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What Are the Hardest Nursing Specialties?


Did you know that the most common career change for nurses is a move to physical therapy? What nursing specialties are toughest, leading to a career change like this (or any other career move)?

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.”

What are some of your toughest challenges as a nurse? What types of nursing jobs do you think are the hardest? Let us know in the comments section.



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