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Specialising in an area of nursing can enrich your working life and improve the patient experience, as well as broadening your career opportunities
Specialist nursing roles are perfect for those with an interest in a particular type or area of nursing that they want to know more about.
Nursing Standard. 39, 8, 23-24. doi: 10.7748/ns.39.8.23.s10
Published: 31 July 2024
Nurses working in specialist roles will have specialist skills, competencies and experience, and be practising at an advanced level, says the RCN.
This is a broad category of roles, which tend to be within a clinical remit or area, such as school nursing, occupational health and sexual health, or relate to a clinical condition, such as dementia, cancer or diabetes.
Although specialist nurses work within a multidisciplinary team, they have a large amount of autonomy and will often be responsible for a caseload or group of patients.
What are the titles of specialist nursing roles?
There is a dizzying range of different titles. A 2017 study looking at names for advanced and specialist nursing roles found almost 600 different options, once the specialism had been removed.
Some of the most commonly used titles were clinical nurse specialist, nurse specialist/specialist nurse and nurse practitioner, according to the research in the Journal of Clinical Nursing – which also pointed out that the variety in titles was confusing for patients, employers and those who commission services.
Is a clinical nurse specialist the same as an advanced nurse practitioner?
This is an area of some debate. According to a review in the British Journal of Nursing published in 2019, there is a lot of crossover between the two types of role.
The main difference is that a clinical nurse specialist is focused on a specific area, while an advanced nurse practitioner is often more of a generalist, with the role requiring a greater breadth of clinical knowledge.
Why do some nurses want to become specialists?
Specialist nurses are passionate about the area they work in.
‘I enjoy being able to support patients and their families through their journey, and I feel privileged to be alongside them at this time,’ says Macmillan senior acute oncology clinical nurse specialist Helene Buijs, who works at London North West University Healthcare NHS Trust.
‘There are lots of different routes to becoming a specialist nurse. Extra education is essential, but there can be difficulty in getting courses funded by employers at the moment’
Bethany Kelly, clinical lead diabetes specialist nurse, Wiltshire community teams
What value do nurse specialists bring to patient care?
Numerous research studies have found that patients highly value the input of nurse specialists.
These nurses are experts in their field and have an understanding of the entire patient pathway and how to manage complex care, as well as making the patient journey more efficient and a better experience for patients, according to an overview of the evidence published by London South Bank University.
Charity Macmillan Cancer Support says cancer nurse specialists improve quality and experience of care for patients, demonstrate leadership and increase productivity and efficiency.
What skills and qualifications do you need to be a nurse specialist?
Due to the range of different roles and job descriptions, it can be difficult to state exactly what qualifications nurses need to become specialists.
Only certain specialist nursing roles are regulated, such as health visitors and school nurses on the specialist community public health nurses section of the Nursing and Midwifery Council (NMC) register. Nurses and midwives must have taken an NMC-approved course to join this part of the register.
Wiltshire community teams clinical lead diabetes specialist nurse Bethany Kelly says in general there is an understanding that a specialist nurse will be working towards, or will have, a master’s qualification in their clinical area. Depending on the area, they will also often be non-medical prescribers.
‘There are lots of different routes to becoming a specialist nurse,’ says Ms Kelly. ‘Extra education is essential, but there can be difficulty in getting courses funded by employers at the moment.’
The RCN advises looking at job vacancies for the role you want, so you can see exactly what skills, qualifications and experience employers are looking for in candidates.
What other skills do you need to be a nurse specialist?
Good communication skills are fundamental for a specialist nurse, says Ms Buijs, as they will be required when working closely with patients, the multidisciplinary team and other services.
‘Being compassionate and having good people skills are also essential,’ she adds. ‘This includes listening and being able to elicit fears and give psychological support to families as well as to the patient.’
Nurse specialists often work autonomously and have their own caseloads to manage, so good time management skills and the ability to prioritise work are important, says the RCN.
» Build up your nursing experience and don’t rush towards becoming a specialist nurse, advises Macmillan senior acute oncology clinical nurse specialist Helene Buijs. ‘I’ve noticed a tendency for people wanting to sub-specialise too early without having a good clinical foundation,’ she says ‘But experience clinically in the field you want to specialise in is imperative. When you know the area you want to specialise in, start building up expertise and experience so you are in a good position when a role becomes available’
» Take advantage of any study day opportunities or online training focusing on the area you want to specialise in, recommends clinical lead diabetes specialist nurse for Wiltshire community teams Bethany Kelly. ‘There’s loads of online learning and things people can do,’ she says. ‘If you have that passion, and you can demonstrate this, it will show when you get an interview for the job that you want’
» Ask to shadow those who are already in the post This can be a valuable opportunity to find out more about the job you are working towards, what it involves, and the kind of skills and education needed. It also shows your commitment to the area when you eventually apply for an available post, adds Ms Kelly
» Make sure you have chosen the right area to specialise in ‘Choose an area you absolutely love because you’re going to be completely embedded in it,’ says Roald Dahl clinical nurse specialist for teenagers and young adults Neil Fletcher, who works at Barts Health NHS Trust in London. ‘It’s also about keeping your eyes and ears open to new roles. The job that I am in didn’t exist ten years ago but nursing is progressing, advancing and developing more opportunities. You may spot the gap where a nurse specialist can make a big difference to patients’
» Volunteer to become the ‘link nurse’ for the condition or issue in the clinical area to gain extra skills and training. ‘This is a good way to find out more about the area and connect with specialists,’ says Mr Fletcher
» Make contact with nurse specialists in the area you are interested in through social media. ‘I’ve found X [formerly Twitter] so helpful,’ says Ms Kelly. ‘It has let me connect and network with others in the same field as me, and it can really change your career pathway; it certainly has mine’
Numerous studies have found that patients value nurse specialists’ input in their care
Picture credit: Tim George
What band are these posts?
This is another contentious area, as specialist nursing jobs can be advertised at a range of banding levels – and are sometimes banded too low.
Posts will generally be between bands 6 and 8, and nurse specialists advise that band 6 posts should be only for those at the beginning of their specialist nursing career, and before they have completed extra education.
‘There is a lot of variety in banding,’ says Ms Kelly. ‘But anyone who has a master’s degree in their area should be at the very least a band 7.’
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