Areas of work, specialisms and alternatives

Your career options in nursing

25 Jan 2023, 13:38

Qualified nurses can work in a variety of different specialisms from children's nursing to mental health. Take a look at our overview of nursing areas of practice.

Confident nurse in blue scrubs with a stethoscope around her neck holding a clipboard.

Career areas in nursing for graduates: Adult nursing | Agency nursing | Children's nursing | Learning disability nursing | Nursing home work | Nursing lecturer | Voluntary organisations |

Nurses plan and provide medical care to patients in a variety of settings. They work alongside doctors, health care assistants and other medical professionals to ensure a patient’s proper care. To work as a nurse you will need to complete a degree in nursing; some courses specialise in a particular branch of nursing, for example, mental health nursing.

You will also need to be registered with the Nursing and Midwifery Council (NMC) in order to practise. To stay registered at the NMC you will need to revalidate your registration every three years, and will need to meet certain conditions including 35 hours of continued professional development and 450 hours of registered practice in the previous three years.

As well as professional qualifications nurses must possess personal qualities such as compassion, commitment, dedication to patient care and organisation. Nurses must be confident working in situations that can often be traumatic and stressful. A good bedside manner is essential, as is the ability to work with and treat people from all walks of life.

There are many different types of nursing and there are plenty of opportunities for promotion. Some nurses work in primary care, which is the first stage of contact with the healthcare system, while others work in secondary care, which follows first contact and involves the provision of specialist medical services. Primary care is typically provided by general practice (GP) surgeries, while secondary care nurses tend to work in hospitals.

Qualified nurses can choose to specialise and work with a specific group of patients, for example the elderly, children or those with learning disabilities, or they can opt to be an agency or bank nurse, allowing more flexibility around when they work.

Adult nursing

Opportunities for adult nurses range from caring for patients to becoming a specialist in promoting health.

A graduate career in adult nursing involves caring for the physical aspects of adults and, depending upon your skills and progression, the management of people plus resources. This involves monitoring people: their blood pressure, heart rate and bodily functions as well as helping patients to wash, dress and get about. Adult nurses need to be able to assess how sick patients are and respond to changes quickly.

In the NHS there is a clear career structure supporting nurses in their development from staff nurse working on a ward, for example, to autonomous consultants managing a caseload of patients in the community. There is a wide range of opportunities available for adult nurses ranging from becoming specialists in promoting health, to caring for patients when they are at their most vulnerable whilst recovering from major illness or surgery. Settings are therefore diverse, ranging from an intensive care unit to a patient’s own home.

You will need a BSc in nursing, specialising in adult nursing, in order to begin a career as an adult nurse. Newly qualified nurses who work in a hospital environment on a ward will generally look after a group of about eight patients during a span of duty. They Once qualifies, nurses will work as part of a multidisciplinary team – acting as the main point of contact for the patient and coordinating the contributions of other healthcare professionals.

Many newly qualified nurses will seek employment in hospital trusts so that they can hone their skills in recognising and caring for sick adults. There are also opportunities to work in community settings.

Nurses need to be able to communicate with a range of people from patients and their families to staff and members of their team. The ability to spot sick patients is important and nurses should have a good depth of knowledge so that they know what to do in most situations.

Agency nursing

Agency nursing can involve working in a variety of environments and, as each position is temporary, can allow nurses the flexibility to chop and change jobs. As an agency nurse you will be required to work in a variety of roles with little training when you arrive at each new assignment; as such, a certain amount of experience would almost certainly be necessary prior to joining an agency.

Agency work offers flexibility in terms of personal control over free time and avoidance of working mandatory weekends. It provides first-hand exposure to new protocols, techniques and work environments, and the opportunity to develop experience, knowledge and self-confidence in many areas. The increased rate of pay that the majority of agency work provides also motivates many nurses to join agencies.

On the down-side, the nature of being a serial temporary employee means you often won’t develop work relationships or friendship groups within the workplace; it demands the ability to cope with being the constant new person, which may not be everyone’s cup of tea.

You will need a BSc in nursing in order to begin a career in agency nursing. For more specific areas of work, you may also need relevant qualifications. Graduates working as agency nurses register with an agency that provides them with shift or contract work. Nurses tell the agency their personal work requirements – whether they want part-time or full-time employment, what hours they can work and any other specifications and are then contracted accordingly.

An agency nurse must be able to walk into any environment and regardless of unfamiliarity, integrate immediately and perform effectively in numerous tasks. This means that agency nurses need to be extremely skilled and confident in what they do and must be able to work independently, not asking their colleagues questions at every turn. Flexibility and adaptability are crucial, as is being friendly, outgoing and having the ability to meet and get on with new people.

Children's nursing

A graduate career as a children's nurse involves working with children who have relatively minor conditions right through to those who have serious, chronic and/or life-threatening conditions. With the right skills and progression it can also involve managing people and resources plus – potentially – research and setting up projects.

The work is as much about providing reassurance to the child’s family as it is about providing care for the child. In most cases a great deal of the care is provided by the family and the nurse’s role is to work with the family to teach, build confidence and support them in looking after their child. This is particularly important if the child has a lifelong condition.

Your nursing degree will usually specialise in children’s nursing. There are several specialist children’s hospitals in the country and most general acute trusts will also have at least one children’s ward. Children’s nurses also work in A&E and in child and adolescent mental health services. A newly qualified nurse would initially be expected to consolidate their learning by taking responsibility for the care of a group of patients and then take on more complex roles.

Children’s nurses need to be highly observant and flexible problem solvers who recognise when a child is becoming very sick very quickly. They need to be prepared to act as the child’s advocate whenever and wherever necessary. Good communication and interpersonal skills are essential but children’s nurses also need to be emotionally resilient.

Learning disability nursing

People with a learning disability have a significant impairment of their intellectual and social functions. These impairments are present from childhood and are not the result of an accident or illness in adulthood. People with a learning disability can often experience physical, sensory and/or mental health problems.

Learning disability nurses work in partnership with a range of professionals along with the client’s family and carers, assisting in an all-encompassing way to provide a person-centred service. They work with some of the most vulnerable and socially excluded people in society, promoting health and well-being and working to enable people with a learning disability to live fully integrated and independent lives.

In order to work as a learning disability nurse within the NHS you will have to hold a degree in nursing, focusing on the learning disability branch. Becoming a learning disability nurse opens up a huge range of opportunities to work with children, adults and older people who will each have a diverse range of needs. Nurses can work in a number of different settings including community teams, prisons, schools, respite facilities and secure services, amongst others.

As a newly qualified nurse you will need to have highly developed communication and interpersonal skills to be able to relate to people at different levels. You should also be able to work both independently and as a team member of a multidisciplinary group.

Their work can be physically and emotionally demanding and may include a lot of travelling to clients' homes.

Mental health nursing

Mental health nurses work with service users, their carers and their families in a range of settings and in teams with a variety of functions. Some nurses work in in-patient settings, aiding the recovery of people whose mental health problems require a period of hospital care.

Others work in forensic, day and residential services, and many belong to community mental health teams working with people in their own homes or local communities.

To work as a mental health nurse you will need to complete your pre-registration nursing degree specialising in mental health. Newly qualified nurses will need to consolidate and extend their knowledge, skills and experience before they find a route into the role and setting that they aspire to.

Some organisations now provide rotation schemes, which give newly qualified nurses a chance to explore a range of settings in mental health services. This approach often enhances employment prospects and may even aid them in the career pathway that takes them from staff nurse to consultant nurse.

Mental health nurses need the ability to listen, respond and empathise with their patients. They need good observation and interpersonal skills to be able to understand service users’ issues and concerns. Emotional intelligence and the ability to help people find solutions will help, as will the capacity to remain calm.

Nursing home work

Nursing homes care for people with care needs that cannot be met in any other care setting apart from in hospital. They also provide palliative care and intermediate care enabling people to recover following illness and injury. There are more beds in nursing homes than in NHS hospitals. Most nursing homes are owned either by voluntary or for-profit providers, though some are institutions run by the NHS or local councils. Some homes are stand-alone while others are part of a large group.

The role of a nurse here is to take charge of shifts, to work with care assistant colleagues, medical staff and visiting therapists to provide high quality care. The role involves advanced assessment, delivering care and working with older people and their families.

The deputy is responsible for managing the home in the absence of the matron or manager. The matron is responsible for all aspects of the home including managing domestic staff and controlling budgets. There are opportunities for nurses to work as regional managers and manage a group of homes.

Nurses considering working in a nursing home should be patient, as you will be working with the same people and the same problems day after day. You should also be emotionally resilient as it can be emotionally taxing to build up relationships with people who may not have long to live.

You will also need experience in caring for the relevant patient group, for example older people. Postgraduate qualifications in relevant areas such as wound care or palliative care are a bonus.

Lecturer in nursing theory and practice

Lecturers in nursing are qualified nurses employed by universities to teach students on pre-registration and post-registration nursing courses. Most will also have a teaching qualification.

Pursuing a career in teaching does not mean an end to working in a clinical setting. Many lecturers also have a clinical supervision role, helping students to develop their skills on the job as they assess and care for patients. Joint lecturer/practitioner roles – where nurses split their time between teaching and clinical work – are becoming increasingly common, and those in these roles have the option of continuing to pursue a clinical career path.

Teaching takes place in a variety of settings, including formal lectures, tutorials, practical skills sessions and clinical settings. There are opportunities in teaching for nurses from all branches: adult, children’s, mental health and learning disabilities.

University policies vary, but generally a new lecturer in his or her first job might expect a settling-in period of one or two months. During this time they may shadow an experienced lecturer, familiarise themselves with the university’s policies and procedures, and prepare teaching materials. The first couple of years in the job can be challenging because of the need to research and write notes for all teaching sessions.

Some lecturers combine teaching with bank work at weekends or evenings, but this will be very much dependent on their workload. Lecturers have the potential to progress right to the top of the academic tree – even to vice chancellor level. Some choose to move into research where there is also an excellent career path.

Key personal qualities needed for teaching are strong organisational skills, being able to keep calm under pressure, the ability to motivate others, and having the flexibility to adjust your teaching style to people with often very mixed abilities.

Nursing lecturers need to be registered with the NMC, complete a period of full-time experience (or equivalent part-time experience) in a relevant nursing field where students gain practice experience, and acquire additional professional knowledge which must be relevant to the intended area of practice and at no less than first degree level.

Voluntary organisations

In a nursing career with a voluntary organisation you could help people in need anywhere in the world.

Aid agencies recruit nurses to work overseas in conflict areas or areas struck by natural disasters.

Most aid agencies recruit nurses on a fixed-term paid contract of six to twelve months. Many organisations have a basic remuneration structure that usually increases with experience and seniority. In between assignments, a lot of nurses do bank or agency work. Nurses work in public health roles in hospital or community settings. Hospital-based roles are normally for surgical ward nurses or operating theatre nurses.

You will work with local nurses managing a number of patients and providing both on-the-job and more formalised training. You might also assess where improvements can be made to processes and equipment. Community public health nurses work with leaders of local communities setting up health programmes.

Nurses working for voluntary organisations are often involved in managing budgets and providing technical expertise and training. The work might focus on HIV and AIDS or mother-and-child healthcare. The campaign could be to reduce the stigma attached to certain diseases, prevention or health and hygiene promotion. You need to be experienced, so this area is not suitable for newly qualified nurses.

All roles require nurses with experience of managing and training staff. Experience of overseas work is essential for community health roles and desirable for other positions. Communication skills are very important for working with different cultures and languages, and an ability to understand the political context of the region you're placed in will help. Some aid agencies will take nurses without this much experience, so it's a good idea to investigate what different organisations require.

There are specialist courses and educational programmes that help to equip professionals for humanitarian work. Qualifications range from one-day courses through to masters level programmes. Most humanitarian organisations or non-governmental organisations (NGOs) provide in-house training and pre-deployment preparation.

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