Should you work in a hospital or an outpatient setting?
Here are some factors nurses should consider when making their decision.
When it comes to finding your ideal work environment, nurses today have a wide variety of choices and job opportunities. In addition to the traditional inpatient acute care setting, there are also numerous other nursing jobs in outpatient or ambulatory care settings, including home health care, community health centers, and private practice.
How do you decide which type of health care setting is the right fit for you? These strategies can help you make up your mind.
Research your options
A good first step when you’re looking for more information about the various health care setting for nurses is to review the websites of professional nursing associations, including the Academy of Medical-Surgical Nurses (for hospital/inpatient settings) and the American Academy of Ambulatory Care Nursing (for ambulatory care/outpatient settings).
Talking to other nurses to get input and advice is also valuable, recommends Michele George, MBA, BSN, RN, National Director of the Academy of Medical Surgical Nurses.
“I worked in home health nursing for many years,” she says, “and then I decided I wanted to move back to an inpatient setting in the area of patient quality, so I reached out to friends who were working in patient quality in hospitals, and they gave me a lot of great feedback and ideas.”
Some settings even allow nurses to “shadow” another nurse to explore new areas of practice and see if they are a good fit, says Deborah Dunn, EdD, MSN, GNP-BC, ACNS-BC, GS-C, President of the Gerontological Advanced Practice Nurses Association.
Consider your preferred workplace size. Large hospital systems may feel similar to an established corporation, while working at a smaller private practice may sometimes feel like a mom-and-pop business—everyone pitches in where they’re needed.
Then think about your own career development. Your ideal work environment should encourage you to grow. What kind of long-term opportunities are available to you? A private practice may be able to offer more flexibility and opportunity for self-driven research or advocacy, while a hospital may have a more structured path that also comes with greater offers of advancement and more resources for employee development.
Other factors to consider when deciding between an inpatient or outpatient setting include earnings, work-life balance, employee benefits, and perks. For example, hospitals have larger HR budgets and may be able to pay for things like relocation and tuition reimbursement. And while hospitals can offer more options on shifts, there’s typically less flexibility during those shifts; a private practice often has regular business hours, but flexibility within them.
Rule of thumb: Make sure your values and priorities align with your employer’s, whether that’s a hospital or outpatient setting.
Consider the stage of your career
Nurses who are fresh out of school often choose to begin their careers by working in a hospital setting because it can provide such a wide range of experiences and opportunities. That was the case for Marissa Bartmess, BSN, RN, who graduated with a BSN from East Tennessee State University in 2017.
“I decided to work in a hospital after graduation because I wanted to gain a variety of nursing experience, and I continue to work in a hospital while completing my PHD in nursing,” says Bartmess. “The experience gained as a bedside nurse in a hospital is extremely valuable.”
Even if you’re sure you want to specialize in a particular field of nursing, starting out by working in a hospital is an ideal stepping stone, says Dunn.
“My advice to newly graduated nurses who are interested in working with older adults is to begin by getting a solid foundation in hospital-based acute care,” she says. Hospital jobs give new nurses broad-based experience in medical and surgical conditions and a solid foundation of knowledge and skills, not only in common acute and chronic illness management, but in health promotion as well, says Dunn.
Look at nursing trends
As health care shifts from inpatient to outpatient care, the opportunities for nurses seeking jobs in ambulatory care settings continue to grow, says Kristene Grayem, MSN, CNS, PPCNP-BC, RN-BC, President of the American Academy of Ambulatory Care Nursing.
“This means nurses can choose from jobs in private medical practices, ambulatory surgery centers, university and community hospitals, hospital-based clinics, nurse-managed clinics, schools, and patients' homes, to name a few,” says Grayem. “This opens up the choices for nurses who may want to change their practice setting, or for nurses just entering the field.”
Certain nursing-specialty jobs are also projected to increase in the coming years. Nephrology nursing is one such specialty, according to Lillian Pryor, MSN, RN, CNN, President of the American Nephrology Nurses Association.
“With the incidence of kidney disease climbing steadily with no end in sight, the need for qualified nephrology nurses is becoming even more critical than in the past,” says Pryor. “Add to that sweeping legislation in Washington, DC, that will dramatically change kidney care in America, job opportunities in nephrology nursing are more vast than ever before.”
Opportunities in geriatric nursing are also rising, says Dunn. “Currently, one in every seven persons in the U.S. is 65 or older and just under 40 percent live with four or more chronic conditions,” she says. “There is a critical and growing need for practitioners who understand the challenges of aging, the individual and unique contexts of both helping people to strive for healthy aging, as well as adjusting to living with chronic illness.”
Next step: Get hired
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