10 Hardest Nurse Practitioner Specialties

Written By: Donna Reese MSN, RN, CSN

We all are aware that nursing, in general, is a tough profession, nurse practitioners included. Most of us went into nursing with an altruistic attitude and helping others is a big part of our job satisfaction. However, each NP position comes with a challenge and when looking for jobs, you may ask what is the hardest nurse practitioner specialty? As you might expect, the answer depends on the person as what may be hard for one NP may not be as difficult for another. Here we have listed the 10 hardest nurse practitioner specialties that prove tough for many NPs, along with some tips on what can be done to make the job less arduous. So don’t be put off by the title of this article because you may be one of the special nurse practitioners who finds a perfect fit with one of these sometimes less than desirable opportunities.


(The following are the 10 Hardest Nurse Practitioner Specialties and insights into what makes them so hard.)

1. Adult Acute Care Nurse Practitioner

An adult acute care nurse practitioner is an advanced degree nurse who has obtained her NP credentials in this specialty area in order to work in an inpatient facility such as a hospital caring for adults on med-surg units or other areas of acute care.

For most medical professionals, inpatient hospital work is considered hard due to the long hours with mandatory weekend coverage, the severity of patient illness, the stress of a hectic environment, and staffing shortages. Along with the frustration of hospital politics and frequent policy changes, an adult acute care nurse practitioner has plenty to complain about when it comes to work, making it one of the hardest nurse practitioner specialties.

However, nurse practitioners who enjoy a hospital environment may find all of the aggravation of acute care worthwhile. Not all of us are disturbed by pressure from management and seem to be able to rise above all of the noise and flurry that some find upsetting in a hospital. One of the great reasons to be a hospital nurse practitioner is that they make an excellent salary and at present, very highly in demand with many hospitals offering sign-on bonuses to attract NPs to hospital careers.

Therefore, NPs who are looking for a stimulating medical environment with great pay may find a career as an adult acute care nurse practitioner quite appealing and not feel that acute care is one of the hardest nurse practitioner specialties.

But, if you are done with hospital nursing, there are numerous non-hospital opportunities for adult acute care nurse practitioners that may be less stressful. Telemedicine is one excellent option for NPs with this specialty degree that is very much in demand. So, there is no need to worry that your advanced degree will go to waste if you no longer wish to be a hospitalist. You are still very much sought after outside of inpatient acute care.


2. Oncology Nurse Practitioner

Oncology nurse practitioners provide care and support for patients of all ages with a variety of cancers and malignant conditions. An oncology NP has to deal with severely ill and dying patients every day. In this practice specialty area, there are touching moments but many sad moments as end-of-life issues with patients and their families are a regular part of the job. Watching someone die slowly is a hard part of nursing.

I recall as a young nurse saying that I never could work in an oncology unit because it would be too sad, especially working with children who had cancer. Little did I know that I would gain much experience in this area later in my nursing career. There is so much more to oncology nursing than meets the eye. As an oncology nurse practitioner, you are instrumental in assisting and comforting your patients by helping them to understand their disease, treatment, and (hopefully) recovery. A skilled oncology NP can make all the difference in the life of their sick patient by providing both emotional and physical support.

Yes, being an oncology NP can be sad and hard, but knowing that you make such a crucial difference in your patients’ quality of life makes it worthwhile for many NPs. Those in oncology nursing may agree that it is one of the hardest nurse practitioner specialties but also, they admit that they love it and would not change specialties for the world. I say thank you to them for their dedication and expertise that make a difference for so many.

3. Psychiatric Nurse Practitioner

A psychiatric or mental health nurse practitioner is an advanced degree nurse who is trained to provide mental health support for their patients. They can work across the lifespan and in both inpatient and outpatient settings.

Listening to people’s problems all day and dealing with individuals in crisis is a hard way to spend your workdays. The job of a psychiatric nurse practitioner can be emotionally draining and tends to chip away at the most optimistic spirits. A career as a psychiatric nurse practitioner is considered one of the most difficult nurse practitioner specialties due to the negative emotional impact it can have on the practitioner.

Those who work with psychiatric patients and the mentally ill have to take special care of themselves to prevent burn-out and depression. That means that mental health NPs need to be aware of their limitations and self-examine and seek their own care as needed. Work-life balance becomes vital to reset the events of the day and move on towards self-care and enjoyment away from the stressors of work.

Psychiatric nurse practitioners are very much in demand and make an excellent salary. Therefore, NPs with this specialty degree can have the reassurance that if they need a job change, there is an array of great job opportunities available that may better suit their current employment needs.

4. Emergency Nurse Practitioner

Emergency nurse practitioners can be found in hospital emergency rooms, trauma centers, and urgent care centers providing acute emergency treatment for patients of all ages. As one of the hardest nurse practitioner specialties, those working at inpatient acute emergency locations may agree that the fast pace and urgency of patient needs can create a stressful environment.

In addition, emergency nurse practitioners deal with a variety of sometimes bizarre, dangerous, or potentially hazardous situations in the ER that can cause increased stress and occasionally bodily harm. One never knows who may walk into an emergency room or what kind of disaster may occur where the medical staff has to quickly think on their feet to keep up with the situation.

On the flip side, some NPs thrive in this type of stimulating job and prefer to be energized by an emergency room environment. For them, the high, hazard-type pay that emergency nurse practitioners receive adds to their job satisfaction.

There is one less stressful emergency nurse practitioner environment that may appeal to those who are not enthused by the demands of inpatient ER work. Urgent care centers employ NPs in this subspecialty and once away from an inpatient environment, emergency nursing can be very rewarding. For an even calmer opportunity, there are urgent care telemedicine jobs that are seeking nurse practitioners with an emergency background or certification.

5. Armed Forces NP

Some may think that being a career army, navy, or air force nurse practitioner is the hardest nurse practitioner specialty. Nurse practitioners in the armed forces can be stationed all over the US and world working on a base, in government hospitals and facilities, and in war zones.

Having to move frequently and without any choice regarding location or type of job, can take a toll on even the most stoic military NP. In addition, it may be necessary to leave your family for long periods creating additional stress and loneliness. Living with uncertainty and the possibility of nursing in a war zone is difficult over the long run. In addition, knowing that you cannot just quit the job when you want, adds another level of hardship for NPs.

However, many nurse practitioners love being a provider in the military. Once again, job satisfaction boils down to personality type and individual preference for career choice and work environment.

For NPs in the military, there, fortunately, is plenty of emotional support and resources available for those in need of mental health assistance due to the stress. Nurse practitioners need to be cognizant that they are at risk of burn-out, depression, and other mental health issues that may develop working in a challenging and ever-changing environment and be willing to accept emotional health services if needed.

6. Adult-Gerontology Nurse Practitioner

Adult-gerontology nurse practitioners are nurses with an advanced degree specializing in the care of adults, with particular concentration on the elderly population. Adult-gerontology NPs can work in nursing homes, assisted living facilities, hospitals, and extended care facilities.

Although adult-gerontology nurse practitioners are quite marketable currently due to the surge of the baby boomer population aging into their senior years, this NP specialty can be one of the most difficult nurse practitioner specialties. This is due in part to the complexity of care for our aging population and somewhat depressing environment when working with the elderly in certain facilities.

Nursing homes and extended care centers are not especially known for their uplifting work setting. In particular, Alzheimer units can be especially frustrating and sometimes pathetic areas to work for medical providers.

However, a nurse practitioner with a heart towards nursing our senior citizens, may not view this career specialty as depressing at all. In fact, some elderly-focused NPs derive satisfaction from helping our most vulnerable and deserving patients in this population. It is encouraging to be aware that adult-gerontology nurse practitioners can find work easily due to job demand. So, if you are unhappy in your current job situation as an NP, there may be better alternatives available.

Also, there are mobile NP and telemedicine positions offered for adult- gerontology nurse practitioners for those who are looking for a change from inpatient care.

7. Correctional Nurse Practitioner

According to the Federal Bureau of Prisons, correctional nurse practitioners provide medical treatment and care for people incarcerated in prisons across the US.

Correctional nursing can be extremely stressful due to the nature of the patients. Most people in prisons have suffered much trauma and have had to toughen up to survive and their past trials are manifested in their demeanor and actions daily. This translates to a tense environment that trickles down to the medical staff. In addition to dealing with mental issues, treating substance abuse, and years of patients neglecting their health, this position can be quite overwhelming and sometimes frightening.

However, some nurse practitioners may disagree that working in corrections is the hardest nurse practitioner specialty. In an excerpt that describes behind the medical scenes in a prison, nursing staff find working with the underserved population gratifying. I think that you are either cut out for correctional work or you are not. For those nurse practitioners that can see beyond the discouragement and rough environment and view the patient as a human who deserves appropriate and kind treatment, then perhaps a position as a correctional nurse practitioner would be gratifying.

8. Substance Abuse Nurse Practitioner

The subspecialty of substance abuse nurse practitioner is an NP who has taken a substance abuse certification exam. A substance abuse NP can work in hospitals but mainly treats patients in drug and alcohol rehabilitation centers. A previous background in psych nursing is desired.

For many of the same reasons as a correctional NP, substance abuse nurse practitioners may rate this specialty area as one of the hardest nurse practitioner specialties. Working in an environment that is sometimes tough, peppered with course languid and patients who have lived on the fringe, NPs may find the job to be dismal and wearing.

For substance abuse NPs to survive an often-draining position, self-care is vital. Keeping in mind that the job can cause burn-out, substance abuse nurse practitioners who are content in staying in a treatment environment, need to stay mindful that the day-to-day grind may not be healthy without the balance of caring for yourself first and foremost.

9. Critical Care Nurse Practitioner

A critical care nurse practitioner works at a hospital on a trauma or burn unit, or ICU taking care of critically ill patients.

Possibly one of the most difficult nurse practitioner specialties, a critical care nurse practitioner has to learn to deal with life and death situations daily due to treating the most acutely ill or traumatized patients. Because of the complex nature of cases and the busy work environment, stress can be high for critical care NPs. In addition, frequent emergencies occur and work hours may be long and tend to bleed over into the evenings, weekends, and holidays.

Nonetheless, some NPs thrive in a critical care career and would argue that although this specialty is challenging, it is not one of the hardest nurse practitioner specialty areas.

It is wise when choosing a nurse practitioner specialty to have previous nursing experience in the area that you are planning to specialize. Most nurses know what they are getting into when they choose to become critical care nurse practitioners. If ICU or trauma nursing is your background and passion, then it is safe to say that going for your advanced degree in critical care is an excellent choice even with the demands of the position.

10. Neonatal Nurse Practitioner

A neonatal nurse practitioner specializes in the care and treatment of newborns and infants. This specialty NP works in hospitals and non-acute settings such as community clinics and pediatric offices.

Listed as one of the hardest nurse practitioner specialties, a neonatal NP has the delicate job of working with our tiniest and most frail patients. Treating premature and critically ill infants in the NICU has to be heartbreaking when they do not make it. Nothing is more upsetting than to see a newborn perish even with your best efforts and having to console their grieving parents.

Stepping away from an inpatient setting may ease the acute nature of your little patients. Opportunities in clinics and pediatric offices are available for neonatal nurse practitioners that will give you the option to do what you love without the life and death cases that you find in a hospital NICU.

However, if you love babies and have experience in pediatrics and newborn nursey, you may be equipped with what it takes to make an exceptional neonatal nurse practitioner in any locale. Quite possibly, the wins and rewards in this position will outweigh the grief that sometimes comes with the territory.

My Final Thoughts

So, after going through the 10 hardest nurse practitioner specialties, what do you think is the hardest nurse practitioner specialty? You may surmise that the answer is quite subjective. What may be a hard specialty for some NPs may not be difficult for others. Whatever you decide, it is a good idea to know what you are getting into when you choose a specialty area as a nurse practitioner. In addition, self-analysis as to what type of environment is suitable for your personality will help you choose a position where you will be happy and can flourish as a nurse practitioner.

Donna Reese MSN, RN, CSN
Donna Reese is a freelance nurse health content writer with 37 years nursing experience. She has worked as a Family Nurse Practitioner in her local community clinic and as an RN in home health, rehabilitation, hospital, and school nursing.