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Does the job fit? My experience and advice in choosing a nursing specialty

Learn how making the right choice can lead to a fulfilling career

By Mallory Browne
June 6, 2022
Courtesy of Mallory Browne
“When I graduated with a bachelor of science in nursing (BSN), I felt a degree of accomplishment,” Mallory Browne says. “A few hours into my first shift, however, the realization that I could not anticipate any of the day’s events dawned on me.” Pursuing a specialty made her a better and more confident nurse, she says.

Choosing a nursing specialty can be daunting. My message to fellow nurses is to explore as many professional opportunities as possible and take advantage of the ones that intrigue and inspire you.

As I earned my nursing degree I took on extra roles within group projects, spent countless hours on individual papers, and meticulously reviewed hundreds of PowerPoint slides. When I graduated with a bachelor of science in nursing (BSN), I felt a degree of accomplishment.

My first position

I accepted my first nursing position as a postoperative surgical nurse in my hometown. Excited to show off my new Registered Nurse (RN) title and eager to care for my own patients, I made my way to the hospital for my first shift. With a spring in my step, I smiled as the warm morning summer breeze played with my hair. I carried a pen in every colour, a new notebook, detailed notes on the most common surgeries, and the all-important well-packed lunch.

In theory, I was conversant with the day that would lie ahead. There would be handover at 7:15 a.m., and then I would check on my four or five patients where I would introduce myself; take their vital signs; perform a “head-to-toe” assessment including cognitive function, chest, breath and bowel sounds, pain assessment, a brief psychosocial check-in, and blood glucose checks if necessary; and, finally, administer the morning medication.

I would then give my patients their breakfast and assist them with eating, followed by bathing, and help the infirm to the bathroom with their walkers. After cleaning and changing those who needed assistance, it would be time to do something similar for lunch and again later on, in the early evening before handing over to the night shift.

A few surprises

A few hours into my first shift, however, the realization that I could not anticipate any of the day’s events dawned on me. The chaos of the unit was overwhelming: dripping IVs, revised doctors’ orders, abnormal blood glucose checks and subsequent insulin adjustments, blood transfusions, allergic reactions, isolated patients, anxious family members, and death. I had not factored any of this into my neatly arranged schedule and it all started to weigh on me.

In order to competently perform my nursing duties, I reluctantly had to cut short conversations with lonely patients, delegate patient hygiene to care aides, chart during my lunch break, and develop a just-do-it approach.

No amount of preparation would make me feel capable of confronting the uncertainty lurking throughout the ward. I looked up to the senior nurses who ran the unit. They walked with purpose, their chins held high, and at a pace that I, a new grad nurse, could not keep up with.

Coming to terms with uncertainty

A few weeks in, I was surprised to receive compliments and praise for my efficiency, attention to detail, and resilience. But I was bewildered. How could my colleagues congratulate me when I felt an overwhelming sense of exhaustion and failure? Was I a good nurse?

With the demands on the unit, I was unable to be the nurse that I wanted to be: able, empathetic, composed, and available. The perfectionist inside me inhibited my ability to let things be, to work with the uncertainty, and to move on from the day’s events at the end of my shift.

I felt that I might benefit from learning about the preoperative and intraoperative phases of care to improve my overall knowledge of the perioperative experience while simultaneously enhancing my job performance and career prospects. At the time, though, my main motives were to complete my understanding of the patient journey and equip myself with skills to make me feel more competent.

Further training

I decided to enrol in perioperative training and accepted a full-time position as a perioperative nurse. The major perk of this position was that it supported (and paid for) my training. It would also provide me with a change of environment and a team-based approach to care.

In this field I have been able to build on skills that I know I can excel in. Working within the operating room, one has to be prepared, organized, and focused for slated surgical cases and any impromptu trauma that may present. It is important to be able to anticipate the surgeons’ needs and aim to be one step ahead.

In my current role I have received feedback that has given me greater feelings of accomplishment and well-being. If you study the implant sets and surgical steps, watch a YouTube video, take notes, prepare with the clinical resource nurse, and show up ready to collaborate with the team, you will experience nothing short of resounding success.

Certification and beyond

Being a specialist nurse with certification not only helps you take better care of your patients, it also increases your confidence and your value to the institution. Certification affords nurses instant recognition by employers and fellow nurses. It attests to a nurse’s dedication to lifelong learning and specialization in a chosen nursing field. Perioperative certification is available from the Canadian Nurses Association and the Competency & Credentialing Institute, with resources and training curriculum available from the Association of periOperative Registered Nurses.

The earlier you decide the subspecialty, the quicker you will find fulfilment.

There are many nursing specialties that one can explore, and selecting one to pursue may be challenging. Specialties include, but are not limited to, psychiatric, community/public health, neonatal intensive care, intensive care, perioperative, and emergency nursing.

It is important to take time to watch videos, read articles, research the specialty, and perhaps ask to shadow a specialty-trained nurse to see what a typical day entails. Different nursing specialties require different characteristics, and it is necessary to keep this in mind when deciding on a field in which to practise. For example, emergency nursing deals with acute conditions, is fast-paced with little time to form relationships with patients, and is different from medical ward nursing, which is arguably slower-paced and more inclined toward the social aspects of care.

With the experiences, skills, confidence, and ability that I have gained from my time working as a perioperative nurse, I believe that I could return to the same postoperative surgical unit and rewrite my story. I have had extensive practice prioritizing tasks, answering/returning pages, delegating, teaching, communicating within a team, and most importantly, inserting the dreaded Foley catheter! I have read numerous textbook excerpts and articles on the concept of sterility, and now a dressing change no longer triggers me to perspire from stress as it once did.

Finding fulfilment

One day in the near future (perhaps sooner than you wish), just like me, you will be holding the trauma pager on an off-hour shift, teaching others about implant sets and surgical steps, as well as being a role model, just as the nurses on the surgical ward were for me.

The earlier you decide the subspecialty that best complements your personal characteristics and professional goals, the quicker you will find fulfilment in your role. Also bear in mind that for the first few years post graduation, you might not yet have the skill set to thrive in a particular specialty. For that reason, a period of learning and patience is required for growth so that you can make an informed decision once you have acquired and honed the necessary attributes.

This settling-in period can keep you from constantly shifting from one nursing specialty to another. Yet, new nurses should aim to operate slightly out of their comfort zone because the excitement of taking on tasks not yet fully mastered — with appropriate guidance, of course — accelerates learning and personal growth.

Helping people is always meaningful. But with extra effort, knowledge, skills, and good advice, I believe new nurses will discover even more layers of gratification in our noble profession.

Mallory Browne, RN, works in the operating room of the BC Children’s Hospital.