May 11, 2017

Ask Nurse Keith: Nursing Outside of the Hospital

Ask Nurse Keith: Nursing Outside of the Hospital

By Keith Carlson, BSN, RN, NC-BC    

As a career coach for nurses, I’m often asked very similar questions by many nursing professionals. Our challenges may feel unique to us, but you can often find other nurses who feel just like you do. In other words, you’re not alone, nurses -- many of our struggles are universal.

The Bureau of Labor Statistics reports that there were 2.9 million active nursing positions in the U.S. in May of 2016, and 1.6 million of those were “in the general medical and surgical hospitals industry.” 

The majority of new nurses seek acute care positions to refine and advance their skills. But once the first year or two is over, some nurses are confused about whether they should stay in the hospital or try something new. If 1.3 million nurses work outside of the hospital, that means there must be plenty of non-acute opportunities out there. 

Here’s an email I received from a nurse who was questioning her next career move: 

Hi Keith,

I’m seeking help with planning the “next steps” of my nursing career. 

I’ve been a nurse for four years, and I’ve worked in med-surg, telemetry, and a unit dedicated to cardiac and respiratory, with the occasional renal patient. I feel like I’m “over” acute care, but I’m struggling with the decision to rejoin the health/tech/communications/informatics world where I used to work as an analyst and product developer. I know there are jobs for nurses in those sectors, but I feel nervous about what will happen to my career if I leave the hospital. Will my clinical skills get rusty? Will I need them again and not have them? Will I still be a “real” nurse? 

I’m also concerned with work-life balance. My kids are pre-teens, and I want to be around more as they get older and need my guidance (as much as I know they’ll probably reject my guidance, LOL!) 

Finally, I’d like to know about best practices for finding non-hospital jobs that would be a good fit with my interests and skill set.


Afraid to Leave Acute Care 


Nurse Keith’s Response

Dear Afraid, 

Your questions and concerns are more common than you think. Not every nurse likes acute care, and a little less than half of all RNs in the U.S. work outside of the hospital. In other words, you’re in good company. 

Not using a skill means that it probably will get “rusty” –  if you don’t start an IV for five years, it’ll take some time to get back in shape. Think about a muscle that isn’t used – it’s still there, but it needs attention to get it moving again.

When I finished nursing school, I went straight into community nursing and home health, and I never looked back. Did I fail to develop some skills by skipping acute care? Absolutely. Did I care? Not really – I honestly don’t really like hospitals. I’ve been happily employed in non-acute settings for several decades, and that was a choice that wouldn’t work for everyone. 

Allowing some skills to wane isn’t necessarily a problem – it all depends on what you want to do in your nursing career.

Ask yourself these nursing career questions:

  • What are my greatest strengths? 
  • What gives me the most joy in my work? 
  • What aspects of nursing are less enjoyable for me? 
  • What are my short-term, mid-term, and long-term career goals? 
  • Does acute care “feed” me enough to stay for the long haul?
  • What does work-life balance look like to me? What do I want out of life?

There are plenty of other questions you can ask yourself, but this is a good place to start. Now let’s dig a little deeper. 

1.3 Million Nurses Can’t Be Wrong

If over a million American nurses work outside of the general medical-surgical world, many must have nursing jobs and skills they feel pretty good about. Where might some of them work? 

  • Outpatient dialysis
  • Cancer centers
  • Long-term care, assisted living, and skilled nursing facilities
  • Home health care
  • Addiction treatment centers
  • Inpatient or outpatient hospice
  • Public or private clinics
  • Community health centers
  • The private offices of physicians and advanced practice nurses
  • Public and private schools
  • College and university health centers
  • Biotech
  • The pharmaceutical industry
  • Entrepreneurship and self-employment

As you can imagine, the nurses in these specialty areas have very interesting and marketable skills. Some of these nurses may not have skills suitable for med-surg, but many of them likely don’t want to work in acute care anyway (and if they did, there’s no shortage of refresher courses). 

Acute Care Isn’t Everything

As the population continues to age (20% of Americans will be 65 or older by 2030), the need for home health and outpatient care will grow. More nurses will be needed to help provide dialysis, home health, hospice, ambulatory surgery, and other services.

With a growing shortage of physicians and increased autonomy for nurse practitioners and other advanced practice registered nurses, you can also consider continuing your education and leveraging your expertise as an APRN. And specializing in geriatrics is a pretty good bet. 

Best Practices For Your Job Search

In terms of best practices for a non-hospital job search, the same general rules apply. Here’s some to consider: 

Understand that many jobs are found through relationships, not ads. Cultivate and nurture your network through face-to-face and online connections, including LinkedIn, conferences, seminars, meetups, and ad hoc conversations. 

Maximize your resume for the type of position you’re seeking. A resume oriented to med-surg won’t be that attractive to a biotech company. 

Low-stakes informational interviews are a great tool for gathering information about an industry or area of nursing practice. Talking to insiders will help you gear your search, resume, and interview skills towards the type of position you’re targeting. 

Other than a killer resume and cover letter, develop a business card to use in your networking, as well as a good “elevator pitch” about who you are and what you’re all about as a nurse.

Follow Your Nurse’s Heart

In the 21st century, we hopefully aren’t Puritans who work seven days a week from sunrise to sundown in order to feed our families and survive. Work-life balance is crucial, as well as doing something that brings fulfillment and joy, personally and professionally. 

Once you’re a nurse, no one can take that away from you. Make choices that feed your spirit, put food on the table, and help you to realize a career that’s just right for you.  


Want to Find the Best Nursing Jobs For You?

High-paying nursing opportunities abound. As a registered nurse, you are in control of your career. Check out the best jobs from coast to coast on our job board. Get the pay and career path you deserve. Click here to see open positions for nurses now.

Keith Carlson, BSN, RN, NC-BC is a Board-Certified Nurse Coach, award-winning blogger, nurse podcaster, speaker, and author. Based in Sante Fe, New Mexico, Nurse Keith’s work has appeared in a variety of online and print publications. 

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