Nursing Specialties (page 6)
Nursing has come a long way from the days when caring for the sick in hospitals was seen as the sole nursing role. While nurses still care for ill clients, many of these clients are in the community or at home. Nurses also focus on wellness and health maintenance, as well as the psychological, cognitive, social, and spiritual needs of clients.
Many of the nursing specialties described here require that you be a registered nurse, and some require additional training. But these requirements may vary per institution, so if a hospital or outpatient center has your special area of interest and you are a practical nurse, ask them about the requirements before you rule them out. Many specialties have available certifications. Most of these certifications require that you have experience, continuing education in the specialty, and a certification exam.
Ambulatory Care Nursing
American Academy of Ambulatory Care Nurses: www.aaacn.org
Ambulatory care nursing is characterized by rapid, focused assessments of patients, long-term nurse/patient/family relationships, and teaching and translating prescriptions for care into doable activities for patients and their caregivers. The emphasis is on pain management and client education to keep people with injuries and chronic injuries healthy and independent in their home surroundings. Ambulatory care nurses respond rapidly to high volumes of patients in a short period of time and deal with issues that are not always predictable. Ambulatory care nurses work in community-based hospitals, schools, workplaces, and homes. Client encounters may be face-to-face, via phone, or via another communication device.
Association of Camp Nurses: www.campnurse.org
Camp nurses work in traditional camps or camps for children with disabilities or chronic illnesses, either of which may be day camp or residential. They provide routine and emergency care to children and staff, monitor children with chronic diseases, educate campers and staff on prevention, and collaborate with camp administrators to develop and implement policies that reduce the risk of injury or illness. Flexibility, critical thinking skills, and problem solving skills enable camp nurses to protect and promote the health of the entire camp community. Humor and creativity help, too. Camp nurses deal with problems as simple as lice and as complex as diabetes or HIV/AIDS. They review health records, assess, administer medications, dress wounds, calm separation anxiety, and manage behavioral problems. Camp nurses also attend to the needs of staff, who may present with illnesses, infections, or injuries.
Cardiac Rehabilitation Nursing
Association of Rehabilitation Nurses: www.rehabnurse.org
Cardiac rehabilitation nurses provide assessment, support, and education for clients with heart disease who need to make lifestyle changes to prevent their disease from getting worse. They work in hospitals, ambulatory care, and fitness centers, and their clients include people recovering from heart attacks or heart surgery. Cardiac rehabilitation nurses monitor these clients during exercise to prevent injury and overexertion, promote stress management, and teach healthy diet, adequate exercise, and smoking cessation. ANCC provides certification as a cardiac rehabilitation nurse.
Case Management Nursing
Case Management Society of America: www.cmsa.org
Case management nurses organize and coordinate individualized resources and services for clients. They work with clients of all ages, with all types of illnesses and health problems and in all types of healthcare settings, but many target specific populations, such as older adults or people post organ transplant. The case manager's goal is to foster quality self-care. Case managers use a plan of care called clinical pathway to assess the needs and progress of their clients. ANCC offers certification for nurses as case managers.
College Health Nurse
American College Health Association: www.acha.org
College health nurses work in college health centers to assist students with health maintenance, illness prevention, and illness management. They also maintain health records and assure that immunizations and other wellness needs are up-to-date. Since most students are young adults, college health nurses focus on issues such as dating safety, sexually transmitted disease prevention, and sports injury prevention. However, as more adults return to college, college health nurses face new challenges, such as the prevention of cardiovascular problems. Most illnesses and injuries are minor, like sore throats and sprained ankles, but college nurses still need to be ready for emergencies, including ones related to psychiatric disorders. ANCC provides certification for college health nurses.
Community Health Nurses
Association of Community Health Nurse Educators: www.achne.org
Community health nurses work in the field through government and private agencies. They work with individuals, families, and groups to improve their overall health by educating them about common issues such as illness prevention, parenting, elder care, and healthcare problems, as well as issues pertinent to that community such as lead poisoning and farm safety. Community health nurses provide home follow-up care, immunization clinics, health education, and referral of clients to appropriate agencies for assistance. Community health nurses need to be well versed in disaster management including sudden mass casualty incidents, unfolding infectious disease outbreaks, or evolving environmental disaster. While bioterrorism is always a concern, flooding is more commonplace and often just as deadly. ANCC offers certification for community health nurses.
Correctional Health Nursing
American Correctional Health Organization: www.achsa.org
National Commission on Correctional Health Care: www.ncchc.org
Correctional health nursing provides freedom of practice in a restricted environment—jails and prisons. Correctional nurses remain neutral and unbiased by their clients' offenses and assure that their clients receive the same healthcare treatment they would receive if not incarcerated. One of the key issues in correctional health is the issue of custody versus care. Correctional nurses provide quality care within the necessity of custody because safety comes first. Correctional nurses care for their clients from intake until release and must be proficient in assessment, infectious diseases, responding to emergencies, the needs of an aging prison population, and managing chronic illnesses and psychiatric disorders. They also need to differentiate legitimate complaints from malingering in clients who can be very manipulative. There are a number of opportunities for growth in the corrections field, with roles ranging from staff nurse to manager to nurse practitioner to director. Nursing does not offer certification in correctional health; however the National Commission on Correctional Health Care (NCCHC) offers basic and advanced certification in correctional health care called the Certified Correctional Health Professional (CCHP).
Critical Care Nursing
American Association of Critical-Care Nurses: www.aacn.org
Critical care nurses work with clients who have life-threatening conditions due to illness, injury, or major surgery. They provide complex assessment, high-intensity interventions, and continuous nursing care. Critical care nurses require a specialized body of knowledge, experience, and skills to provide care to patients and their families. Critical care nurses work in a variety of intensive care units: cardiac, burn, medical, surgical, neurological, neonatal, and pediatric. The American Association of Critical-Care Nurses provides certification programs for the following subspecialties: adult, neonatal, pediatric, progressive care, cardiac medicine, cardiac surgery, and nurse manager and leader.
Developmental Disabilities Nursing
Developmental Disabilities Nursing Association: www.ddna.org
Developmental disabilities nurses work with clients who have developmental disabilities, including mental retardation and autistic spectrum disorders. These clients range in age from infant to older adult and many have associated problems such as cerebral palsy, hearing and/or visual impairment, and seizure disorders. Developmental disability nurses provide holistic care, meeting the client and family's physical, cognitive, emotional, social, and spiritual needs. The Developmental Disabilities Nursing Association provides a certification program for developmental disabilities nurses.
Emergency Nurses Association: www.ena.org
Emergency nursing crosses all ages and areas of nursing to provide care that include birth, death, injury prevention, women's health, disease, and life and limb saving measures. Emergency nurses apply the nursing process to clients of all ages requiring stabilization and/or resuscitation for a variety of illnesses and injuries. Emergency nurses work in hospital emergency departments; military settings; clinics, health maintenance organizations, and ambulatory care centers; business, educational, industrial, and correctional institutions; and other healthcare environments. Emergency care also happens at the point of contact, where clients live, work, play, and go to school. The Emergency Nurses Association provides certification for emergency nurses, pediatric emergency nurses, and ground transportation nurses.
Air and Surface Transport Nurses Association: www.astna.org
Flight nurses care for emergent and nonemergent clients during surface and air transportation, including interfacility transport and emergency scene calls for medical emergencies and trauma. Cases range from the simple to the challenging. Prerequisites to becoming a flight nurse include three to five years of critical care nursing, Advanced Cardiac Life Support (ACLS) certification, and usually Pediatric Advanced Life Support (PALS) certification. Flight nurses are employed by trauma centers and other acute care facilities, public and private transport companies, and the military. The Air and Surface Transport Nurses Association (ASTNA) provides certification as either a certified flight registered nurse or certified transport registered nurse. The Board of Certification of the Emergency Nurses Association also provides certification for flight nurses.
International Association of Forensic Nurses: www.iafn.org
Now more than ever, healthcare frequently becomes enmeshed with the legal system, creating numerous opportunities for healthcare providers in the field of forensic health. The word forensic means "pertaining to the law." Forensic nursing applies to those instances where nurses interact with the law or legal issues. Forensic nursing is the application of nursing science to public or legal proceedings, the application of the forensic aspects of nursing in the scientific investigation and treatment of trauma and/or death of victims and perpetrators of abuse, violence, criminal activity, traumatic accidents, and environmental hazards. Forensic nurses work in a number of settings with a variety of clients: sexual assault victims and perpetrators; victims and perpetrators of domestic violence, child abuse, and elder abuse; juvenile delinquents; victims of traumatic accidents; clients with criminal backgrounds; and mentally disturbed offenders. Forensic nurses can also: work in the coroner's office on death investigations; assist law enforcement in collecting evidence; act as legal consultants; work with medical malpractice issues; work in organ and tissue donation; deal with environmental issues (food and drug tampering, hazards, terrorism, epidemiological issues); and create violence prevention programs. Healthcare settings that deal with forensic issues include, but are not limited to: emergency treatment facilities, schools, correctional facilities, psychiatric settings, and outpatient and community health settings. Forensic health research is a rapidly growing area.
Society of Gastroenterology Nurses and Associates: www.sgna.org
American Board of Certification for Gastroenterology Nurses: http://www.abcgn.org/
Gastroenterology/endoscopy nurses provide essential care to clients undergoing screening, diagnostic, and treatment procedures for gastrointestinal problems. Some of these nurses specialize in endoscopy, the use of a flexible scope to examine the gastrointestinal tract. Gastroenterology nurses work in hospitals, outpatient centers, and private offices. The American Board of Certification for Gastroenterology Nurses and the Society of Gastroenterology Nurses and Associates offer certification for gastroenterology nurses.
International Society of Nurses in Genetics: www.isong.org
Genetic Nurses Credentialing Commission: www.geneticnurse.org
Genetic nurses work with clients of all ages who have, or who are suspected of having, a genetic disease or disorder, such as cystic fibrosis, neuromuscular disease, and Down Syndrome. Genetic nurses work with other healthcare specialists to provide risk identification, screening, diagnostic testing, and treatment. They work as case managers, program coordinators, genetic counselors, and educators at university medical centers and research facilities. The psychosocial impact of having a child with a possibly incurable genetic disease or disorder can be traumatic, thus genetic nurses also need psychosocial skills to support and assist families in handling these conditions. The Genetic Nurses Credentialing Commission offers certification for genetic nurses.
National Gerontological Nursing Association: www.ngna.org
Gerontological nurses care for the physical and psychological needs of older adults in a variety of settings, including hospitals, long-term care facilities, community health centers, senior centers, and client homes. They focus on maximizing clients' functional abilities, as well as promoting, maintaining, and restoring health. ANCC offers certification for gerontological nurses.
HIV/AIDS Nursing Certification Board: www.hancb.org/about.htm
HIV/AIDS nurses provide educational, therapeutic, and supportive interventions. Their goals are to prevent infection; promote client, family, and community adaptation to HIV infection and its sequelae; and to ensure continuity of client care by collaborating with the interdisciplinary team. HIV/AIDS nursing requires knowledge and skills that include pathophysiology, learning principles, family dynamics, grief and loss, coping with chronic illness, care of immunocompromised clients, risk assessment, and risk reduction. HIV/AIDS nurses use research findings to maintain an adequate knowledge base in an evolving field such as HIV/AIDS nursing. Care is multifocused and occurs in an array of settings including primary care, acute care institutions, communities, and schools. The HIV/AIDS Nursing Certification Board offers certification for HIV/AIDS nurses.
American Holistic Nurses Association: www.ahna.org
American Holistic Nurses Credentialing Corporation: www.ahncc.org/pages/1/index.htm
Holistic nurses use the mind-body-spirit-emotion approach to the practice of nursing. They act as a bridge between conventional healthcare and complementary alternative health care since they are educated in both models. Complementary alternative health refers to health practices that incorporate plant, animal, and mineral-based medicines, spiritual therapies, manual techniques, and exercises. Holistic nurses work in a number of settings and may specialize in one or more modalities, such as aromatherapy or energetic healing. The American Holistic Nurses Credentialing Corporation provides certification for holistic nurses.
Home Health Nurses
Home Healthcare Nursing Association: www.hhna.org
Visiting Nurse Association of American: www.vnaa.org
A specific type of community health nurse, home health nurses, also called visiting nurses, provide cost-effective and compassionate home healthcare to some of the nation's most vulnerable individuals, particularly the elderly and individuals with disabilities. They enable these persons to meet their healthcare needs at home and avoid expensive hospitalization. ANCC offers certification for home health nurses.
Hospice and Palliative Care Nursing
Hospice and Palliative Care Nurses Association: www.hpna.org
National Board for the Certification of Hospice and Palliative Care Nurses: www.nbchpn.org
Hospice and palliative care nurses aim to relieve suffering and improve the quality of life for persons who are living with, or dying from, advanced illness, as well as those who are bereaved. Hospice care can take place at a hospice or at home, as it is a philosophy and not a location. Hospice and palliative care nurses aim to relieve suffering, control symptoms, and restore functional capacity, while remaining sensitive to personal, cultural, and religious values, beliefs and practices. Hospice and palliative care nurses work in collaboration with the interdisciplinary team but distinguish themselves from their colleagues in other nursing specialty practices by their unwavering focus on end-of-life care.
Infection Control Nurses
Association for Professionals in Infection Control and Epidemiology: www.apic.org
Certification Board of Infection Control and Epidemiology: www.cbic.org
Nurses play a critical role in preventing and controlling infectious disease, including tuberculosis, HIV/AIDS, and nosocomial (developed in hospital) infections. Infection control nurses identify, control, and prevent outbreaks of infections in hospitals, long-term care facilities, and community agencies. Infection control nurses collect and analyze infection control data; plan, implement, and evaluate infection prevention and control measures; educate individuals about infection risk, prevention, and control; develop and revise infection control policies and procedures; investigate suspected outbreaks of infection; and provide consultation on infection risk assessment, prevention, and control strategies. The Certification Board of Infection Control and Epidemiology, Inc. (CBIC) is a voluntary autonomous multidisciplinary board that provides direction for and administers the certification process for professionals in infection control and applied epidemiology.
American Informatic Nursing Association: www.ania.org
Nursing informatics integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Informatics involves all aspects of computerization as it relates to nursing and healthcare, but informatic nurses may specialize in certain areas. This fast growing field is used in hospitals, computer hardware/software companies, health care consulting firms, educational institutions, regulatory agencies, and pharmaceutical and research facilities. ANCC offers certification for informatic nurses.
Intravenous Therapy Nurse
Infusion Nurses Society: www.ins1.org
Infusion Nurses Certification Corporation: http://incc1.i4a.com
Intravenous (IV) therapy nurses initiate, monitor, and terminate therapies including medications, antineoplastic agents, investigational drugs, blood products, and parenteral nutrition. They performs venous and arterial punctures, maintain the intravascular site including tubing and dressings, monitor for infections, and assess patients for adverse reactions and complications. The Infusion Nurses Certification Corporation provides certification for infusion nurses.
International Lactation Consultant Association: www.ilca.org/examprep.html
International Board of Lactation Consultant Examiners: www.iblce.org
Lactation consultant nurses help new mothers master breast-feeding and manage problems that may arise. Lactation consultant nurses advocate for breast-feeding mothers in the workplace, and they work in the health policy arena to encourage the development of progressive breast-feeding programs and legislation.
Legal Nurse Consultants
American Association of Legal Nurse Consultants: www.aalnc.org
A group of forensic nurses, legal nurse consultants (LNCs) act as legal consultants on medical issues, particularly lawsuits. Other LNCs work with product liability, child custody, elder law, or criminal cases. LNCs work with law firms on cases to review medical records and client treatment. Some work as salaried employees, others independently. LNCs can educate attorneys about standards of medical care; explain medical procedures; and provide assistance with discovery requests, deposition questions, and the selection of expert witnesses. The American Association of Legal Nurse Consultants offers certification to legal nurse consultants.
Medical-Surgical Nursing (Adult Health Nursing)
Academy of Medical Surgical Nurses: www.medsurgnurse.org
The foundation for nursing practice, medical-surgical nursing has evolved from an entry-level position to an adult health specialty. Medical-surgical nurses care for adult patients in many settings, such as hospitals, clinics, ambulatory care units, home healthcare, long-term care, urgent care centers, and surgical centers. Medical-surgical nurses perform assessments, and administer care, treatments, and medications. ANCC provides certification for medical-surgical nurses.
Never Forgotten, by Tina Abbate
I still vividly recall my first few days in the neonatal intensive care unit. I was a new graduate, a fresh-faced registered nurse, ready to conquer the world. My desire to vanquish quickly vanished (as did the color from my face) as I took my first steps onto the unit and surveyed my surroundings. Alarms beeped and blared haphazardly while people scurried around, exuding an aura of importance and purpose. Individuals garbed in stark white coats were huddled together at a bedside with brows wrinkled and engaged in an apparently intellectual discourse. I captured blips of important conversations: "the TPN was lowered to 5cc/hr," "the doctor wants an ABG at 10 o'clock."
TPN? ABG? What could that possibly mean? Is everything an acronym around here?
I felt like the lone duck in a gaggle of geese.
I met baby Alex [pseudonym] on the second day of my orientation. He was two hours old, tipping the scale at 430 grams. It seemed implausible for a baby weighing less than a pound to survive outside of the womb. He was born prematurely by nearly four months. His head was barely the size of a baseball and his body was practically devoid of the vital protective layer of fat. His eyes were fused shut. His skin was translucent and rather gelatinous looking. Baby Alex could fit into the palms of your hands.
I had never seen a baby that small up close and frankly, I could not stop staring. All of the technology that surrounded him—a ventilator, IV pumps, a radiant warmer—catapulted me into an entranced state. These machines represented Alex's life support. These machines gave compromised neonates a fighting chance at survival. We had a lot to do for our pint-sized patient. His response to the ventilator was less than desirable. The doctors made numerous adjustments, slowly increasing the pressure necessary to expand his stiff, underdeveloped lungs. Blood work, paperwork, vital signs, IV fluids, suctioning—how will I ever make sense of it all?
Alex's mom and dad came into the NICU around noon to visit their son for the first time. They sat quietly at his bedside for quite some time and finally Mom turned to me and asked, "Is he going to die?" How could I possibly answer her appropriately? I fumbled around in my head, desperately trying to think of the appropriate response. Another nurse quickly said, "Alex is very sick, and we are trying everything within our power to help him live."
Twelve hours had passed and my shift was over. Alex was 14 hours old and actually demonstrated signs of improvement. He finally responded to the vent, as indicated by his blood work. A glimmer of hope sparkled for the first time. I sent Alex a mental message, "Hang in there, little man. I will see you tomorrow."
The next day arrived and I marched into the NICU, chin up, and ready to face the challenges that loomed ahead. I walked into Alex's room and went toward the back wall where he was stationed yesterday. He was not there. I assumed that the night nurses moved him to another room. I approached a night shift nurse, "What room did they move Alex to?" She smiled apologetically. "Alex died this morning, around 3:00."
It felt as if someone had forcibly kicked me in the chest. I hurried away and ran to the nearest bathroom. I sobbed uncontrollably. I asked, "Why, darn it why?" With all of the modern medical ministrations we have readily available, Alex should still be alive.
Babies represent a beautiful futuristic hope. Some grow up to become influential pillars of our society and some die before they even have the chance. In a threefold utopian dream, all babies would be healthy and robust, leading full lives, devoid of any pain or suffering. Reality, unfortunately, dictates a different story.
I embarked on two startling realizations. First, it is okay to submit to your emotions. Second, the nurse's involvement within the family dynamic is far more considerable than I had ever imagined. As nurses, we are inherently embedded within the fabric of a patient's story. It is okay to thrust your heart and soul into your profession and there is no harm or shame in displaying natural emotions. I would imagine that suppression of these raw sentiments might progress into impairment for the long term. After all, we are humans caring for humans.
Dr. John De Frain stated, in the early 1990s, "The death of a baby is like a stone cast into the stillness of a quiet pool; the concentric ripples of despair sweep out in all directions, affecting many, many people." We will never forget baby Alex.
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