The career paths of nurses are as diverse as their hours and job demands. Beyond the operating theatres and GP clinics, nurses can take leadership and consultancy roles in research, infection control, occupational health and midwifery.

1. Occupational health

Occupational health nurses are leaders in keeping the workforce healthy and safe. Companies are increasingly focused on the wellbeing of their employees, and the nurse plays an important role in providing continuity of care which involves basic health screening, assessments, follow-up and preventative nursing.

It offers new challenges which may differ from GP clinics or critical care units, and these nurses might encounter difficult families that may threaten their sense of well-being. With an annual pay of USD75,200, this may pave opportunities for consultancy in occupational health.

Sandy Bruskewitz started her career in occupational health 37 years ago as a “first aid nurse”. Today, as an occupation health nurse in Texas, she juggles roles as a health promoter, wellness team member, health coach and safety observer.

She says that the pendulum has swung between getting employees well enough to work and helping them improve their health to stay on the job, adding the company’s financial interest as an important consideration.

2. Certified nurse midwife (CNM)

For nurses who are comfortable with obstetrics, labour and delivery, and prenatal care, this job may be ideal. This will be most satisfying if you are more inclined to nurturing and expressive roles. Apart from delivering babies, CNMs offer healthcare advice and aid to female patients such as gynaecological examinations, family-planning education, and prenatal and postnatal care.

Usually midwives develop a good working relationship with a qualified obstetrician or gynaecologist, and have both the knowledge and practical skills necessary to know which pregnancies are beyond their scope of practice. The average annual salary is USD84,000.

Though attending to births may evoke more optimism than those labouring in intensive care units, there will still be negative outcomes. Dealing with the unexpected, particularly the negative, may challenge your outlook and you may need to exercise professional judgment and discretion.

Kerri D. Schuiling, provost and vice president of academic affairs at Northern Michigan University says, “The CNM’s role during a birth is to attend to the mother during her labour, and carefully assess the progress of the labour and how the foetus is withstanding the stress of the labour. We see ourselves as working with women during labour and birth. We also provide support to family members present, but our main role is supporting the mother as she labours to give birth.”

3. Infection control

With escalating incidences of hospital-acquired infections along with outbreaks of influenza, measles and other infectious diseases, the demand for infection control nurses is increasing. Nurses in this area must be knowledgeable about specific transmission of given diseases, and the precautions required to keep infection at bay.

Staying abreast with developments in new and dangerous bacterial strains and viruses is crucial to help monitor the situation as the nurse is a vital link that keeps people healthy. Knowing how to maintain good health outcomes and minimise discomfort should be a priority. Infection control nurses are paid an average annual income of USD79,900.

"Keeping people healthy is dependent on their environment,'' says Robin Wagner, associate professor in the University of Cincinnati's College of Nursing. “We have to be educated on the chain of infection. All the pieces have to be there for infection to occur,” he added.

Every day, nurse Melanie DuBose begins her day by checking various databases used by Cincinnati Children's Hospital Medical Centre to see if any patients have been admitted with or developed any infections. "It's all about trying to brainstorm and think about people's behaviours and how we can best protect our patients and the institution.”

4. Research education

This presents a good avenue for those who prefer a non-clinical nursing job. Nurse researchers also work in hospitals, non-profit and private companies. Generally, they perform analysis and create reports based on research gathered from medical, pharmaceutical, and nursing products and/or practices. Nurse researchers have to ensure that trial patients fully understand their options and thus engagement with patients is necessary to guide them through the consent process. With a yearly income of USD 95,000, the work may be tedious at times but nevertheless interesting, with its intellectual and technical challenges.

"The 'ah-ha' moment when the trial results are discovered is exciting," says Marsh, research nurse supervisor of the department of Infectious Diseases in the US. "But my role allows me to interact with patients on trials for several months, or even years, and the relationships I build with them are especially rewarding."

Managing the clinical and operational aspects of protocols such as during cancer treatment trials is a primary responsibility for Marsh and her fellow research nurses.

Shyunika Bolden, a research nurse in Clinical Cancer Prevention in the US says, "We can't guarantee a cure, but we can guarantee that we're going to take the best care of our patients while giving them access to treatment options they might not have had otherwise." MIMS

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