What’s the hardest nursing specialty?

Gabriel Blaj | Veer

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.

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.”

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.”

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.”

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.

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25 Responses to What’s the hardest nursing specialty?

  1. Molly Stokes RN

    I have worked in several fields of nursing for the past 45 years. The hardest for me was psych intensive care in a large metropolitan hospital. The only time I was injured was by a pt. high on drugs, not a generic mental health pt. I had a concussion and was off work for 3 months. I didn’t think I could ever return to nursing. The pt. should have been charged but the hospital would not support me doing that. Psych is challenging but the rewards are great.

  2. dawnvictoria RN

    I am surprised that nephrology nursing didn’t make the list of hardest nursing jobs. Most end stage renal disease patients did not treat their hypertension and/or diabetes, so their kidneys failed. We see the same patients 3 times a week and constantly work on education about fluid intake, diet restrictions and medication compliance. We deal with families as well as patients facing chronic illness. Depression and anger are common in our patient population. This isn’t a case of getting them well and sending them home. Dialysis is a maintenance therapy with constant challenges. Every success is sweet and every loss is heart-breaking.

  3. bnesmom

    I whole-heartedly agree with DawnVictoria! I have been a hemodialysis nurse in an outpatient setting for more than 11yrs. (I worked night shift on a med-surg floor for 4yrs prior to that.) Dialysis is mentally, physically and emotionally challenging. Patients require constant education, and encouragement. We are nephrology, cardiac, respiratory, vascular, med surg, endocrine, wound care, psych, oncology and sometimes hospice nurses. We live for the phone calls telling us that a patient has received their long awaited transplant; we pray that today will not be the day that the patient we have spent more time with than some of our own family members has passed. We are frequently the recipient of anger, frustration and resentment. You have to learn to bite your tongue a lot. Somedays I think that I just can’t take it anymore. Without fail, one of my “long-timers”, will read my face and say “I’m glad you’re here today” or “Slow down -you’re working too hard”. The ones I am there to save, save me from myself. I have been honored to take care of some true heroes…they inspire me to get up every day and be thankful for my health, family and friends and to not sweat the small stuff. It is a difficult job, but somedays I get far more than I give.

    • NurseTW

      I have to agree with both you and dawnvictoria’s comments I am an acute inpatient dialysis nurse and I see both the chronic and the acute patients. It is a hard job. The outlook is seldom positive. The small victories are treasured. I am grateful to have the knowledge and ability to help these patients. Some days I simply pray for the patience to practice the golden rule with the oh so stubborn, orange juice chugging, non compliant, grouchy patients. Because, at the end of the day I get to go home.

  4. Ivy RN

    As a Float Pool nurse, I work in most of the above settings. Here are my votes: Behavioral Health is the most emotionally exhausting. Patients in drug and alcohol detox are so unhealthy; so enmeshed in hopeless lifestyles, that a nurse can leave a 12-hour shift feeling pretty hopeless herself. If I work more than 2 days a week here, I feel like I start to become just like these people.

    For sheer physically exhausting work, nothing beats orthopedics. Most of our knee and hip replacements on these floors are there because they’re obese in the first place. Then their surgery and related pain issues makes mobility an even bigger challenge for the nurse. Just getting someone out of bed to the bathroom feels like a marathon some days. Then there are post-op IV antibiotics to consider, and the constant round of pain meds….. I wear a pedometer on our ortho floor, and on an average 13-hour day, I walk 7 miles.

    The most nerve-wracking floor though, is telemetry. The alarms constantly ringing; my beeper going off in my pocket every 90 seconds… even on the night shift, it’s never quiet. By the end of a 12-hour shift on telemetry, my nerves need to be scraped off the ceiling with a spatula.

    • Sheryl RN

      I personally feel that working as a float pool nurse is the most difficult area of nursing, that is if you are a strong nurse and work hard and choose to take difficult assignments. I say this because I have worked along side with other float nurses that may have possibly taken the position to think they wouldn’t have to ever take difficult assignments. They use their float status to state that this isn’t their floor so they aren’t fully trained and can’t do the things that the other nurses can’t do. However, a properly trained float nurse, such as myself can do nearly everything on nearly every floor and that requires a lot of knowledge and extra training. It also requires the ability to be extremely flexible because many times you are moved from floor to floor several times a day and expected to change assignments. Your brain has to switch gears very quickly from one type of nursing to another and you always have to be on time and not get behind on your charting in case you are asked to float to another department. It’s an exhausting job and drs don’t know or care that this isn’t your regular floor so you need to know your stuff and have a high level of confidence. Float nursing isn’t for the new grad or the insecure. It’s tough and thankless at times and takes a special type of person to handle the pressures of the job.

  5. nursenicole

    I spent 10 years in Oncology, acquired my ACLS, let my chemo cert lapse and switched to tele…never looked back, once in awhile I float to Oncology and see that gruesome “let’s throw everything at the wall and see what sticks” death. I’ll never go back…

  6. Belasko RN

    I’m surprised critical care is not in there. It deals w/ all those areas (except home health) and then concentrates it down to the sickest of them.

    • Sheryl RN

      I agree, as a float nurse, ICU is one of my least favorite places to go because of the level of difficulty one mentally, but also physically. Our unit doesn’t have any CNAs and we do total pt care. It is so draining taking care of obese PTs on vents and hanging multiple drips throughout a 12 hr shift.

  7. Juan Mendez

    With no doubt, the NICU, you must be a gifted nurse to survive there…

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  9. Andrea Ducharme

    Pediatric oncology…..& Army Nusing! Hooah!

  10. sdassrn

    I believe every field of nursing has its own level of difficulty. I have been a pediatric nurse for almost 8 years never thought i will stay this long specially in a government setting from our country the Philippines. What’s challenging about my role as a Nicu and Picu nurse is that i see children from the time they’re struggling to breathe and seing them I see parents specially mothers who have a full hope healing their sick child. Since we cater indigent patients i act as a social worker, a foster parent to a child who’s mother is a teenager, a guidance counselor, a teacher, a provider all at the same time in a 12 hour shift. But above all the sacrifices and frustrations is all gone when my patients greets me with a sweet smile in their faces and see them going home.

  11. Gracey501

    I read this article and whole heartedly agreed about the challenges listed for each specialty. However, I noted there wasn’t anything listed about the challenges which occur for ICU/Critical Care Nurses. We are the people all of the above specialties call when it all goes down. We are the “fix it,” “cure it,” “make it go away” Kings and Queens. Challenges? We handle the sickest of the sick, the torn up and broken and we hold your hand when there is nothing else to be done but pray. We console families, other nurses and each other and reassure you that we have done everything that could be done. However, we do it quietly, humbly and without the accolades. We are ICU nurses. With that mentioned- Nursing is challenging regardless of what field you practice in. I have been blessed to range from Med-Surg-ICU-ED to the Cath Lab and believe me the all have their moments. Maybe its time to agree that instead of wondering who has it the hardest- we start to agree that we all do, just on different days. Nursing, the toughest job you will ever love :).

    • MelissaM4

      I completely disagree with your assessment of the ICU nurse. But hey, to each their own.

  12. MrsShippy

    I have worked in a lot of different specialties and each one has its own challenges. Thank goodness there are so many wonderful different nurses to handle so many different facets of nursing. I don’t know if I could work in a pediatric oncology unit without it ripping my heart out. They’re all wonderful, they’re all challenging at times. I wouldn’t want it any other way.

  13. Flygirl1

    I am really surprised that flight nursing has not been mentioned. In my first 11 years of nursing, I worked in Labor & Delivery, ICU, CCU, and ED, IV Team, and a short time in Neonatal ICU. While those areas can be both rewarding and challenging, none of those areas compared to my 24 year career as a flight nurse. Making life and death split-second decisions for critically ill or injured patients of all ages is a huge responsibility. Learning the advanced skills is important, but most importantly, it is having the proper judgement to implement those skills appropriately. Not only do flight nurses have to have a vast amount of expertise in any type of illness or injury for any age of patient, they have to be able to operate safely and diplomatically out “in the field” as well as in the hospital setting. Other elements of flight nursing to be recognized are the inherent dangers of flying and the long shifts in all kinds of weather. I’m honored to have been able to fly for 24 years, but I don’t think many people respect this particular field of nursing.

  14. oldpsychnurse

    This is an interesting list and any one of them can be difficult or terrible. One area left off is the one I consider the worst – organ procurement coordinator. National average ‘length of stay’ is 14 months. The next hardest-ER, then psychiatry. The two where you are most at risk of being assaulted. After that, they are all pretty much the same. And I have done most of them.

  15. spierannunzi

    NICU is one of the hardest specialties, hands down. I worked with many of the best In that dept. Some of the most wonderful, talented and caring individuals. God Bless them all!

  16. mrrj7928

    Where’s ICU?

  17. babsrn 78

    I’m surprised Neurology and Neurosurgical didn’t make the list. I have done a little of everything over the past 12 years, but I found this to be one of the toughest.

  18. Jo-Anna Schanno

    The Case Management nurse is in a very tough specialty. Medicare and state and federal regs make getting what the patient needs rather than what the patient qualifies for is a tough job!!

  19. stufunee

    Although it’s been my only nursing job in my short career (2.5 yrs) I have to say that Burn ICU is a very challenging field. We see pees and adults in my unit and we get patients who are so burned they barely make it through the door. It is hard to see someone who is beyond recognition to deal with the co-morbidities along with the actual burn. Very emotionally, physically, mentally draining.

  20. PediOncNurse

    I was very surprised to not see my specialty on this list. I have been a pediatric oncology nurse for the last 5 years and every day I am asked how I could want to work in such a sad area. The reality is that my job has far more better times than bad. There’s no feeling like getting to throw a “Last Day of Chemo” party for a child that has endured more in their little lives than most adults ever go through. However, the sad parts of my job are gut-wrenching. We spend months, even years getting to know the same kids and their families. When cancer takes the life of a small child, we have to lean on each other to keep going. We recently had a very unexpected death that almost had me questioning if I could continue in this specialty but then you see the next bald, giggling 4 year old tearing down the hall with his IV pole in tow. The knowledge and skills we use to treat childhood cancer are so complex but it always keeps me on my toes.

    • katebRN

      I agree with you! I’m a general Pediatric nurse but we care for Pediatric Oncology patients as well! Pediatrics in general, is a tough specialty since we are taking care of patients and also the parents who are seeing their children go through something so hard and difficult. One of the hardest things to see is the patients suffering from the rough side-effects of chemo, but somehow they always manage to be so resilient and tough. I praise and am thankful for ALL pediatric nurses out there!!