The Best and Worst Specialties for Nurses in 2023
Choosing a nursing specialty can be a challenge, especially right now. The best specialty for obtaining the highest level of job satisfaction will depend on various factors, including salary, autonomy, and the potential for career growth. Read on to find out the best and worst specialties for nurses.
The Best Specialties for Nurses in 2023
|Best Specialties Based on Salary||Best Specialties Based on Satisfaction Ratings||Best Specialties Based on Autonomy||Best Specialties Based on Potential for Career Growth|
As you can see, there are some clear patterns among the best nursing specialties: CRNAs, Nurse Practitioners, Nurse Educators and Certified Nurse Midwives consistently ranked on the lists of the best nursing specialties.
Best Nursing Specialties Based on Salary
- Nurse Practitioner
- ICU Nurse
- NICU Nurse
Certified Registered Nurse Anesthetist (CRNA) - $195,610
CRNAs are the highest-paid nursing specialty by a long shot! The annual median salary for CRNAs, according to the U.S. Bureau of Labor Statistics (BLS), is $195,610 or $94.04/hr.
Nurse Practitioner - $118,040
Becoming a nurse practitioner (NP) is a great stepping stone for nurses who want to earn a significantly higher salary. The BLS reports that NPs earn an annual median salary of $118,040 or $56.75/hr. However, top earners make as much as $163,350 or more.
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Intensive Care Unit (ICU) Nurse - $119,012
ZipRecruiter reports that ICU nurses are another highly compensated nursing specialty, earning a median annual salary of $119,012 or $57/hr. Income ranges widely depending on location and hours worked per week; however, top earners across the country earn as much as $251,500!
Neonatal Intensive Care Unit Nurse - $126,854
ZipRecruiter reports that the annual median salary for Neonatal ICU nurses in the U.S. is $126,854 or $61 per hour. Like all nursing specialties, income can vary widely depending on factors such as location, hours worked, and the facility. But ZipRecruiter found that some of the highest-paid NICU nurses earn as much as $274,000 annually.
Certified Nurse Midwife - $114,210
RNs who love working with new moms and infants will also love the salary certified nurse midwives (CNMs) earn annually! According to the BLS, CNMs earn a median annual income of $114,210 or $54.91 per year.
Best Nursing Specialties Based on Satisfaction Ratings
There are countless nursing specialties that one can choose from, especially given the ongoing nursing shortage. But Nurse.org found that these were the specialties that reported the highest levels of job satisfaction.
- Nurse Educators
- Home Health Nurses
- Nurse Managers
- OR-Perioperative Nurses
- Pediatric Nurses
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Nurse educators reported the highest satisfaction ratings of any other type of nurse, with 33% reporting that they were happy where they are in their current role. Nurse educators are master’s prepared nurses that generally work in academia, not at the bedside, which may explain why they are faring better than many other types of nurses.
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Home Health Nurses
Home health nurses had the 2nd highest satisfaction ratings, particularly among nurses practicing clinically.
One of the main reasons that home care nurses enjoy a higher job satisfaction is because there is more autonomy and less oversight from management – both major issues reported by nurses in our survey.
Nurse managers are typically advanced practice registered nurses who've earned at least a master's degree. They manage and oversee the nursing staff in a healthcare facility, and are also known as nurse administrators.
As they are at the management level, nurse managers are facing less time at the bedside and therefore may have had to deal with fewer struggles than bedside nurses during the last two years. With that being said, nurse managers have had to overcome ongoing staffing shortages as well as constant difficulties from bedside nurses.
OR and perioperative nurses, also commonly referred to as surgical nurses, also reported higher levels of job satisfaction compared to the average. These are registered nurses that have been trained to assist during surgeries. They care for patients before, during, and after surgical procedures and work on everything from life-saving procedures to elective ones.
Pediatric nurses also reported being happy in their current role at higher rates than other types of nurses. Pediatric nurses are registered nurses that specifically work with newborns, children, adolescents, and teenagers.
Best Nursing Specialties Based on Autonomy/Responsibility
A healthy mix of autonomy and work responsibility can help provide nurses with a higher level of job satisfaction. Here are the nursing specialties that offer the highest level of autonomy and responsibility.
- Nurse Educator
- Nurse Practitioner
- Home Health Nurse
CRNAs have far more autonomy than the average registered nurse. Although CRNAs often work under the guidance of anesthesiologists, they are qualified to make independent judgments regarding various aspects of a patient’s anesthesia care. Thirty states across the US allow CRNAs to practice independently, and other states allow CRNAs to practice under the supervision of a physician.
Nurse educators typically work in clinical settings alongside many other nurses. However, they don’t spend very much time, if any, providing patient care at the bedside. Nurse educators are mostly responsible for training and educating nursing staff and improving their clinical competency so they can provide the highest possible standard of patient care.
This master's or doctoral degree-level role requires a high level of autonomy that allows the nurse educator to work uniquely with nurses of different skill sets, levels of education, and experience.
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Nurse practitioners are APRNs with master’s or doctoral degrees. Their higher education allows for significantly higher responsibilities such as providing primary care, assessing, diagnosing, prescribing medications, and collaborating in the care of patients alongside physicians and other healthcare professionals. Nurse practitioners also have specialized certification and training in a specialty such as family practice, gerontology, neonatal, pediatric, or women’s health.
The autonomy that NPs have allows them to practice within a much greater scope of practice than most other nursing specialties.
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Certified Nurse Midwives
As APRNs, CNMs also have a wider scope of practice and autonomy. According to the American College of Nurse-Midwives, as of 2022, 27 states in the US and the District of Columbia have “full practice authority,” which means CNMs can practice autonomously. Twenty states require a signed collaborative practice agreement with a supervising physician, and three states require physician supervision.
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Home Health Nurse
Some nurses move into home health nursing due to burnout from working in a hospital providing bedside care. In fact, as many as 80% of nurses feel burnt out and frustrated with working with administrators in the hospital setting.
Home health nurses provide ongoing care to patients outside of the hospital setting. Many home health nurses enjoy the responsibility and autonomy of caring for patients in their own homes.
Best Nursing Specialties Based on Potential for Career Growth
When considering which specialties are the best, it's also important to consider that specialty's potential for career growth: how in demand is that specialty? These are the specialties that are predicted to have the greatest growth in demand:
- Nurse Administrator
- Nurse Practitioner and CNM
- Nurse Educator
There is a huge opportunity for medical and health service managers, including nurse administrators, in the coming years. According to the BLS, the job outlook for nurse managers will grow by 28% between 2021-2023.
The AANA reports that there are increasing opportunities for CRNAs to find employment all over the country. They also add that CRNAs represent more than 80% of the anesthesia providers in rural counties.
Nurse Practitioners and Certified Nurse Midwives
Not only are NPs and CNMs earning a higher salary, but their career outlook in the fields is also excellent. The BLS reports that NPs and CNMs can expect 40% job growth between 2021-2031. In contrast, the BLS states that the job outlook for registered nurses for the same period is only about 6%, which is as fast as average professions.
Some of the reasons that nurse educators have a higher potential for career growth is that they may enjoy their specialty more than many other nurses.
Nurse educator positions are a promotion from working as a bedside nurse where they learn valuable teaching skills that have a huge impact on hospital performance ratings. If moving into an administrative nursing position interests you, this may be a great route to take!
The Worst Nursing Specialties in 2023
All nursing specialties have their pros and cons, but these are the so-called worst specialties for nurses based on salary, satisfaction, autonomy and career growth.
|Worst Specialties Based on Salary||Worst Specialties Based on Satisfaction Ratings||Worst Specialties Based on Autonomy||Worst Specialties Based on Potential for Career Growth|
The Worst Nursing Specialties Based on Salary
It is important to remember that there are many factors at play when it comes to nursing specialty salaries, including your city and state, your facility, and whether you work full-time or part-time.
- School Nurse
- Home Health Nurse
- Research Nurse
- Nurse Educator
- Health Policy Nurse
School Nurse - $61,727
Many nurses love the idea of moving out of the clinical setting and into an environment where they can help children in an educational setting. If this is you, school nursing may be a perfect fit. However, school nursing is also one of the lowest-paid nursing specialties.
ZipRecruiter reports that the median annual salary for school nurses in the US is $61,727. However, this range also ranges widely -from as low as $25,000 to as much as $96,000 per year.
Home Health Nurse - $74,345
ZipRecruiter reports that as of August 2022, home health nurses earn a median annual salary of $74,345 or $36/hr. However, despite a potentially lower salary, many home health nurses enjoy the flexibility this specialty offers and enjoy caring for people in their homes.
Research Nurse - $76,294
There are many types of research nursing positions. However, ZipRecruiter reports that the national median average income for clinical research nurses is $76,294 or $37/hr.
Nurse Educator - $78,967
Payscale reported that the average median nurse educator salary in the US is $78,967. However, income ranged from as low as $59,000 for the lowest 10% to $109,000 for the top 10%.
Nurse educators teach and instruct nursing staff in clinical settings on maintaining clinical competencies, improving nursing practice, and providing the highest standard of patient care.
Health Policy Nurse - $87,359
ZipRecruiter found that as of August 2022, home health RNs earned a median income of $87,359 or $42/hr. However, they also found their incomes range widely from $39,000 to $143,500.
The Worst Nursing Specialties Based on Satisfaction Ratings
Based on our survey, nurses in the following specialties reported the highest levels of dissatisfaction, burnout, discomfort, and other negative feelings:
- Emergency Room
- Progressive Care Unit (PCU)
- Labor and Delivery
It is difficult to determine if nurses in these specialties were experiencing burnout prior to the pandemic, but previously labor and delivery nursing positions were one of the most coveted jobs in the nursing profession. Now, these nurses reported some of the highest levels of dissatisfaction in areas of feeling short-staffed, not receiving hazard pay or adequate back-up, and feeling underpaid.
Telemetry nurses had the highest reported levels of job dissatisfaction, with 0% reporting that they were happy in their current role. In addition, 9% of telemetry nurses felt underpaid.
Telemetry nurses are registered nurses that generally work in the hospital setting using high-tech equipment to measure life signs, dispense medication, and communicate with patients that suffer from acute disorders such as caring for patients who are recovering from cardiac intervention, such as a cardiac stent or coronary artery bypass grafting (CABG) surgery.
Emergency Room Nurse
Only 2% of emergency room nurses reported feeling happy in their current role. On top of that, they had the highest reports of feeling unsafe at work, at 82%.
Throughout the pandemic, ER nurses were on the frontline and generally were the first nurses that encountered COVID patients. They dealt with countless struggles including ongoing PPE shortage as well as overrun emergency rooms. Now, as the number of ER cases stabilizes, ER nurses are struggling with caring for unvaccinated patients.
Progressive Care Unit (PCU) Nurse
Progressive care unit nurses, commonly referred to as PCU nurses, have a difficult job with only 3% replying that they were satisfied in their current role. Similar to a long-term care nurse, PCU nurses care for patients that require intermediate care prior to going home or a long-term care facility.
Unfortunately, since COVID, PCUs have become units that house patients that do not have anywhere else to go. Some are awaiting beds in long-term care facilities while others would be able to go home if there wasn’t a shortage of home health nurses. This could explain why 94% of PCU nurses reported feeling understaffed - higher than any other specialty.
Medical-surgical nurses, commonly referred to as med-surg nurses, are the most common type of nurses. These nurses require the broadest knowledge of nursing as they are required to care for patients suffering from a variety of ailments.
Med-surg nurses have the highest nurse-to-patient ratio. During COVID, this number continued to rise. At one time, med-surg nurses would care for 4 to 6 patients during a shift. At the height of COVID, that number rose to 7 to 9 patients in some areas of the country. Unfortunately, as a result, this led to very high nurse dissatisfaction rates, with 92% of med-surg nurses reporting they feel understaffed.
Labor & Delivery Nurse
This might be the most shocking nursing specialty on the list. Generally speaking, labor and delivery nurses usually have very high job satisfaction; however, given the changing climate many labor and delivery nurses have had to also handle intense patient relations.
During the height of COVID, some maternity wards were not allowing expectant mothers to have a support person, including the baby’s father, present during delivery. As a result, there were countless unhappy patients and families which helped lead to increased nurse dissatisfaction. Other issues L&D nurses report having are that 84% feel underpaid, 91% feel understaffed and 89% feel they don't have adequate backup.
Worst Nursing Specialties Based on Autonomy/Responsibility
Unfortunately, many nurses report that they are dealing with increased workloads and have fewer resources than ever before. This means that nurses are taking on more patient responsibility, which sometimes translates into unsafe patient ratios.
In fact, in Nurse.org’s 2022 State of Nursing Review, 80% of nurses say their units are inadequately staffed. This puts the nurse’s license and the patient's safety at risk. Some nurses reported that they felt they were increasingly running tasks, making it exceedingly difficult to provide adequate patient care.
- Progressive Care
- Labor & Delivery
91% of Telemetry nurses said that they felt underpaid for the amount of work and responsibility they had. In addition, 91 % reported they experienced staffing shortages and felt unsupported in their roles.
The emergency room is well-known for being a high-stress environment. To top that off, 88% of nurses in the Nurse.org survey reported that they were facing staffing shortages and felt underpaid for the amount of work and responsibility they had during shifts.
Progressive care nurses also have increasing duties for patients who require a higher level of care but are not quite sick enough to need ICU care. 94% reported staffing shortages in their units and felt underpaid for their increased job responsibility.
Medical-surgical nurses also feel the burden of increasing responsibility, with 92% reporting staffing shortages and 74% saying they feel unsupported by administration and staff.
Labor & Delivery
Many labor & delivery nurses say they love their jobs because they enjoy providing care to women and families during the most vulnerable and memorable points of their lives. However, 91% also state that they face staffing shortages, and 76% report feeling unsupported in their jobs.
Worst Nursing Specialties Based on the Potential for Career Growth
Career growth can come in many forms. Most commonly, nurses find career growth opportunities by advancing their education or finding higher-paying nursing roles that require more responsibility, better critical thinking skills, and more work.
It may also help to acknowledge that burnout may prevent nurses from staying in a position that may have eventually offered some career growth opportunities. In fact, 90% of nurses practicing in a clinical setting report a high level of burnout, versus 78% of nurses not working in a clinical setting. In contrast, 65% of NPs and APRNs reported job burnout.
The jobs listed below include nursing specialties based on the potential for career growth without simultaneously also earning advanced education or applying for higher-paying nursing roles. In other words, staying in a lower-paying position that also has little upward potential indefinitely throughout your nursing career will also limit your overall career growth. But that doesn’t mean these are not great careers!
However, if career growth is important to you, you may want to look at other options at some point.
- School Nurse
- Home Health Nurse
School nurses make a tremendous difference in students' lives by providing health education and supporting those with chronic healthcare conditions, such as diabetes or Crohn’s disease. Unfortunately, aside from increased pay from years of service, there is not a lot of potential upward mobility in a school nurse career.
Home Health Nurse
Some nurses move into home health nursing to get away from working at the bedside. While home health nursing is typically much less stressful than working in a hospital, some nurses may lose some of their bedside nursing skills, which may prevent upward career growth if they decide to move back into a hospital role.
How to Choose the Right Nursing Specialty for You
There are many pros and cons to every nursing specialty. In many cases, knowing what is best for you is impossible until you’ve worked as a nurse for a period of time.
For example, one person may have desperately wanted to work in the ICU after graduating from nursing school, but after their first year on the job, they realized they hated it. Instead, they decided their passion was working with children, so they applied for a pediatric nurse position and moved to a different unit. At the same time, an ICU position opened up for a nurse who loved working in the ICU.
In other words, everyone has their own idea of what makes a specialty better or worse. Here are a few questions to ask yourself when deciding on the best specialty for you:
- Do you want to work with adults, children, or infants?
- Do you want to work in a hospital, a university, a school, or other health facilities?
- Do you thrive under pressure or want to work in a low-stress environment
- Are there specific specialties that you enjoyed in nursing school, such as psychiatric care, ER, or med/surg?
- Do you want to work directly with patients or in an administrative role
- What are your financial goals?
- Do you want to earn higher education to take on more responsibility and have more autonomy?
- Are you open to relocating for your dream position or earning more money?
- Have you considered travel nursing?
It may also help to reach out to other nurses to ask about their experiences working in different specialties.
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