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Charting the Course of Your Nursing Career: Finding the joy in being a nurse.

Haylock, Pamela J. MA, RN

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AJN, American Journal of Nursing: 2003 - Volume 103 - Issue - p 33-36

Every nurse should be enterprising and deliberate in pursuing a career. Most nurses enter the profession with a desire to make a significant contribution, a passion for the work, and an idealized image of what nursing is and what nurses do. But the wrong practice setting provides the quickest route to an unrewarding experience that depletes energy and passion, inducing burnout. Deliberation and planning can determine whether you have an uninteresting or frustrating job or an exciting, gratifying career.

A few years ago, I spent several weeks with my mother during the course of her hospitalization. My conversation with the nurses often concerned the various career paths we’d taken. I was interested in what enticed them to work in critical care, neurology, and neurosurgery, in some cases for many years. I asked a senior nursing student in a baccalaureate program about her career plans. Her initial one was identical to mine, despite the years that separated our professional debuts: we both expected to work in a hospital medical–surgical unit, to transfer to critical care, and to then determine the next step.

My first job was on the medical– surgical unit at the Johns Hopkins Hospital. After that, the plan fell by the wayside. Returning to Iowa to find employment in something other than acute care, I joined the staff of a county health department as a public health nurse and was exposed to the policy side of health care. I saw the contribution nurses make in the public health sector while working in the communicable disease control and health care facility monitoring divisions. Half of my duties involved epidemiology, and I was a member of a team that made daily rounds to clinics to interview people who had been diagnosed with sexually transmitted diseases (gonorrhea, syphilis) or other communicable diseases (tuberculosis, hepatitis) to begin the process of tracing the people with whom they’d had contact.

My other public health function derived from a partnership with the state health department to improve the monitoring of the county’s many subacute health care facilities––the various levels of nursing homes. I was a member of a team that consisted of county sanitarians, food inspectors, and a county fire marshal. This proved to be another revelatory experience: some nursing home residents lived in appalling conditions while others were living in models of good care. I was involved in closing down an especially abominable nursing home, but was troubled by the dilemma of where the residents would then be placed.

During two summer breaks from working toward my master’s degree, I was one of two nurses at a boys’ camp in Maine, a job I found through the AJN classified ads. Nothing beats Maine in the summer.

My internship with the sole county public health nurse in the rural area where I grew up was an enlightening experience. I became aware that this small county is a microcosm of rural health care needs and I learned much about the way many rural people live––the challenges to health care presented by the great distances to health care facilities and providers, by the lack of transportation, insurance, education, and financial resources, and by the conception of health as “the ability to work,” one that deters residents from seeking medical care, often until they’re quite ill.

Nursing is a career unlike any other. Nurses come into contact with a great variety of people, cultures, and issues, offering many a problem to be solved. The trick to developing and keeping the passion for nursing lies in finding your niche. There is a role, position, or job somewhere that best suits each of us.


The best nurses I know are intelligent, ethical, creative, imaginative, and courageous people who are willing to take risks on behalf of their patients and are prepared to approach their needs from a scientific perspective. Excellent nurses also are thoughtful, they listen and communicate well, and they willingly assume roles as both team members and leaders. They’re generous, willing to spend time with patients, clients, and colleagues to share their knowledge and expertise. Finally, and most important, the compatibility of the nurse, the type of job, and the work setting are essential to success. Her priorities must be consistent with those of her colleagues and the institution.

Planning. Successful career planning starts with self-assessment: this can make the difference between floundering in a series of unsatisfying jobs and enjoying a rich and rewarding nursing career. Nurses who are most satisfied with their work are those who have achieved a great deal of expertise in a practice or specialty area. An efficient way to begin exploring nursing opportunities is by reviewing the nearly 100 specialty nursing organizations in the country. The American Nurses Association Web site ( lists nursing organizations that are affiliated with the ANA as members of its Nursing Organization Liaison Forum.

Choosing a specialty can be as easy as determining a patient population that appeals most: infants, children, adults, the elderly; individuals, or groups. Consider the type of professional interaction to which you are particularly suited. Take stock of your strengths and weaknesses, noting the areas in which you need to learn more. Are there areas that hold no appeal whatsoever? Do you have an adventurous nature? Do you like a fast or a slow pace? Do you want to have long-term relationships with your patients and their families or would you prefer more limited contact? Are you good at solving problems independently or do you do better in group effort?

My own experience serves as a good example of self-assessment and the determination of “fit.” Very early on I learned that I liked psychiatric nursing. I loved listening to patients and families, and experienced some meaningful successes in helping them address spiritual, emotional, and psychosocial issues. I thought that I’d become a mental health nurse someday. However, I’m also intrigued by the physical sciences and pathophysiology: cancer processes present an especially fascinating enigma. The rapidly evolving nature of cancer treatment, the problem of symptom management, and the emotional impact of cancer on the patient, family, and caregivers make oncology nursing the field that is right for me.

The following are some specialties to which you may be well suited:

The various branches of the U.S. armed services offer a wide range of career opportunities that may include travel to postings in a number of states and foreign lands. Military service can also offer additional education and specialty training opportunities.

Operating room, emergency department, and most critical care positions are extremely technical, fast-paced, and require exquisite teamwork. They usually offer little opportunity for personal relationships with patients and families.

Home care nurses and nurse practitioners working as primary care providers must have considerable preparation, creativity, and skills, as they must assume much autonomy.

Public health positions allow nurses to address population-based challenges.

Nurse executives use communication and organizational skills to work as team members, in settings ranging from private and community-based practices to vast health care complexes, balancing the demands of health care businesses with the needs of health care providers and recipients.

Pediatrics. My nursing school roommate enjoyed working with infants and children. She is now a pediatric nurse practitioner who coordinates long-term monitoring of high-risk infants and children. Some pediatric nurses find fulfillment working in hospital pediatric units and critical care settings, while others work alongside pediatricians in offices, pursue school nursing, or work in community-based programs that offer services to families.

Neonatology nurses combine critical care competence with sensitivity to the challenges presented by premature birth. Neonatal nurse practitioners often assume primary care roles, providing follow-up care to newborns and their families for months.

Labor and delivery nurses anticipate mothers’ and families’ needs and address challenges that follow the addition of a new baby to the family.

Gerontology nurses find fulfillment in a rapidly expanding field of services designed to meet the needs of the elderly. Communities that attract people nearing retirement age maintain wellness clinics and senior centers in which nurses are involved in creating and implementing long-term wellness strategies. A holistic nursing approach is essential in helping elderly people adapt to changes imposed by aging or chronic illness.

Networking. Announcements of open positions are not always found in the classified sections of newspapers and nursing journals. Because such information often travels by word of mouth, networking skills are indispensable for opening avenues of information on job opportunities and what’s going on in the local practice arena. Joining a specialty nursing organization or interest group is essential to participating in a useful network.

When I moved to San Francisco, I wanted to be an oncology clinical nurse specialist, but no such position was advertised. I accepted a staff nurse position while pursuing leads offered by members of the local oncology nursing interest group. A colleague told me about a new position, a job that proved to be my entrée into full-time oncology nursing practice. It was the position I had envisioned for myself five years earlier.

Designing your position. An increasing number of nurses are designing their own jobs, creating ones that are not listed anywhere but that exist in the imagination. Communities, health care facilities, and entities outside traditional health care settings have unrecognized needs, and nurses can identify and craft positions to meet them.

Several of my colleagues who have an intense interest in politics combine political savvy with nursing expertise working as health policy analysts for nursing organizations and other businesses related to health care.

A friend with a long and successful oncology nursing career who is a passionate advocate of cancer patients wanted to have more autonomy and fewer constraints imposed by loyalty to a particular hospital or set of physicians. She worked with a small group of cancer survivors in Bozeman, Montana to create a cancer resource center in which she functions as a “navigator,” helping clients through the cancer care system. This new resource has received some financial support through a partnership with a community hospital. Creative fund-raising efforts, including an equestrian demonstration program and a barn dance, have generated additional support.


Think of a nursing career as a lifelong journey, one that requires planning, imagination, curiosity, and commitment. The destination might not be an actual place: it might have more to do with the kind of person you are and the kind of nurse you want to be.

Focus on a destination. Having a destination in mind minimizes purposeless wandering. A good way to start is by writing down what you’d like to be doing, including where you want to be doing it (if that’s important to you) two, five, and 10 years later.

Take stock of your own resources, identify gaps, and make efforts to fill them. Nursing education is a basic reserve of skills and knowledge. Additional education, experience, and skills shore up the basics to a level commensurate with the next phase of the trek.

Take a personal inventory. Assess your likes, dislikes, interests, and skills, and identify areas you are interested in pursuing in greater depth.

Develop and hone networking skills and use the network effectively. Let others know who you are, what your skills are, and what position or type of work you’d like to have. Be aware of professional opportunities in the community and carry business cards.

If a job is not consistent with your image of the nurse you are or want to be, find another one or change your function. The nursing shortage can work in your favor. Most likely, there’s another position, job description, or career choice within the profession that would provide a better fit.

Imagine new and creative ways of meeting the needs of your patient or client population. Nurses are the health care practitioners closest to the patient and are therefore in a good position to identify unmet needs. They also have the skills and creativity to devise strategies to assist in meeting those needs.

Skilled travelers have the knowledge, ability, and confidence to get off the beaten track while remaining alert to signposts along the way. Although formal education is indispensable, curiosity, imagination, and the commitment to lifelong learning are just as essential to nurturing the passion that is vital to a fulfilling career. A detour can lead to either a dead end or the best stretch of the journey. With careful investigation, planning, curiosity, and the judicious taking of risks you’re likely to find the joy in being a nurse.


© 2003 Lippincott Williams & Wilkins, Inc.