted Living places through the social workers at various SNFs, helping families sort through their options when their SNF benefits ran out. She got paid commissions by the Assisted Living places chosen. The downside on both is that you are responsible for payroll taxes and any retirement plan. Then there are those working for the various home health care and home hospice care subcontractors for big health care systems like Kaiser. There I assume there is more stable income level with payroll taxes and some sort of pension benefit taken care of, but you have the flexibility of being out and about visiting multiple patients and their families where their emotional and mental needs are as great as their physical needs. I suspect none of these pay to the levels you are seeking, but they do provide the flexibility and the satisfaction of dealing with the "whole" patient and their family's emotional/mental issues in non-violent encounters. Ultimately, I fear, you are going to have to weigh the financial rewards of an institutional setting vs. the rewards of flexibility and variety that you seek.
Dust057 · 46-50
@dancingtongue actually your response has me thinking I could probably exceed the limited salaries of any of the positions I listed by creating and managing my own healthcare business, hiring CNAs, taking on role of Nurse Manager/CEO, and filling the needs you've identified with a labor force. It would be a consuming project to manage, but an excellent opportunity to try my hand and finding innovative solutions to many of the issues we've both been privy to in the industry.
dancingtongue · 80-89, M
@Dust057 A very fluid industry open to innovation and more humanistic approaches.