Take your career into the future.

Have you ever thought about becoming a population health expert? What about a healthcare simulation educator or a research nurse? The rapidly changing healthcare milieu is creating and expanding many career choices in these cutting-edge nursing specialties. Other hot areas include post-acute care, health coaching, and nurse practitioner (NP) services.

Population health: A sweet spot for nursing

Population health is most simply defined as the health outcomes of a group of people, including how those outcomes are distributed within the group. As the healthcare delivery system evolves, improving the health of populations will become increasingly important, and the demand for nurses skilled in this area will grow, according to Susan Swider, PhD, PHNA-BC, FAAN, director of the DNP programs in advanced public health nursing and transformative leadership: Population health, and professor in the department of community, systems and mental health nursing at the College of Nursing at Rush University in Chicago.

“About 60% to 80% of the factors that cause health or illness are outside of the clinical setting,” Swider says. “If we want to move the needle toward improving health, the system has to recognize and address those factors.”

Addressing population health also is critical to the bottom line in an era of value-based payments, where reimbursement is increasingly based on patient outcomes.

“Health systems now have to do more than provide good clinical care; they have to address all the factors that affect patient health,” Swider says. “This fits with nursing’s sweet spot because we are taught to holistically assess patients’ family, home, and community,”

What are the opportunities?

Nurses with population health expertise are in demand in many roles and settings including the following:

• Ambulatory care. Nurses with population health knowledge and skills are front and center in evolving models of care that help patients manage their own health. This includes performing health screenings and helping patients understand and improve prevention. Population health nurses also help patients manage medications and other treatments within the context of their abilities, resources, and environment.
• Care coordination and transition management. Nurses with population health expertise are highly desired in this specialty. They ensure a smooth transition of care for individuals and families during and after discharge from the acute-care setting and into long-term care, ambulatory care, home care, and hospice. It includes ensuring safety and as much support as needed to maintain health within a patient’s environment.
• Large healthcare systems. Large healthcare organizations are looking for more population health nurses. Opportunities include leading interprofessional teams. Some systems are adding or growing a department of population health, and many are looking at their patient population health needs both in and out of the clinical setting. This opens up many roles in which nurses work with community outreach to address issues that impact the health of a community.

What are the key skills?

Nurses interested in expanding their knowledge or transitioning into a population health career should have or develop these key skills:

• a basic understanding of data and epidemiology
• ability to work with and coordinate a healthcare team
• experience in community health outside the hospital
• expertise in screening for and addressing social determinants that impact health
• motivational interviewing and patient engagement skills.

What education is needed?

Swider recommends a minimum of a bachelor’s degree in nursing. To be a leader in the specialty, a master’s or doctorate is needed. Certification in public health, which is interrelated to population health, also is available:

• American Nurses Credentialing Center (ANCC) Advanced Public Health Nurse Certification (PHNA-BC): nursingworld.org/our-certifications/advanced-public-health-nurse. (Note: Currently this is only available for renewal.)
• National Board of Public Health Examiners Certification in Public Health (CPH): nbphe.org University programs that offer advanced degrees in population health or public health include:
• Johns Hopkins School of Nursing MSN Public Health Nursing Track: nursing.jhu.edu/academics/ programs/masters/publichealth/ index.html
• Rush University Transformative Leadership: Population Health Doctor of Nursing Practice (DNP): rushu.rush.edu/college-nursing/programs-admissions/transformative-leadershippopulation-health
• University of San Francisco Population Health Leadership Doctor of Nursing Practice: bit.ly/2R3uC3o

Learn more about population health

• American Association of Colleges of Nursing (AACN): aacnnursing.org/Population-Health-Nursing/About-Population-Health-Nursing
• Association of Public Health Nurses: phnurse.org
• Interdisciplinary Association for Population Health Science (IAPHS) and the IAPHS Conference: iaphs.org

Addressing unmet medical needs in clinical research

Clinical research is a big, fascinating field that offers many career possibilities for nurses, according to Bonnie Miller, MS, RN, clinical research consultant, faculty, and past president of the Northern California Chapter of the Association of Clinical Research Professionals.

“Any drug or medical device we use has gone through years of clinical research,” Miller says. “It’s all about addressing unmet medical needs.”

What are the opportunities?

Employers include biotech, pharmaceutical, device, and diagnostic companies, as well as contract research organizations and medical centers, Miller says. “The field values nurses because we have clinical expertise and experience working with patients and families,” she notes. “Nurses are well respected and have a lot of career mobility and opportunity.”

A variety of roles are available to nurses in clinical research, from patient advocacy and teaching to technical writing of protocols and reports for regulatory agencies. Roles that are high in demand include:

• Clinical research associate (CRA). The CRA is responsible for monitoring the progress of a clinical trial at the site level. A CRA must ensure that the trial is conducted, recorded, and reported according to protocol and regulatory requirements.
• Clinical research coordinator (CRC). The CRC works directly with study subjects at a clinical research site under the immediate direction of a principal investigator.
• Project manager.

What are the key skills? Nurses have key skills needed in clinical research:

• clinical assessment and knowledge
• collaboration
• critical thinking
• attention to detail
• flexibility, adaptability
• documentation
• organizational
• teaching and mentoring.

What education is needed?

Currently, no specific degree requirements exist to enter the research field, and many nurses learn on the job and seek out certification. However, a bachelor’s or advanced degree is recommended, and many universities offer clinical research degrees or certifications.

Certification in clinical research also is available through:

• Association of Clinical Research Professionals (ACRP): acrpnet.org/certifications
• Society of Clinical Research Associates (SOCRA): socra.org/certification/certificationprogram-overview/introduction

Learn more about clinical research

• ACRP website and annual conference: acrpnet.org
• SOCRA website and annual conference: socra.org

Healthcare simulation—bridging the training gap

Healthcare simulation is a growing field that bridges the gap between the classroom and the “real” clinical world. Today’s simulations include life-like robots that can mimic almost every known human physical condition to help develop learner’s assessment skills. They also have life-like skin and organs on which to practice procedures and interventions.

Demand for nurses to work in this specialty will continue to increase as the healthcare system addresses ongoing issues of quality and safety, according to KT Waxman, DNP, MBA, RN, CNL, CHSE, CENP, FSSH, FAAN, associate professor and director of the executive leadership DNP program at the University of San Francisco, director of the California Simulation Alliance, and 2018 president-elect of the Society for Simulation in Healthcare.

The ultimate goal is for all nurse learners, from students to seasoned nurses, to develop new skills and practice in a controlled environment where they’re allowed to make mistakes on devices and manikins, rather than on humans. In addition, simulation offers the opportunity for team training.

“The number one reason for errors in healthcare is due to communication breakdown,” Waxman says. “Simulation puts nurses, physicians, and other team members together in scenarios to learn to work together and communicate.”

What are the opportunities?

Many opportunities exist for nurses in the healthcare simulation field.

“Nurses are often sought after to work in healthcare simulation because they’re really good at leading interprofessional teams,” says Waxman. “Nurses are a perfect fit.”

Most hospitals, healthcare systems, and schools of nursing are using simulation as part of their educational programs, according to Waxman. Indemand positions include:

• Healthcare simulation educator. These nursing educators receive specialized training and certification to teach healthcare simulation in schools of nursing and within health systems.
• Leadership roles. This includes managers, directors, and coordinators of simulation centers and labs or educational programs that include simulation, such as nursing residency programs for new graduates.

What are the key skills?

If you think you need highly evolved tech skills to work in the healthcare simulation field, you’ll be pleasantly surprised.

“Don’t be turned off from this career if you’re not tech savvy,” says Waxman. “Nurses are needed to teach and facilitate learning, not to work the equipment.”

You should, however, be someone who’s willing to learn new technology.

What education is needed?

No specific degree is required to break into the healthcare simulation field, although certain positions, such as nurse educators and clinical nurse specialists, require advanced degrees.

Advanced degree programs that include an emphasis on healthcare simulation include

• Drexel University College of Medicine Master of Science in Medical and Healthcare Simulation: drexel.edu/medicine/academics/graduateschool/medical-and-healthcare-simulation
• University of Central Florida Master of Science in Nursing and Healthcare Simulation (online program): nursing.ucf.edu/admissions/graduate- programs/msn/nursing-and-healthcare-simulation/index
• University of San Francisco Healthcare DNP with an emphasis on simulation: usfca.edu/nursing/programs/graduate Certification also is available. Programs include:
• Boise State University Simulation Graduate Certificate for Healthcare Professionals: hs.boisestate.edu/nursing/sgcp
• Society for Simulation in Healthcare Certified Healthcare Simulation Educator (CHSE) certification: ssih.org/certification/chse
• University of Central Florida Post-Baccalaureate Certificate (online program): nursing.ucf.edu/admissions/graduate-programs/graduate-certificates/healthcare-simulation/index

Learn more about healthcare simulation

• International Nursing Association for Clinical Simulation and Learning (INACSL): inacsl.org
• INACSL’s annual conference: https://www.inacsl.org/education/annual-conference/

Post-acute care

Post-acute care is an umbrella specialty that covers care after discharge from acute care. It includes rehabilitation, sub-acute care, assisted care, home care, hospice, and long-term care.

What are the opportunities?

Exciting opportunities for nurses in post-acute care are continually growing and evolving, according to Judi Kulus, MSN, MAT, RN, NHA, RAC-MT, DNS-CT, vice president of curriculum development at the American Association of Directors of Nursing Services (AADNS).

Quality reporting, new regulations, and valuebased payments require greater communication and collaboration between hospitals, long-term care facilities, home care, and other post-acute care providers. Post-acute care offers an unprecedented opportunity for nurses to improve collaboration across the continuum and shape quality outcomes. If you’re up for a challenge, post-acute care is a great area to grow and develop a nursing career, and have a voice.

“The field is wide open for nurses to be challenged in their nursing skills and to be leaders,” says Kulus. “Nurses help to lead the way for more evidence-based practice-based protocols and in using technology for delivering quality care.”

Nurses can choose from a variety of subspecialties in clinical, quality, compliance, and reimbursement career tracts. And you’ll find many ways to build a career in leadership. Here are some examples of in-demand subspecialties:

• adverse event investigator
• case manager
• compliance nurse
• director of nursing services
• infection control and prevention specialist
• liability mitigation nurse
• nursing informaticist
• quality assurance and performance improvement specialist
• reimbursement specialist
• risk manager
• safety specialist
• staff competency training nurse
• What are the key skills?

Needed skills and experience varies depending on the specialty, but nurses interested in a career in post-acute care should have:

• a robust knowledge of and competency in all body systems
• an understanding of a variety of conditions that affect health throughout the lifespan, including mental health and chronic conditions
• an understanding of social and environmental factors that affect health.

What education is needed?

A bachelor of science in nursing (BSN) or advanced degree is not necessary to begin a career in post-acute care. Positions in entry-level hands-on care offer associate-degree nurses the opportunity to refine many basic skills that are required to grow into other advanced roles in post-acute care.

“Nurses with an associate’s degree are very welcome and can come into the field and build their career from there,” Kulus says. “In addition, many certifications don’t require a BSN, but it’s an advantage to finish an advanced degree eventually as you develop your career.”

Learn more about post-acute care nursing

The American Association of Directors of Nursing Services (AADNS) supports post-acute care nurses with education, resources, legislative representation, and a strong collaborative community. It also offers the Director of Nursing Services-Certified and QAPI Certified Professional certifications. aadns-ltc.org

• The Society for Post-Acute Care and Long- Term Care Medicine provides education and resources and sponsors an annual conference: paltc.org
• The Long Term Care Nurses Association (LTCNA) provides education and resources and sponsors an annual convention: ltcna.org

Nurse practitioners becoming a hot commodity

Job growth for NPs is predicted to increase 30% between 2016 and 2020, according to Keith Carlson, BSN, RN, NC-BC, a board-certified nursing coach and owner of Nurse Keith Coaching based in Santa Fe, New Mexico. He says that NPs are in demand nationwide. A high concentration of jobs with generally high salaries exist in urban areas, large populous states, and states with large elderly populations, such as New York, California, Florida, and Texas.

“NPs are seen as a hot commodity right now, and many NPs are needed and moving in the direction of home health, community health, geriatric health, and primary care,” Carlson says.

Two factors are driving up the demand for NPs in these areas: the aging population and the Affordable Care Act.

“As the country ages, everyone’s aging, including the physician and nurse populations,” Carlson says. “A large number of baby boomer healthcare professionals are retiring at a rapid rate, and we haven’t seen the pinnacle of that yet. With that comes a need for a lot of geriatric care professionals, including primary care professionals.”

And more opportunities for NPs exist in outpatient care and ambulatory surgery centers.

“NPs are also in high demand in underserved and rural areas,” Carlson says.

Learn more about the NP role

• American Association of Nurse Practitioners: aanp.org
• Gerontological Advanced Practice Nurses Association: gapna.org
• American Academy of Nurse Practitioners Certification Board: aanpcert.org/about

Health coaching: Helping people stay healthy

Nurse health coaches, who focus on prevention and health promotion, are in demand in many organizations, including insurance companies, according to Keith Carlson, BSN, RN, NC-BC, a board-certified nursing coach and owner of Nurse Keith Coaching, based in Santa Fe, New Mexico.

“Insurance companies are hiring nurses as telephonic case managers who provide health coaching and case management to help patients manage chronic conditions more effectively and stay out of the hospital,” Carlson says. “It’s a huge benefit to their bottom line.”

The opportunities for nurse health coaches are growing in other areas as well, including healthcare organizations and fitness centers. Some nurses take the entrepreneurial path and own their own health coaching consulting companies. Others work in the corporate sector where they help employees optimize their wellbeing to enhance the workplace, productivity, and employee satisfaction as well as reduce insurance costs.

“Registered nurses are natural coaches because we learn to coach patients, even though we don’t call it that—we call it patient education,” Carlson says.

Learn more about health coaching

• American Holistic Nurses Association provides education, conferences, and the Nurse Coach certification. ahna.org/Home/Resources/Nurse-Coaching
• See the article on page 76.

Catherine Spader is a medical and healthcare writer/editor in Littleton, Colorado.