What’s the Hardest Nursing Specialty?

No one ever said nursing was easy (at least, no nurse has ever said such a foolish thing). Some shifts can feel like going ten rounds with Apollo Creed — we know that often the work is as challenging as it is rewarding. But did you go the extra mile? Did you pick a specialty that is known to be extra tough?

We asked our readers to talk about what they see as the hardest specialty. As you can imagine, we got lots of different answers! Here are just a few of the specialties our readers mentioned — along with a little insight into what makes these nursing jobs so difficult.

Oncology

There’s no surprise that this specialty is near the top of the list. Treating patients who have a low chance of survival is bound to place a strain on you. Oncology nurse Amie Habdas had this to say: “I don’t think I could ever judge what’s the hardest, but I know all the nurses I work with need to lean on each other because there are so many complexities to cancer and cancer care. I became a nurse to help people, and sometimes there is a point where there is nothing else that can be done. That’s the hardest. The 26-year-old who says, ‘I don’t want to die. I want to see my baby grow up.’ The 90-year-old who says, ‘I don’t want to leave my husband—we’ve been married 72 years.’”

Suzi Marquardt points out that working in such a rapidly evolving field of medicine poses a dilemma for nurses from a training standpoint: “Ever-changing treatments and ongoing research means you’ll never know it all. But there is much that is absolutely ‘need to know’…and those things change frequently.”

Hospice

This is another specialty that you’d expect to see described as particularly tough. Palliative care for dying patients draws on your deepest reserves of compassion day after day. Heather Staggs describes the many roles a hospice nurse must fill: “You see the end stage of diseases and the brutality of some deaths. You are a social worker and nurse all in one. Your job is to care for your patients, their family and friends. You see despair on a regular basis. It’s impossible to not carry it home with you. I wouldn’t trade my job for anything.”

Medical-Surgical

This specialty actually got more votes than most. Some medical professionals don’t regard it as a specialty at all—ignoring the fact that it takes a very high level of skill to be able to handle this kind of workload. Darla Hagemeister Gish points out that med-surg requires “a broad knowledge base and a keen eye for picking up on subtle symptoms that could become life-threatening.” Amber Wessem says she rarely sits down except to chart, and describes the work as extremely challenging, both mentally and physically. Ashley Haas says she deals with six to eight patients for 12 hours. “You get every body system and every acuity level. It’s a crapshoot every shift because you never know what kind of patients you will have and what personalities and safety/illness issues you will meet.”

Geriatric Care

Nurses who care for the elderly speak of dementia and Alzheimer’s patients as the most heart-rending cases they deal with. Jennifer Stillings works in a nursing home and describes her patients this way: “disoriented, confused, perseverating, wandering, incontinent, highly impaired vulnerable adults at end of life with little resources and difficult to help with something that has treatment, but no cure.” Kristina Barlett points out that many geriatric patients are simply dropped off at a nursing home and forgotten by their families.

Emergency Room

Things are never dull for long when you’re an ER nurse. Tami Hamill describes a typical shift this way: “ER is definitely wild and crazy! You might be delivering a baby one minute, coding someone the next, then dealing with a mass trauma five seconds later. All that piled in with people yelling at you because they have been there longer than the stab victim, asking ‘Where’s my pain meds?’, and the psych patient who is convinced you’re trying to kill him and he will get you first.”

Psychiatry

This specialty is particularly hard when children are involved. Sara Guzowski talks about pediatric psych/behavioral: “There isn’t always a pill or an easy answer. You are always healing wounds that are unseen and discharging most children to less than desirable situations. However, I love these children! And they teach me about myself and to be a better person daily.”

Correctional Nursing

Here’s one specialty that gives nurses a completely different set of stuff to worry about. Andrea Cunningham tells us that balancing nursing empathy with the emotional distance and circumspection necessary when working with offenders is very difficult. Darlene Johnson points out that there are physical dangers involved as well: “Everything [is] a potential weapon. Everything [has] to be counted.”

Home Health

Working outside a hospital setting doesn’t necessarily mean freedom and light work for nurses. Mary Becker Colo’n reveals: “Home healthcare—both geriatric and pediatric—is super challenging. You are not in a controlled environment. There are homes where people have millions and others where the home is falling apart around you and your patient. Some people don’t have air-conditioning, yet live in Florida. Some people have lots of animals, but can barely care for themselves, and you must do what I call the ‘flea dance’ when you leave. Some patients break your heart, some patients inspire you. All patients need our help, even if they don’t want it. Tough, yes. But rewarding beyond measure.”

What are some of your toughest challenges as a nurse? Let us know in the comments section.

This article was republished with permission from SCRUBS Magazine.

 

33 COMMENTS

  1. Being a dialysis nurse (pediatric at that!) is the hardest nursing specialty in my opinion. Yes, cancer sucks, but kidney disease is just as life threatening- and can not be cured. These patients (especially kids) have to do treatments every day- or 3 times a week, severely restrict their diet and fluid intakes, and most of the time can’t do normal activity. Their disease is easily fatal. They suffer with it their whole lives, even if they get a transplant- they have to be on an average of 20 medications a day to keep their body from rejecting the organ.
    Not only are you the bedside nurse, but you’re care manager, confidant, tough love reinforcement for the dietician, and front line for the social worker. You’re constantly training and educating the patient, parents, and the rest of the family on how to try to make this kid’s life somewhat normal, while they feel like crap all the time. You shove 1” 15gauge needles into their arm and hope it doesn’t infiltrate. You watch them go through line infections, surgery after surgery, admission and transmission, more central lines exchanges than you can count- and all the angst and rebelliousness that comes with teenage years that you, as their caregiver, have to mediate because being too no compliant because they’re pissed off can kill them. Their hearts wear out from constant fluid overload or dehydration, their hair thins from high PTH levels, they feel like they’re starving because everything has too much potassium or sodium or phosphorous.
    It’s daily torture.
    And hardly anyone knows about it.
    There is not enough awareness of this disease, especially in kids. Please feature this condition- ask any pediatric dialysis or nephrology nurse how hard the job is. They become your family, but you often also see them die the most drawn out and terrible death.
    It is a daily challenging job, with lots of secondary emotional trauma, but I can’t see myself doing anything else. In the process of MSN and I plan to stay in Peds Nephrology when I graduate.

  2. I think every area has it’s challenges. Personally, I worked for many years in a pediatric clinic for a children services agency. The things you see, hear and address are sometimes unfathomable! I am currently a psych nurse in a juvenile correctional facility where we are again addressing some of the same things experienced in my previous position. And, believe it or not, some of the same kids.

  3. I am not sure why anyone would pick an area that is incredibly hard for themselves.
    My field of preference is considered to difficult by many. I would do it for free. Do something you love, it all becomes your passion. And be competent in it.

  4. I was a nurse for 53 years. My career was diverse. First a medical unit, then medical ICU and CCU, next a pulmonary research ICU, a general ICU, nursing home, CCU, general ICU x2, ED, IV therapy x2 meanwhile pursuing a BSN followed by MS-FNP-C. Each has its + and – but the central theme is helping others. Patients are putting their lives and trust in a complete stranger. What an amazing show of confidence. I loved each area I worked in. My fellow teammates were incredible. They are the ones who carried me through the tough times because they could understand. No specialty was “the toughest”. Each had challenges and rewards. Simply said, you have to love what you do do do what you love. Then, you have found your nitch.

  5. A long time ago when I first started my nursing career, I worked in an Alzheimer’s Unit and it was very concerning to see these people try to live their lives with a deteriorating brain. This one patient woke up after a nap and walked down the hallway to the nurse’s desk, “Do you know who I am?”, she said crying. She was very upset and I tried to ease her pain and told her who she was and that she was safe here. Sometimes these patients would suddenly become coherent and ask “what is wrong with me”? Sometimes you would get the funny incidents where two female patients who didn’t know each other were sitting next to the nurse’s station and one said to the other, “Well if you didn’t lose the car we could get out of here”. A female patient who used to be a nurse would come to the nurse’s station and steal all the charts, “You are not doing it right”, she would say. This was a good introduction to nursing as I have used what I learned to my other exploits in my nursing career.

  6. If you want to know the hardest unit just ask the nurses what unit they would least like to float to. In my hospital it’s my unit, SICU. We are also a neurosurgical/neuro trauma, and level 1 trauma unit. This is a no holds barred unit.

    • IMO night nurse at the nursing home with the most cognitive patients (e.g. first floor). I float around all units but am mainly on the dementia floor. It is WILD at night on dementia floor!! When I go to the neighbouring unit (mild dementia, cancer patients, stroke victims, etc) it is waaaay more chilled out. It gets boring at points though since everyone sleeps quite well on that side. On the dementia unit you will have 10 people awake, extreme risk for falls all shift, physically abusive patients most nights, and probably 3-5 people awake until 3-4AM. I like this unit best because it keeps my job interesting, but BOY is it stressful in ways lol. The other units definitely keep me sane haha.

    • RN since 1994. I worked in many specialty areas, ER, ICU (many different ones), open heart, IVT, M/S, etc. Level 1 trauma was the most intense/critical work I ever did, hands down. The hardest to deal with emotionally was the acute rehab unit, my very first RN job. It was really sad, young kids who are new quads for life, etc. Really hard in a different way.

  7. I worked on a Burn Unit for 3 years, and NICU for 3 years. Burn nursing was the most difficult. There is never a good outcome with a burn patient. NICU was sad sometimes, but often had a good outcome. Burn patients are the sickest patients in the hospital when you are dealing with multiple organ failure, fluid overload, and no immune barrier once their skin is gone. You literally have to hurt them to help them. The pain is overwhelming, and the scarring and surgeries go on & on. Patients come in talking and you get to know them for a few hours, but then they quickly succumb to their injuries, are intubated and critical within hours as their fluid third-spaces. It’s a really tough place to be.

  8. This is like asking what makes the best nurse? To the administrators (suits) the best nurse works extra shifts, never calls out, never goes in to overtime, dots all her “i”s and crosses all her “t”s . He/she is the one they always point the accreditation surveyor at knowing they they will always have the right answer. To her co-workers, the best nurse is the one that has your back, will answer your call lights when you are swamped, always has time to answer a question or lend a hand. To the ER staff, the best nurse is one that knows all of the ACLS protocols without looking, can run a code and comfort a child with equal ease. To the attending physician, the best nurse is the one that knows all of their patient’s labs when asked, always let’s the doctor know what verbal order she needs, especially if she calls him in the middle of the night and catches all his errors.
    To the patient, the best nurse is the one that just held her hand, washed her hair, changed her sheets, brought her pain medication and sat with them, for just a minute.

    The best nurse is all of these things just like the hardest specialty is all of them.

  9. I’m surprised to see that PICU and NICU aren’t in this list. You’re a nurse, a stepparent, a friend, and a social worker all in one. You know them from birth and help them with treatments and transplants and watch them thrive…or die anyway. You hold their parents hands and wipe their tears as you hold your own in. You go home to your old beautiful children with a sense of survivors guilt but at the same time you’re just so thankful.
    It’s not for everyone but it’s a beautiful life.

    • i totally agree, picu is so intense, most times always a one on one, because of the staffing issues throughout our profession, not unusual to pair a one on one. we do it because we love it, and it teaches us how to value the children who have come under our care. loved every minute. miss it.

  10. I was glad to see Med-Surg listed. I have worked Post-op surgical, GI, Med-Surg and School Nurse in my long career. Of the 4, I would say Med-Surg was the most challenging with Post-op coming in second.
    Every day was a crap shoot as to what type of patients I would receive and what level of care they would need. We were not staffed according to acuity so a 12 hour shift seemed much longer some days.
    I had a supervisor years ago say that one day every patient would need 2 nurses…one to care for him/her and one to do the paperwork. He had no idea how true that became.
    I loved helping people and if the job was just the care of the patients what a joy it would be. Unfortunately the old “If it is not charted, it is not done” theme is still true.
    The supervisor made a rule that we had to have our computers on a roll around table in the halls so our presence would be more obvious. What they didn’t seem to comprehend is that we were also sitting ducks for every person whether family member, visitor or employee to stop and chat and interrupt our train of thought. When one visitor in and out during the day told me every time she saw me I was sitting at the computer I had to hold my tongue to keep from telling her that all the times she wasn’t looking and traveling the halls I was in rooms taking care of my patients. You gotta love people for sure.
    Nursing is one of the most rewarding jobs ever, but don’t do it if you don’t love it…it will break you.

  11. I have read multiple post, and like most of my fellow colleagues, I feel that nursing in general is a tough specialty in healthcare. I am currently an ICU RN and have been for three years now. Prior to that I was a CNA for a short period and an LPN for 10 years working in LTACH, nursing home, and assisted living with hospice. For Me, especially since this pandemic has started, this is the most death I have seen since starting my nursing career. This made me question what made me go into Nursing from the beginning! Like one experience nurse said, ” You have to have a love and passion for the profession/people”. If not this is definitely not your calling. Overall, I Love nursing as a profession and will be going back to school for an advanced degree.

  12. I HAVE BEEN AN RN FOR 20+ YRS. YUP IM ONE OF THE “OLD SCHOOL” NURSES!! I HAVE WORKED IN ONCOLGY FOR 10+ YRS AND TOOK A 2ND JOB IN HOSPICE IN ORDER TO HELP MY SON WITH COLLEGE TUITION. I KNEW THE ADDED HOURS WOULD BE EXHAUSTING PHYSICALLY BUT DIDNT REALIZED THAT IT WOULD ALSO BE EMOTIONALLY TAXING. WORKING BOTH AREAS LEAVES ME DRAINED BUT I HAVE LEARNED SO MUCH ABOUT THE PTS AND THEIR FAMILIES AND ABOUT PEOPLE IN GENERAL. MOST OF ALL, I HAVE LEARNED A LOT ABOUT MYSELF. THE PTS NEED SO MUCH PREP FOR THE UNEVITABLE BUT THEIR JOURNEY ENDS AND THE FAMILIES CONTINUE TO NEED SUPPORT/GUIDANCE/GRIEF COUNSELING. IN THE AREA WHERE I WORK IT IS MOSTLY A HISPANIC CULTURE THAT DOES NOT RELY ON PROFESSIONAL COUNSELING. THEY LEAN MORE ON THE NURSE FOR COUNSELING AND EVEN JUST A SOUNDING BOARD. IT CAN BE OVERWHELMING!!!!!!!!!!!

  13. I was a CNA for many years over 10 I have been a nurse now for 4 years and let me say : while CNA work is hard physically, s nurse’s job is not easy at all. As a nurse the responsibility lies heavily on us. You have to supervise other grown adults who at time resent the nurse because they think all we do is sit down. What they don’t realize is that there is so much paperwork involved in nursing and it must be completed. Also the CNA does her job and is done. They go to the nurse and report abnormal vitals skin tear or God forbid a fall the work that has to be done is tremendous especially in a nursing home, and often times you have to repeatedly ask the CNA for vs so that you can go ahead and chart on your residents/ patients. And I’ve had it where the CNA reports abnormal findings @ the end of the shift rather than at the time they’ve found it. Sometimes your’re there hours after your shift still working while the CNA is gone. I appreciate the work that they do but it’s not the same and it took me becoming a nurse to realize that. I’ve known CNA’s who ho out of there way to try and make work hard for the nurse. The nurse and CNA should work as a team but I’ve found often they work against each other. While the nurse can help the CNA with her work, the CNA can’t help the nurse do hers. So when a CNA to say that the nurse has an easy job all I will do is tell a CNA to become a nurse and we’ll see how easy the job really is. Now as for the topic I work as a psych nurse and a corrections nurse and yes they are difficult fields but Dialysis nursing is a very challenging field to work in.

  14. Foster care nursing is quite difficult. One must maintain pediatric knowledge, abuse and neglect issues, be up to date on the law as well as court/ social services policies, and coordinate with multiple community agencies. All this while maintaining an electronic health record. Never mind the secondary trauma of knowing what horrible things people do to children.

  15. As a semi-retired Family Nurse Practitioner for > 24 years I loved reading all of the comments. These point to the main fact about a good nurse, you have to love it, you have to have a “calling” for the Art and Science of Nursing. It is so hard physically, but also emotionally, spiritually, and mentally. I really believe it is the hardest health care “job”. I have been in the ER, L & D, clinic, Public Health Dept., Nursing Home, and loved and relished them all, while thinking that the current job was the hardest. I thought clinic would probably be boring, but guess what? Not! It is like mini-ER, only at a distance of some miles removed from needed machines and expert help. These musings should remind all nurses and increase their pride in their profession, without nurses the entire field of health care would collapse and fail. Please remember there is nothing like a nurse, and all of the various jobs and fields all difficult and demanding. Please do not even think of entering this field if you are not ready to go beyond the job description and work extra hours. You will be doing yourself and this proud profession a disservice. There is nothing like a Real Nurse!

    • The very first book they made us read in college was The Art,Science and Spirit of Nursing, and you knew , by the end of the book, if you possessed the qualities needed to take on this career. I have worked in many area’s of Nursing, PICU, L & D, and Pediatric Diabetes Education all challenging in different ways. Some were physically hard, but they were all mentally challenging and I also would never have had it any other way. No matter what track you take in your Nursing career it will be hard, because you will always have someone’s life in your hands.

  16. Oncology remarks hit home as did the hospice/geriatric. Personally I like ED because of the diagnostic challenges each case presents. Thanks for all Nurses!

  17. I’ve been a Hospice nurse for just over 5 years, doing a great deal of continuous/crisis care – – 1 on 1 care with a patient or patient plus family and friends in 12hr shifts. The cases I enjoy the most are where I’m with a patient or pt plus family and friends for multiple days. I get to know or learn about my pt and who they are/have been; what they did for a living; sometimes hear stories about them in their lives before Hospice; I get to know them as they were in their regular lives. I also get to sometimes learn about and get to know the patients family – brother(s), sister(s), etc. The risk here is in getting to know my patien(s) , family members, friends, there are inevitably going to be some I really bond with. Not too long ago I cared for such a patient & family. Almost from the time I arrived at the patient’s home, he & Ireally strongly bonded, along with his 2 family members, and that bond grew with each shift I spent with them. With this pt, and the condition they were in, there was no real way to even make a guess at the time they had left, & this was very troubling to not only the patient, but the family as well, particularly the patient’s sister. This pt was alert, oriented, and knew very well, because of their particular health conditions and living arrangements, they were going to have pretty close to zero quality of life. One day, early on, when I was there, and no family was around, this patient, on multiple occasions, literally begged me to help them end their suffering; to help them end their life. Had laws been as they are in Oregon, I would have been ok with doing that, knowing all I knew about them and the bond we had developed. As it was, the laws were not like those in Oregon, and I could do nothing but what the Dr had ordered and keep them as physically and emotionally as comfortable, free as much as possible, within the constraints of current law, from pain and discomfort. Truly the most difficult Hospice case I’ve ever worked. But I still can’t imagine doing any other type of nursing. I am a Hospice nurse; It’s who I am and what I do.

  18. Nursing supervision has its dilemmas you are responsible for other nurses triumphs and trials
    You are torn by patients concerns and nurses being stretched to the limit
    Still love it though

  19. I work with a nurse for a long time as a cna in a nursing home.Not all nurse work hard and take care of the patient, cna do all the hard labor and they never appreciated for what they do.

    • I’ve been a nurse a little over 21 years, and in those years have worked with, and, been cared for by CNAs, and I will be the first to agree with you that CNA work is hard, often back-breaking work, but I greatly appreciate the work you all do! There have been many times, especially doing the work I’ve been doing over the last 5 years, that of the healthcare workers I encounter throughout a typical day, it’s the CNAs that are smiling, joking, laughing with patients they care for and are always eager to help me should I ask them to, and I very much appreciate it!

    • I’m an RN and many shifts we have no CNA. I have been the CNA for the whole floor, and I have done my RN job in addition to being the aid. We really appreciate CNAs, because we need more time to actually care for our patients. But trust me, nursing is far harder of the two. Nobody is going to ask an aid to help with CPR or IV medications. But everyone asks the nurses to do the patients’ medical care plus make their bed, get ice, do vitals. We just don’t have enough hands to do it all ourselves.

    • They beat up the elderly. Leave them lying in their own filth. Try to steal the wedding rings off their fingers even if it means breaking the finger. Ignore horrendous bed sores. Steal their clothes. Curse them, slap them and make their lives a living hell.

  20. There is no “light duty” for nurses as we work with sick and/or dying patients. All of the above nurses articulated the special demands and challenges by the army of caregiving nurses. When I left the Marine Corps as a Military Police I thought I had seen “the under-belly of the dragon;” with blown off body parts, mangled features and a world of prostheses. This wasn’t not true. The daily 12 hr shifts in ICU’s “life by the minute” with 11 pumps, ventilators beeping, ports and shunts, catheters and central lines going in and out of our patients bodies as they exist suspended somewhere between life and death…is in a word “impossible.” But it’s not just our patients that we run to rescue from “circling the drain” it’s the Rapid Responses on every floor, the Code Blues that hurl us into phrenetic transhuman machinations that seem to erase time itself. An hour snaps by, it seems, as if the Rapid or the Code team are enveloped in some sort of time warp…after which either life or death has snatched our patient to their next destination. Returning to our respective units picking up where we left our patients and families who too are filled with fear and anxiety. Knowing glances and nods from our colleagues as they return to their patients after backfilling for our absence, and once again the baton of our patient’s care is return to us…only to repeat this dance again and again and again.

  21. I am a relatively new nurse. I have had my license 20 months. Currently transitioning from a Respiratory Therapist 35 years to nursing has proven challenging.
    After reading this article on the different types of nursing specialities I realize I can relate to most of them. This was so perfect for me to read. It put into words that I have felt but could not express. Im trying to find my “niche” somewhere in this profession.
    I am so grateful.

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