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What Are the Hardest Nursing Specialties?


One of the best parts of being a nurse is that once you get your degree, you can pursue all types of nursing specialites that will further your nursing career. Nurses work in various departments and positions related to different aspects of the patient care experience, including in non-bedside nursing jobs. You don’t have to stick with the same job if you need a change or want to make more money for your time. Consider pursuing a nurse speciality to find your home in the healthcare industry.

But not all nursing fields require the same level of care. Some rank among the most stressful nursing jobs usually due to time constraints and a lack of resources. Other specialities require access to more complex information. A stressful nursing work environment can leave you drained and exhausted, but it can also help you put your skills to the test in new ways.

So, what nursing specialties are the toughest?

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. When considering the types of nursing jobs out there, 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 specialties in nursing. As you can imagine, we got lots of different answers! Here are just a few of the types of nursing specialties our readers mentioned — along with a little insight into what makes these nursing jobs so difficult.


There’s no surprise that this one is near the top of the list. Treating patients who have a low chance of survival is bound to put 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 one of the different nursing specialties 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 nursing 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 it’s 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 on 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 nursing or NP 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. While it’s not one of the highest paid nursing specialties, it is certainly much different than others. 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 of 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.”

Legal Nurse Consultant

A legal nurse consultant is a nurse who advises lawyers regarding the health condition of a person involved in a lawsuit. The firm may rely on the nurse to give testimony during the trial. For example, the nurse may need to speak to a person’s mental health status or review injuries when someone is suing for potential damages.

Nurse Practioner 

A NP requires the most training and education of any nursing specialty. You will work in primary care and serve a range of different patients throughout the local community. NPs are often the main source of care in rural areas. They also collaborate with other medical professionals. You will need to be well versed in all types of patient care.

Pediatric Nurse

This field can be stressful because it involves working with children, including those suffereing from terminal illness and disease. It can involve a lot of heartache, but you are also likely to form strong bonds with the kids along the way. You will also spend a lot of time reviewing information with the child’s parents or guardians while they process this difficult situation.

Flight Nurse

Being a flight nurse is easily one of the toughest specialities because it requires you to provide care in a high stress environment. Patients may need to be airlifted to and from medical facilities in an emergency. Others may be trapped in an isolated area, such as the remote wilderness. It will be your job to keep the patient stable until they reach the hospital.

What are some of your toughest challenges as a nurse?

Registered nursing can mean many different things. Not all RNs are bedside nurses caring for multiple patients at once.

And not all nursing jobs require this much stress. Some specialities are among the least stressful nursing jobs because they give you more time to spend with patients. For example, did you know that the most common career change for nurses is a move to physical therapy? Occupational health nurses tend to have a more relaxed schedule because they can easily spend up to an hour or more with just one patient. Others spend time their time researching the way providers can better educate patients. When a nurse speacilizes in a new field, they are giving themselves the choice to work how and where they please.

What types of nursing jobs do you think are the hardest? Let us know in the comments section. And find a nurse role that works for you for and your unique skillset.


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