Nurse Specialist or Nurse Generalist?

Nurse specialists and nurse generalists are both common within the nursing profession and 21st-century healthcare, and both serve important purposes in patient care as well as non-clinical settings. What does it mean to choose to be a specialist or generalist? What are the repercussions for your nursing career? And how can one accomplish both?

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Nurse Specialists Matter

In both medicine and nursing, generalists and specialists both serve many important purposes. Choosing which one to be can be difficult but it's not out of the question, and sometimes it's possible to have the best of both worlds. Why does this choice matter and how does one make the most prudent choice for nursing career growth and satisfaction?

In medicine, it's often said that there's a shortage of primary care physicians (especially in rural areas and some small town and inner cities) because being a medical specialist pays much more handsomely. Nurse practitioners are thankfully filling those gaps in primary care. So, is money the greatest allure of specialization?

The nurse who graduates from an ADN or BSN program is basically a novice generalist who has a whole lot more to learn. When I was in my ADN program, I became the class "specialist" in orthopedics — especially hip replacement post-op care — because I was frequently assigned such patients. Nursing students need as many clinical experiences as possible, but circumstances sometimes lead us down certain paths for one reason or another.

Even though ortho was something I became significantly comfortable with, upon graduating I actually chose to skip med-surg and acute care in favor of community health and home health. I never looked back, and I indeed developed my own form of expertise, albeit not in the hospital setting.

Nurse specialists have a crucial purpose: those in ICU, flight nursing, OR, ED, and other critical areas are absolutely necessary for the saving of lives. Pediatric nurses, dialysis nurses, school nurses, and others also play their parts in specific areas of clinical focus and patient care.

We always need a certain percentage of nurses and other clinicians to specialize — how else would those ICU and OR patients receive the highly specific care they need? Specialization is life-saving and central to the full function of any healthcare facility, and those who serve in such positions are often in high demand.

Nurse specialists are born of extensive clinical experience, high-quality education, and certification processes that determine a nurse's knowledge and expertise. Some nursing specialty certification pathways are extremely rigorous, molding enrolled nurses into high-level clinicians with a plethora of skills and intellectual/clinical rigor.

Nurse Generalists Matter

A nurse generalist knows a lot about many things; in some ways, you could call a nurse generalist a polymath of sorts. Generalists matter as much as specialists do, and they serve in a variety of functions and roles.

Licensed practical or vocational nurses are usually considered generalists, and their work is crucial in nursing homes, assisted living facilities, physician offices, and other milieus where they are the lifeblood of patient care.

Generalist nurse practitioners also serve an important clinical purpose in many facilities. Meanwhile, those individuals with a previous unrelated bachelor's degree become nurse generalists when they graduate from an accredited second bachelor's nursing program (sometimes known as an accelerated generalist educational track).

Most any newly graduated nurse is a generalist, no matter the program they attended. LPNs, ADNs, BSNs, and some NPs bring general knowledge and some learned expertise to the table. There is no shame in being a nurse generalist, and choosing to specialize can lead to many rewards when and if the nurse chooses to pursue that path.

To Specialize or Not to Specialize 

Why would a nurse choose to specialize? Why would the process of specialization and acquiring expertise be appealing to a professional nurse clinician? I believe the following to be compelling reasons to do so:

• Specialization can lead to increased earning potential 
• Being a nurse specialist lends credibility to the nurse's personal/professional brand
• Many positions are reserved for nurses with specific training and expertise
• A nurse's professional standing and credibility are elevated by specialization and certification
• Personal self-esteem can also be positively impacted by the knowledge that one has gone above and beyond in accumulating relevant training and expertise

While specialization is not required nor necessary in order to have a successful and satisfying nursing career, it does bestow certain benefits as noted above. At the same time, being a skilled generalist nurse is also a respectable career choice, and generalists can accomplish a great deal on the twin engines of their professionalism and skill.

In the end, each nurse must make their own decision when it comes to choosing to move beyond generalist practice to specialization. The world will not end if a nurse decides to remain a generalist, nor will her life change dramatically once she's certified and ensconced in her area of specialty.

If nothing else, every nurse can be a specialist in doing the job they are called to do, whether that position is of a clinical nature or not. Specialization is a path that can be chosen or not, and there is no judgment in my mind of nurses who forego that journey. Every nurse is valuable, and no one can take our worth away from us, individually or collectively. Choose your path, own your path, and approach your personal nursing career trajectory with pride and the knowledge of your stellar contribution to  a society that daily relies on courageous and intelligent nurses to be the veritable backbone of the complex 21st-century healthcare system.

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Keith Carlson, RN, BSN, NC-BC, is a Board Certified Nurse Coach offering holistic career development for nurses and healthcare professionals. All things Nurse Keith can be found at NurseKeith.com.

Keith is the host of The Nurse Keith Show, his solo podcast focused on career advice and inspiration for nurses. From 2012 until its sunset in 2017, Keith co-hosted RNFMRadio, a groundbreaking nursing podcast.

A widely published nurse writer, Keith is the author of Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century and Aspire to be Inspired: Creating a Nursing Career That Matters. He has contributed chapters to a number of books related to the  nursing profession. written for Nurse.com, Nurse.org, MultiBriefs News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, BlackDoctor.org, Diabetes Lifestyle, the ANA blog, NursingCE.com, American Nurse Today, Working Nurse Magazine, and other online and print publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, keynote speaker, online nurse personality, social media influencer, podcaster, holistic career coach, writer, and well-known nurse entrepreneur. 

Living in beautiful Santa Fe, New Mexico, Keith shares a magical life with his partner, Shada McKenzie, a gifted, empathic, and highly skilled traditional astrologer and reader of the tarot.