10 PNP Specialties for Career Growth & Better Pay

You’ve been a pediatric nurse practitioner (PNP) for three years now, maybe closer to four. You work in a community office, helping kids with sore throats, fevers, and the occasional bout of pneumonia. Sure, you tackle more serious matters and help these children get healthy (and stay that way), but you’re ready for a different challenge, one that takes you deeper into the work. The good news is, the community needs it. The better news is, you have plenty of options available, many of which can fuel career growth and lead to a more pleasing dollar amount on that biweekly paycheck. Here are 10 pediatric nurse practitioner specialties that could be calling your name.

1. Neonatology

Neonatology is defined as the care of newborns from birth until 28 days of life. This specialty focuses on the care of infants born premature, with birth defects, infections, or other newborn concerns. Many of these children will have various lengths of stay in a crisis nursery or Neonatal Intensive Care Unit (NICU) where closer monitoring and care can be provided. The nurse practitioners may be expected to monitor equipment such as incubators and ventilators; provide family education regarding neonatal, infant, and postpartum care; dispense medications; perform diagnostic tests and procedures; and ensure proper basic care and feeding.

Pediatric nurse practitioners wishing to pursue the neonatology specialty may be interested in continuing their education to receive a master’s, post-master’s certificate, or doctorate degree in a Neonatal Nurse Practitioner program. An AANP study showed that a base salary for neonatal nurse practitioners starts at $107,550. These practitioners often work in a hospital setting and may perform some community outreach or home health.

2. Emergency Medicine/Critical Care

Pediatric nurse practitioners in the Emergency Department (ED) or Pediatric Intensive Care Unit (PICU) care for children from newborn to 22 years old. These children often come to the ED or PICU for critical diagnosis, acute distress, and adverse patient responses. In the ED, nurse practitioners assist in triaging patients to determine illness severity, categorize diagnoses, obtain appropriate testing, and provide designated therapies or hospital admission when indicated. Common diagnoses of children admitted to the PICU include seizures, trauma, severe respiratory illnesses, shock, and infection. Pediatric nurse practitioners in this specialty can be expected to monitor and manage changes in patient status, prescribe medications, and perform procedures such as lumbar punctures, intubation, and central line placement.

Some facilities may prefer or require pediatric nurse practitioners pursuing emergency medicine or intensive care to have an Acute Care Pediatric Nurse Practitioner certification. This can be obtained by taking courses for a post-master’s certificate, master’s program, or doctorate program. The average pay for a pediatric acute care nurse practitioner is $97,670 – $103,722. These practitioners will work in an acute, hospital-based setting.

3. Adolescent Medicine

Adolescent medicine focuses on ages 12 – 25. This period of time is critical for the transition from child to adult. Pediatric nurse practitioners in this specialty focus on the physical and emotional challenges of rapidly changing bodies, sexual health, nutrition, sports medicine, and chronic concerns.

The average salary for pediatric nurse practitioners specializing in adolescent medicine is $97,000. Most adolescent medicine will occur in outpatient clinics, however, some inpatient monitoring in acute patient conditions may occur.

4. Surgery

Pediatric nurse practitioners can be extremely useful in pediatric surgery. These nurse practitioners may see patients before surgical procedures performing preoperative screenings as well as post-op for follow-up of surgical recovery. While pediatric nurse practitioners rarely perform procedures themselves in this specialty, they can be utilized to obtain critical patient information and perform patient teaching when anticipating or recovering from surgery.

Pediatric surgery may require additional learning courses in surgical procedure and on the job training. The average pay for a surgical specialty pediatric nurse practitioner is $93,100 – $112,400. Nurse practitioners in this specialty may work in a variety of locations including in outpatient facilities, clinics, and hospitals.

5. Hospice and Palliative Care

Hospice and palliative care provides patients and families support and guidance to manage emotional and physical needs of chronic illness and end of life care. Nurse practitioners can be expected to assess patients and their families for their concerns regarding life-threatening illnesses; provide supportive therapies; administer medications; increase comfort; and educate patients and their families on illness, progression of illnesses, and expectations in death.

Pediatric nurse practitioners in hospice and palliative care will make an average of $99,000 – $102,000. Hospice and palliative care may be performed in a variety of places, including the family home, inpatient hospital room, and outpatient clinic.

6. Psychiatric-Mental Health

Psychiatric-mental health nurse practitioners are in high need. This is especially true in pediatric medicine. Pediatric nurse practitioners specializing in mental health can expect to manage a variety of diagnoses including ADHD, depression, suicide, and other mental and behavioral health concerns. Management options include pharmacologic measures, counseling, and group/support therapies.

While not required, pediatric nurse practitioners may choose to pursue further education in mental health. Pediatric Primary Care Mental Health Specialist programs (PMHS) and Psychiatric Nurse Practitioner Programs (PMHNP) are available and recommended for those specializing in this subspecialty. The average salary for psychiatric nurse practitioners is $102,163. Most mental health nurse practitioners will work either in an acute, subacute, or outpatient facility.

7. Cardiology

Cardiology is the study of the heart. In children, many cardiac complications can occur including birth defects; acquired heart diseases such as Kawasaki’s, endocarditis, or hypertension; and rheumatic heart disease. Pediatric nurse practitioners specializing in cardiology would be expected to read and interpret cardiac testing such as electrocardiograms and echocardiograms; manage patient’s chronic concerns; prescribe medications and oversee long-term growth and development.

Pediatric nurse practitioners make an average of $90,000 – $117,844 when hired into cardiology. Patients may be seen inpatient in the hospital, outpatient clinic, or in the community through private or hospital satellite clinics.

8. Hematology/Oncology

Hematology is the study of blood whereas oncology is the study of cancer. Pediatric nurse practitioners pursuing specialization in hematology and oncology can expect to care for patients and their families with varying diagnoses including blood disorders such as hemophilia and sickle cell anemia and various pediatric cancers. Nurse practitioners are expected to work with the provider team to develop individual treatment plans, monitor and manage changes in patient status, and perform invasive procedures, such as lumbar punctures, when indicated.

Pediatric nurse practitioners specializing in hematology/oncology earn an average pay of $108,000. They may work in outpatient clinics or inpatient units.

9. Pulmonology

Pulmonology is the study of the respiratory system. Pediatric nurse practitioners in this specialty care for children with respiratory concerns or chronic diagnoses such as asthma, cystic fibrosis, pneumonia, and apnea. Care for these children involves monitoring for acute exacerbations, managing chronic symptoms, prescribing medications, and educating families to prevent complications and decreased quality of life due to pulmonary dysfunction.

The average salary for a pediatric pulmonary nurse practitioner is $90,000 – $114,978. Nurse practitioners may work in the hospital with inpatient admissions, in outpatient clinics, or in community outreach programs or satellite clinics.

10. Gastroenterology/Urology

Pediatric gastroenterology and urology provide opportunities for pediatric nurse practitioners to work in clinics focus on these concerns. Nurse practitioners may be responsible for monitoring and treating patients with chronic concerns such as diabetes, incontinence, constipation, feeding difficulties, infection, abdominal pain, and much more. Therapies may include pharmacologic intervention, behavior modification, mental health evaluation, muscular evaluation, and patient/family education.

The average salary for pediatric nurse practitioners in gastroenterology or urology is $87,429-$110,000. Patients may be seen in an inpatient acute care facility, outpatient clinics, or privately owned community-based practices.

If you’re looking to specialize as a PNP, you’re definitely not limited to those listed above. Also the salaries presented are estimated based on PNP surveys, you may see variation based on location, experience, and facility. This list is designed to help those interested in specialization where pediatric nurse practitioners may seek career opportunities beyond traditional primary care.

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