History of Nontraditional Careers
The Nursing Workforce and Changing Demographics
While a majority of nurses currently work in the hospital setting, the nontraditional (nonhospital) nursing sector is growing.
There are currently over 2.7 million registered nurses in the United States. This figure is expected to increase 16% by the year 2024, with nursing employment surpassing the growth of most other health-related occupations. The upcoming expected growth of the aging population, particularly the baby-boomer generation, will require a larger nursing workforce to provide and coordinate care. The increased prevalence of chronic conditions, such as heart disease and diabetes, will also precipitate the need for a larger nursing workforce.
Patients are living longer but often with multiple chronic conditions and functional impairments. While there will always be a need to have a robust nursing workforce within the inpatient hospital setting, future projections show an increased growth of nursing jobs in nonhospital community-based healthcare settings. More patients will require comprehensive outpatient nursing care to manage both acute and chronic conditions.
The function of nurses is to promote wellness through prevention, to restore health and functioning to those affected by illness or injury, and to advocate for the care of individuals, families, and communities. The changing dynamic of the nursing workforce will extend these activities to a wide variety of nonhospital settings.
As the use of outpatient services increases, the number of inpatient hospital discharges is expected to decrease 3% while the number of outpatient-related services is expected to increase by 17%. Leading the top of this growth in nursing employment settings is home healthcare, which is expected to increase by 43% over the next decade, followed by ambulatory care (40%) and long-term care (24%).
There are many employment and career options nurses can pursue. Information about career planning and trajectories is often lacking in nursing school due to time constraints in educational programs already heavily packed with content. The options for nurses to pursue a nontraditional career in nursing are abundant yet not widely taught or advertised during nursing school or beyond. Information offered to students should include the origins of the nursing profession, which interestingly has its roots in the community, not the hospital.
History of Nontraditional Careers
Just as not everyone is cut out to be a nurse, not every nurse is cut out to work in the hospital. Fortunately, the profession is broad, and the job opportunities are plentiful. The beauty of nursing is that the work setting can be any place the patient is in need of care. Not all patients need nursing care that requires an inpatient hospitalization. In fact, with a growing emphasis on preventive care, nursing care is needed to educate and monitor individuals long before they develop an adverse health condition.
Just as not everyone is cut out to be a nurse, not every nurse is cut out to work in the hospital.
When asked where nurses most commonly work, the vast majority of people would likely answer the hospital. The hospital is the location where most people have encountered a nurse and the setting most commonly depicted on television and in the media. The origin of nursing does not begin in the hospital setting, however.
In the colonial period in America, care of the sick was provided by women, and it was informal in nature. Women presided over care during childbirth and for those who were ill, infirmed, or dying. In the early 1800s, informal nursing care was being given in the home through various religious and charitable organizations. Nurses at this point were not yet formally trained or educated in providing nursing care.
It wasn’t until the industrialization period that there was a greater need to provide care to the growing numbers of residents living in urban areas. It was also during this time that women were becoming employed outside of the home setting. The poor environmental conditions that arose from living in tenement houses paved the way for community-based nursing practice. This included educating individuals and families on how to avoid illness, how to take care of basic hygiene and medical needs, and how to prevent the development and spread of communicable diseases.
Advances in medicine and technology in the 21st century further expanded the profession of nursing. The expansion of healthcare created more nursing jobs outside of the hospital setting and will continue to do so in light of the changing dynamic within the healthcare system.
Inpatient or Outpatient Nursing Career: Skills and Education
Whether a nurse decides to work in an inpatient or outpatient setting, both settings require a strong foundation of nursing knowledge and skills. The inpatient hospital setting is almost always the initial employment setting for registered nurses after they graduate from nursing school and successfully pass their licensure exam.
Inpatient hospitals offer a variety of units that focus on a specific patient care population, and this setting usually has multiple available positions at any given time of the year. The hospital setting enables novice nurses to begin to build their skills and experience providing nursing care. It also introduces nurses to other healthcare professionals through the interdisciplinary care model, which is imperative in promoting and fostering quality healthcare today. Hospital nursing allows nurses to work in the same setting on the same unit, which can offer a consistent level of predictability for daily work expectations.
While these are some of the innate benefits that inpatient hospitals have to offer, there can also be some drawbacks. Hospital nurses often work longer-length shifts, have mandatory rotation between shifts, and may be required to work overtime or on-call. They may be exposed to various staffing-related issues, be subjected to horizontal violence or workplace incivility by nursing coworkers, and have various issues with administration. Lastly, although most nursing positions in the hospital require an RN license for employment, more and more hospitals prefer to hire applicants who have earned a bachelor’s degree in nursing.
Nursing Care Outside of the Hospital
The outpatient care setting is broad and includes all jobs other than those found within the inpatient hospital setting. This can include outpatient specialty centers, physician offices, public health clinics, schools, ambulatory care centers, home healthcare, hospices, occupational health offices, college health centers, and correctional facilities, to name a few.
Most outpatient care settings require at least a minimum of 1-2 years of experience in acute or inpatient care. This is because the roles and responsibilities of nurses in outpatient settings often include a broader scope of care that requires excellent interpersonal skills and a sound knowledge of community-based resources. Nonhospital nurses must demonstrate proficiency in prioritization and organization because they most often work independently in most outpatient care settings.
There are many benefits to working in an outpatient care setting. There is usually a greater level of autonomy and independence in these settings, which enables the nurse to perform his/her duties without as much daily oversight as in the inpatient setting. This can have both positive and negative results. For seasoned nurses, it can prove to be a more flexible environment that does not impose as many personal constraints. For novice nurses, this can be challenging and frightening as there may not be other nurses readily available on site to answer questions and help troubleshoot difficult situations.
Outpatient settings can offer more variety and interest to the daily workday.
Outpatient settings can offer more variety and interest to the daily workday. The patients and clinical scenarios that nurses encounter often differ from day to day, which can satisfy nurses who become easily bored in the same work environment. On the other hand, nurses who do not like surprises or do not like not knowing their daily activities ahead of time may not welcome this unpredictability.
There can also be a deeper level of involvement between the nurse and patient in the outpatient setting, which can enhance and promote the nurse-patient relationship and may lead to better patient outcomes. This is because nurses often have more prolonged interactions with patients in outpatient settings, bearing witness to personal issues and challenges that may not be disclosed to nurses in inpatient settings. However, the enhanced nurse-patient relationship can lead to increased levels of stress and burnout for the nurse when the relationship ends, particularly in an abrupt manner, such as patient death.
Both inpatient and outpatient nursing jobs have their pros and cons. The beauty of the nursing profession is that nurses are able to find their own niche and take advantage of the abundance of opportunities and choices for employment in a variety of settings.
Recommendations for Nontraditional Careers for Nurses
Just as not every nurse is cut out to work in the hospital, not every nurse will be the right fit for each nontraditional job. The best fit for a career in nontraditional nursing can depend on a variety of factors including level of experience, personality, and personal stage in life. For example, a brand new nurse may have expressed an interest in working with children as a school nurse but lacks any pediatric or acute care experience. In contrast, an experienced nurse who is nearing retirement age may be at a stage in life where a position requiring long hours and unpredictable patients is not at all desirable.
Nurses should research the nontraditional nursing career they are interested in before applying and should be prepared to come to the job interview with questions. If possible, nurses should try to speak with nurses who are currently employed in the desired position, as they would be the best source for realistic information about what the job entails.Below, you will find some of the most popular nontraditional jobs in nursing alongside a character trait that might make for a natural “fit.”
Adaptable—Home health nurse. If you have the ability to acclimate and function in any situation and don’t mind a sudden change in plans, home health nursing might be the ideal career for you. Home health nurses provide holistic and comprehensive nursing care to patients in need of acute or chronic home-based healthcare and services. Home health nurses must have excellent interpersonal skills and be able to promote culturally sensitive nursing care to the population they are serving in their community.
Alert—Correctional nurse. If you are observant and vigilant while maintaining tolerance in an unpredictable environment, correctional nursing might be a perfect career choice for you. Correctional nurses provide care and support to inmates residing in jails, prisons, correctional facilities, and/or juvenile detention centers. Specialized knowledge in mental health and substance abuse care is often required in order to provide for the complex care needs of this population.
Compassionate—Hospice and palliative care nurse. If you are a gentle and kind spirit who can comfort patients during their final journey in life, hospice and palliative care nursing might be for you. Hospice and palliative care nurses provide care to patients diagnosed with life-threatening illnesses. Assessments and interventions are performed to maximize comfort and improve the quality of life for patients and families going through a serious illness.
Curious—Research nurse. If you possess a natural curiosity to find solutions to clinical issues or make new discoveries to improve the lives of patients, research nursing might be for you. A research nurse can engage in all aspects of the research process with the goal of improving medical science and, ultimately, patient care. This can involve recruitment and screening of research participants, collection of research data, and analysis of research findings.
Disciplined—Armed Forces military nurse. If you can maintain restraint and self-control in any situation, a career in military nursing might be a good fit for you. Military nurses provide care to members of the armed forces and their families who reside on a military base and/or can be deployed to work overseas in times of war. Military nurses must have excellent assessment skills, particularly in volatile settings, as they often engage in providing emergency and critical care to seriously injured soldiers.
Energetic—Camp nurse. If you possess an energetic spirit and a love of nature and children, camp nursing may be the perfect role for you. A camp nurse provides acute and/or chronic care to campers and staff in the camp environment. This position involves working most often with children and adolescents in health promotion, camp safety education, and emergent care in the outdoor camp setting.
Optimistic—Outpatient oncology nurse. If you possess an innate positivity and hopefulness, you may be well suited as an outpatient oncology nurse. Outpatient oncology nurses use the nursing process to care for patients undergoing various aspects of cancer diagnosis and treatment. Nurses can specialize in a particular type of cancer and/or a specific treatment modality (eg, chemotherapy or radiation).
Tech savvy—Telemedicine nurse. If you like to navigate information systems instead of running away from them, telemedicine nursing might be a natural fit for you. A telemedicine nurse uses various technologies in order to deliver care to patients. This includes the use of audio and video technologies remotely in the assessment, diagnosis, and implementation of care to patients.
Editor’s Note: This article is based in part on a new book by Susan Lowey titled Nursing Beyond the Bedside.
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Cite this article: Nontraditional Careers in Nursing: Options for Nurses. Medscape. Mar 15, 2017.