Four special kinds of nurses

What I love about nursing is that you can do so many different things," says Nancy Hays, a nurse practitioner at Mount Auburn Hospital in Cambridge. Indeed, nursing is a profession of many specialties, and each encompasses a unique combination of skill sets, work setting, and professional and personal challenges and rewards.

The beauty of the field is that with a registered nurse degree in hand, nurses can spend one year or many in general nursing and then segue into a specialty with relative ease, often absorbing the required special expertise on the job.

Nurse Practitioner
Nurse practitioners (NPs) fill a key role in doctors' offices, longterm care facilities, and other settings: They provide primary care for healthy patients as well as for those with routine ailments or chronic disease. Their service helps free up physicians to spend more time with complex cases and seriously ill patients.

"I see patients for physical exams and acute problems," says Hays, who works in an internist's practice within Mount Auburn. "I can write prescriptions, order MRIs, and lab tests. I basically diagnose people."

Almost 30 years into her nursing career, Hays made the transition to nurse practitioner in the late 1990s by getting a master's degree in an NP program at Simmons College. These programs for RNs (registered nurses) generally take two to three years; some career-changers with bachelor's degrees enter combined RN/NP programs.

About 102,000 nurse practitioners were employed in the U.S. in 2000, more than double the number practicing in 1992, according to the American Nurses Association. The median salary for a Boston-area NP in early 2004 was $73,000, according to Salary.com; compare that to the base pay of a staff nurse: $50,000. The demand for nurse practitioners might not be as high as for other nursing specialties, but jobs are there for graduates of NP programs.

"I've got the best of all worlds," says Hays. "I get to interact with patients, do teaching, and also work independently."

Visiting Nurse
"The reward of being a visiting nurse is seeing someone finally learn to take care of themselves," says Janet McDonough, an RN with the Visiting Nurse Association of Boston.

Teaching is a critical part of the job for visiting nurses, who make home visits to patients recuperating from an accident or illness and those with disabilities or chronic disease. Visiting nurses give treatments ranging from wound care for diabetics to monthly injections of vitamin B12 for patients with pernicious anemia.

Beyond the personal rewards of patient care, McDonough likes the civil hours. She works Monday through Friday starting at 8 a.m., and rarely must work past 4 p.m. The visiting-nursing role is well suited to those who like to be on the move; in a typical shift they call on about half a dozen patients.

With ever more medical technologies being adapted for home use-and with managed-care systems pushing for shorter hospital stays-the need for visiting nurses is growing. There are more than 125,000 visiting nurses in the nation, says Jon Spampinato, a spokesman for the Visiting Nurse Associations of America.

To become a visiting nurse, an RN needs about a year of experience in acute care in a hospital or long-term care facility. In greater Boston, visiting nurses with 10 years' experience may earn $60,000 to $70,000, says McDonough. But much of the payoff comes in the form of the personal contact. "Most of the patients like us because we're probably the only people they see," says McDonough.

Oncology Nurse
It requires a special kind of nurse to take on the responsibilities of oncology. These RNs spend much of their day administering powerful drugs with major side effects to seriously ill patients.

"If you can do one thing to make a patient's day better, you're having a good day," says Nora Watts, an oncology nurse at Newton-Wellesley Hospital in Newton. "You're helping people through the toughest times of their lives." Oncology nurses have a wide range of responsibilities, including chemotherapy infusion, radiation treatment, helping patients deal with side affects, and helping families cope with their loved ones' mortality. Because many of the therapies are toxic, the work is technically demanding. "You really have to be on," says Watts. "There's a lot of checking you have to do with chemotherapy."

As cancer rates have risen, the ranks of oncology nurses have grown. There are about 60,000 nurses working in oncology in the United States. Recent graduates of RN programs generally can work as oncology nurses after they spend about a year being mentored in the specialty and pass the chemotherapy certification. Oncology nurses in Boston earn a median of $53,000, according to Salary.com.

Hospice Nurse
"It's a calling. Without grace, you can't be dealing all the time with people who are dying." That's the way Donna Robert describes how she was drawn into hospice nursing two years ago, after many years in general nursing.

Hospice nurses work either in residential hospices or, more commonly, in the homes of terminally ill patients. The end-oflife care they provide ranges from managing pain and symptoms, and coordinating healthcare with social services, to educating families on disease progression. Hospice nurses often must adjust their care to meet patients' cultural and spiritual needs.

Nurses sometimes take a cut in pay to enter the hospice field, and it's a specialty sorely in need. There were about 19,000 hospice nurses in the country in 2000, less than 1 percent of all RNs, according to the National Sample Survey of Registered Nurses. Any special training generally can be acquired on the job.

The sadness of caring for the dying is always mixed with satisfaction, Robert says. "You feel like the people who are around you-families and patients-all so much appreciate everything you do."