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    7 Specialties lead demand for nurses


    Industry experts are predicting a promising decade for those in nursing careers, with employment of nurses expected to grow at least 18 percent between 2011 and 2018, according to the U.S. Bureau of Labor Statistics.

    This surge in demand is good news for travelers, according to staffing representatives who say that health reform, an aging baby boomer population, and burnout in nurses in permanent posts will continue to foster opportunities across a variety of specialties for travel nurses.

    We spoke to some experts in the travel industry, who forecast while many nursing specialties have bright job outlooks going forward, seven will like rise above the rest as peak performers: ICU, neonatal, dialysis, OR, telemetry, labor and delivery, and ER nursing.

    Driving demand

    Richard Kousgaard (rear) says qualified travel nurses are in high demand."It's tough to find good qualified nurses to meet the qualifications for some of these hospitals," says Richard Kousgaard, an account manager and recruiter at Aureus Medical. "There are not enough nurses right now for us, let alone hospitals themselves."

    The traveler industry took a direct hit during the economic downturn, with many staffing firms reporting a decrease in available nursing assignments. However, with the economic rebound, the demand for travel nurses is once again on the rise. Chuck Klee, senior recruiter with RNnetwork, a nurse-staffing firm also based in Boca Raton, says the demand for temporary staffing has grown significantly from where it was two to three years ago.

    "Nowadays, jobs are flowing," he says.

    Staffing representatives say this increased demand has been driven by healthcare reform as well as more nurses leaving permanent posts because they are tired of dealing with administrative issues or politics at the job.

    "Hospitals are being held to a different standard, ratios are changing, customer satisfaction survey scores have got to go up or they are not going to get their reimbursement, you know on and on, that's created the need on the hospital," Kousgaard says. "There is always more money in traveling so there's other nurses jumping ship to do that and make even more income and at the same time not have to deal with the politics of the hospital."

    Cyndi Stamler, regional vice president of Boca Raton, Fla.-based Club Staffing, says healthcare professionals who travel are often able to avoid burn out by continually changing their environment and learning new things at each assignment.

    "Some healthcare professionals just...get burnt out, this way they do 13-weeks or 8-weeks or whatever they want in a position and if they want to stay they can, if they are asked to stay and they want to move on, they can," she says.

    For example, Dawn Cole, RN, BSN, decided to leave her permanent post as a NICU nurse in Montana because she felt she needed a change. Cole says since going on the road nearly two years ago, the mobile lifestyle has helped her to avoid the burnout that she felt was inevitable.

    "I've kind of been rejuvenated in my job and I am excited to learn again," says Cole.

    She's found plenty of job opportunities as a NICU travel nurse, mainly because she possesses some characteristics that make certain specialty nurses a perfect fit for travel assignment opportunities , say staffing representatives, including experience, higher education, working in a sought after nursing field specialty, and the ability to be flexible in demanding patient care environments.



    ICU wants you

    Fast Fact: ICU nurses can work in general intensive care, cardiac care, pediatric intensive care, and neonatal intensive care units.

    Nurses with ICU experience are the among the easiest nurses to place, according to Kousgaard. That’s because hospitals across the country are continually in need of quality nurses to work in ICU departments, which creates an increased demand for travel nurses.

    "There are not enough nurses," he says.

    Ramon LavanderoRamón Lavandero, RN, MA, MSN, FAAN, senior director of the American Association of Critical-Care (AACN Critical Care)Nurses, estimates there are more than 500,000 high acuity and critical care nurses in the United States currently and that number is only expected to rise.

    “If anything, the demand for nurses with expertise in high acuity and critical care will continue to climb steeply. Why? Because, more and more, hospital patients are only those who are very sick and require complex, technology-dependent care. That means pretty much any nurse who works in an inpatient setting will need this unique set of knowledge, skills, and abilities,” he says.

    While demand is consistent, Peggy Patterson, RN, says the lead-time between assignments is not as long as it once was. She says that before 2008, she'd often know where she was going six weeks before her assignment would end and she would have several options to choose from. Now Patterson, an ICU nurse with more than seven years of experience as a traveler, says the maximum amount of notice she usually gets is three weeks.

    But despite the limited lead time, Patterson agrees that the environment for travelers is getting better than it was a few years ago and says travelers now have more places to choose from when selecting their assignments.

    "It's still tight," she says, adding the flexibility is essential to a successful traveler career. Patterson became a traveler because it afforded her a way to make more money than she could in her home state of Mississippi and gave her an opportunity to see the country and visit new places.

    "One of the beautiful things about it is if you are not happy you know it's only going to be 13 weeks," she says.

    Although demand is high, the field is competitive. Kousgaard says even qualified travelers must still have the necessary skills and experience to secure available assignments.

    "When you start getting down to telemetry and step down units, and ICU units, and ER units and NICU units and any of the critical care specialty areas, two years plus is what hospitals are asking for and it needs to mirror the environment that we are placing these people in," he says.

    The American Association of Critical Care Nurses Certification Corporation offers specialty and subspecialty certifications for high acuity and critical care nurses to further their skills and increase their marketability. Lavandero says more than 60,000 nurses have received certification through the organization, making progressive care nursing certification one of the fastest-paced nursing qualification programs.

    The AACN offers a wide array of certifications. Here are seven:

    • CCRN: Adult, Neonatal, and Pediatric Acute/Critical Care Certification

    • PCCN: Progressive Care Nursing Certification

    • CMC: Cardiac Medicine Subspecialty Certification

    • CSC: Cardiac Surgery Subspecialty Certification

    • ACNPC: Acute Care Nurse Practitioner Certification

    • CCNS: Adult, Neonatal, and Pediatric Acute Care Clinical Nurse Specialist Certification

    • CNML: Nurse Manager and Leader Certification





    Fast fact: After telemetry nurses connect patients to machines that measure blood pressure, heart rate, breathing rate, blood-oxygen level, and electrocardiogram information, the computers send data via wires, radio waves, or other means to a remote location where nurses may closely monitor the patient. The nurse interprets this information, assesses the patients' health problems and needs, and develops a nursing care plan for the patients.

    Over the last two decades, demand for general medical surgical nurses has been on the decline, and more hospitals are looking for nurses with telemetry experience as well. David Whitesell, a member of the board of directors for the Professional Association of Nurse Travelers, says medical surgical nurses who want to find work as a traveler must be able to do telemetry.

    "Hospitals want the staffing flexibility as well as the higher training levels of supplemental help," he says.

    Kousgaard agrees that telemetry experience is a necessity for medical surgical nurses and says that travelers who do have the experience will benefit from high demand and will ultimately have more control over their preferred geographic region for assignments.

    While the majority of the time hospitals are looking for candidates who can step down to medical surgical jobs, Kousgaard says he also sees an increasing demand for nurses who can step up to the ICU department.

    "That happens more and more all the time," he says.

    Klee says telemetry nurses should be prepared to work in any hospital setting by making sure they have their advanced cardiac life support certification. It may not be a requirement at all hospitals, but nurses with the certification will be a step ahead of those who don't.

    "Travelers need that ACLS," he says. "These hospitals want you to come in and hit the ground running because there is such little orientation."




    Neonatal needs

    Fast Fact: Location is a key factor influencing salary for neonatal nurses. According to the U.S. Bureau of Labor Statistics, California sits atop the list of top-paying states, with an annual average annual salary of $90,860, followed by Massachusetts with $86,810 per year, then Hawaii at $83,950.

    Neonatal nurses are a unique specialty and Kousgaard says the traveler demand for NICU nurses is often associated with their experience levels. Those nurses who don't have experience working in level two or level three neonatal intensive care units will have a harder time finding steady employment.

    "Those job opportunities don't open up as much as a regular floor nursing and the telemetry and ICU worlds for example," he says.

    He says the specific skills of NICU nurses--similar to nurses who work in other highly specialized areas such as pediatrics or the pediatrics intensive care unit--make it slightly more challenging to find assignments.

    "They have always been a harder modality to keep people employed, especially when they limit their geographical preferences," he says.

    On the other hand, Klee says NICU nurses’ unique skills sets often make them easier to place because there aren't as many travelers in the specialty area.

    "They get jumped all over right away," says Klee.

    Cole, who had ten years of experience working in a level-3 NICU before beginning her traveling career, says she has found steady employment, typically interviewing with five or six interested hospitals before taking an assignment.

    "I am just able to pick where I want to go and which hospital sounds like a nice fit for me and what area my husband and I want to explore right now," she says.

    In the time she's been a traveler, Cole says she has learned skills that she'll be able to carry with her throughout the remainder of her career.

    "I've developed into a stronger nurse because I know I can walk into any unit with a limited orientation and adapt to their care and learn how they do it," she says.

    Openings in the OR

    Fast Fact: Perioperative/operating room nurses assist surgeons and patients before and during surgery. Part of an OR nurse’s responsibility is operating room safety and preparation, aseptic technique, anesthesia, patient preparation, and handling surgical instruments including procedures, sterilization, and disinfection.

    While some aspects of the changing healthcare landscape effect all specialty areas, there are several distinct factors driving the growing demand for perioperative nurses. According to the Association of perioperative Registered Nurses (AORN), one of these drivers is the demographic make-up of the nurses in this specialty area. According to AORN, the average age of perioperative nurses is 53, and survey data of the association's membership indicates that about 25 percent of OR nurses are looking at retirement in the next few years.

    “We have three to four generations in the workforce and we see baby boomers are retiring or choosing to work part-time. Linda GroahThis is opening up the jobs, but the concern is that with health care reform, employers are looking at budgets and not their succession plans, or considering periop as a specialty that needs accommodation for the mature workers,” says Linda K. Groah, RN, MSN, CNOR, NEA-BC, FAAN, chief executive officer and executive director of AORN.

    Other factors driving the increased demand are a growing number of ambulatory surgery centers in the country and a trend toward more office-based surgeries. According to AORN, these facilities look to perioperative nurses when staffing and increase the need for qualified perioperative nurses in the field.

    This overall demand for more perioperative nurses has trickled down to the traveler industry as well. Kousgaard and Klee agree that there aren't enough perioperative nurses to meet growing hospital staffing needs in most regions of the country. Klee explains there is particularly high demand for OR nurses with cardiovascular experience.

    Dialing up Dialysis

    Fast fact: The Medicare Payment Advisory Commission estimates that the number of dialysis centers has grown by 4 percent annually over the past decade. Renal failure is an unfortunately common affliction that strikes people as they age, and can lead to an increased risk of cardiovascular disease. The condition occurs when kidneys become unable to filter waste products from the blood. Kidney dialysis is a treatment that helps clear waste and excess water from the blood.

    The aging baby boomer population and a growing number of people needing acute dialysis are keeping demand high for dialysis nurses.

    Jerry Broughton"We have constantly over 30 jobs...that are open at all times for dialysis nurses and technicians," says Jerry Broughton, a manager for Foundation Medical Staffing, a healthcare staffing firm based in that specializes in dialysis services.

    The need for dialysis nurses is not restricted to one part of the country, Broughton says and reaches from coast to coast.

    "We have jobs no matter what part of the country you want to see or be in, we have jobs there," he says.

    Over the last year, Broughton says requests to Foundation for both acute and chronic dialysis nurses with peritoneal dialysis (PD) skills has increased significantly.

    "When you get a nurse that has PD skills that's a skill that you can definitely find a job for," he says.

    Glenda M. Payne, MS, RN, CNN, president of the American Nephrology Nurses' Association, says home therapies have also become more popular now that providers have been given a financial incentive to encourage patients to use home therapies.

    "There's a real push now for home therapies, hemodialysis, or home peritoneal dialysis, and there is a requirement under the federal regulations that the nurse responsible for that has three months experience in that modality," she says.

    Payne also says that since the Institute of Medicine released its report on the future of nursing in 2010 she's seen more hospitals move toward only hiring nurses with bachelor's degrees.

    "Even if you get an (associate's degree) to start with, which I did, have a plan immediately to get your BSN because eventually you are going to be really limited if you don't have that minimum level of education," she says.




    Labor and delivery

    Fast fact: Labor and delivery nurses are registered nurses who care for women during pregnancy, through delivery and during their postpartum period. L&D nurses are found in clinics, hospitals, clinics, physician offices, and maternity or birthing centers.

    Staffing representatives say that unlike some other specialty areas, the demand for labor and delivery nurses tends to ebb and flow.

    "It seems like when it blows up, it blows up and there's never enough of them," Kousgaard says.

    Joseph Gira, marketing manager for Fastaff Travel in Denver, agrees that demand in this nursing specialty can be unpredictable at times. Just a few weeks ago, the firm had a handful of assignments on hand, only to see a spike a few days later.

    “We (received) 21 orders in the last week specific for L&D,” says Gira. “Plus, another six for postpartum, mom/baby.”

    According to Klee, demand can differ based on location too. For instance, there is currently a high demand for labor and delivery nurses in California.

    "There are a bundle of labor and delivery jobs consistently probably for about the last six months," he says.

    While nurses can virtually choose where they'd like to work in California now, Klee says it may be a completely different situation in six months.

    "It's hard, you can't really narrow it down to one specific specialty or area in the country because it moves for the weirdest reasons," he says.

    Enlisting the ER

    Fast Fact: High-growth field (26 percent expected employment increase from 2010-2020) according to the U.S. Bureau of Statics. According to Salary.com emergency nurses have good earning potential, with a $65,000 median salary as of May 2012.

    Much like the other critical care specialties, staffing representatives say there are often more emergency room jobs than qualified nurses.

    Traveler Deborah Summers, RN, says she's never had a problem finding work and there are a lot of assignments available.Deborah Summers

    "I have gone from one job straight into the next," she says.

    Summers works both ICU and ER assignments and says she opted for the ER specialty after being floated there often during past assignments.

    "I thought well, I kind of like ER," she says. "It's a change from ICU, you know, you get a variety of patients,  they are in and out."

    In addition to several years of experience, staffing representatives say that emergency room nurses may also want to take a Trauma Nursing Core Course (TNCC) to be better prepared to compete in the market. While not all hospitals require the certification, some will.

    "You need to have the basics of what the specialty calls for and every specialty calls for different certifications," Klee says.

    Summers says she's seen some hospitals allow new graduates to specialize but she believes it is best for nurses to spend a few years in the medical surgical world before deciding where they'd like to be.

    "I don't know that I think any new grad should specialize because you don't have the basics down," she says.

    If industry figures are accurate, travelers — new nursing graduates and seasoned practitioners alike — can expect ample opportunity in specialty segments during the next few years.

    Jill Sederstrom is a freelance writer based in Kansas City.

    Jill Sederstrom
    Jill Sederstrom is a Contributing Editor


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