Learn which careers are in demand.
Nurses’ contributions to the nation’s healthcare system have never been more apparent than they are today. The COVID-19 pandemic has deepened understanding of and appreciation for their skills and value, just as it has accelerated healthcare’s shift from inpatient care to more outpatient and in-home care. Nurses now have opportunities to lead and work in a variety of settings, experts say.
“Nursing is one of the most flexible career opportunities you can have,” says Anne Jessie, DNP, RN, senior director of population health and clinical innovation at the Gorman Health Group, and immediate past-president of the American Academy of Ambulatory Care Nursing (AAACN). “You can flex [your skills] and move around, and nobody judges you for this because it’s all part of the profession.”
Here’s an overview of some of the nursing careers that experts say are in demand and will remain so into the future.
Ambulatory care
Ambulatory care nursing extends beyond traditional primary care and specialty physician practices to a variety of settings, including hospital-based outpatient clinics, stand-alone surgery centers and radiology facilities, pain management clinics, school and university clinics, and, increasingly, government-funded Federally Qualified Health Centers (FQHCs) that serve at-risk inner-city populations or residents in rural communities.
Ambulatory care nurses have long had a foothold in the telehealth space, and the pandemic has accelerated the expansion of virtual care for both acute and chronic disease management, Jessie says. She points to care coordination and transition management (CCTM) as one flourishing role. A CCTM RN manages patients with chronic diseases, coaching them to improve their health, engaging them in self-care management, educating them on their condition and care plan, guiding them across the care continuum, and ensuring they have needed supplies and equipment. Jessie says the role is “broader and deeper” than that of a traditional case manager or a nurse navigator and “allows the nurse to build a trust relationship with the patient and family.”
Public and private payers are hiring RNs to do CCTM-like work, as are new companies that partner with large employers to help employees optimize their health. Value-based reimbursement models also have led some medical practices and hospital systems to establish CCTM roles. (RNs using CCTM skills are at the hub of the patient-centered medical home model of care, Jessie notes.) Jessie gives the example of an RN employed by a cardiology practice who might meet a patient hospitalized with heart failure to help ensure they receive timely follow-up, personalized care, and coaching as needed to prevent further hospitalization.
Ambulatory care nursing careers—including jobs in informatics—are open to RNs with all levels of education. Many FQHCs are run by nurse practitioners (NPs) and prefer to hire nurses with a bachelor’s of science in nursing (BSN), but “I wouldn’t shy away, if I had an associate’s degree, from pursuing these and other [ambulatory care nursing jobs],” Jessie says. Many leadership roles (for example, clinic managers) in ambulatory settings require a BSN or even master’s of science in nursing (MSN). Ambulatory care nurses with advanced degrees—doctor of nursing practice (DNP) and doctor of philosophy in nursing (PhD)—are actively involved in ambulatory care nursing research, both within and outside of academia, as well as clinical care.
To prepare for CCTM work, experienced nurses frequently have learning opportunities (for example, to deepen motivational interviewing or shared decision-making skills) once they’re hired into the role, Jessie says. CCTM content is included in the ambulatory care nursing certification available through the American Nurses Credentialing Center, and the AAACN offers a variety of CCTM education materials (aaacn.org/practice-resources/care-coordination-transition-management).
In the meantime, efforts to help student nurses and new RNs prepare for ambulatory practice are growing. “There [traditionally] has been a silo between academia and ambulatory practice,” Jessie says. “It’s not really standardized [for student nurses] to have much experience in outpatient settings.” But that’s changing.
Facilities and health systems are implementing RN residency program content developed by AAACN, she says, and nursing schools and community partners are implementing grants awarded by the U.S. Health Resources and Services Administration to train nursing students and current RNs for primary care roles.
Nurse practitioners
In the United States, there are 290,000 licensed NPs—many of whom have benefitted from the pandemic-driven relaxing of federal regulatory restrictions on their practices—and demand exists for more.
NPs have graduate-level training beyond their initial BSN education and successful completion of a national board certification exam. The trend is toward doctorate education, although “It’s still unclear in the market whether there are discernable differences between the DNP-prepared NP and the MSN-prepared NP in practices, so I don’t think we’re there yet,” says Margaret “Midge” Bowers, DNP, FNP-BC, who practices at the Duke Cardiology Clinic and is an associate professor and lead faculty for cardiology at the Duke University School of Nursing. However, it’s worth noting that the National Organization of Nurse Practitioner Faculties has committed to making the DNP degree the entry level of practice by 2025.
Bowers strongly encourages RNs who anticipate an academic role to pursue a DNP. Others should “explore the health system they work for to see what roles DNPs are currently filling,” Bowers says. “This provides a perspective on local market penetration.”
Psychiatric-mental health NPs are and will be in demand to fill gaps in mental healthcare, Bowers emphasizes. Ideally, these NPs will see increasing opportunities to practice within primary care practices and clinics, where patients can receive mental healthcare at sites they trust and are already visiting.
Another area of growth for NPs is geriatrics and helping older adults age well, Bowers says. Adult-gerontology primary care NPs and family NPs not only are the primary providers for day-to-day management in many skilled nursing facilities, but “both also have opportunities to provide care in the home in a community-based primary care model, allowing elders to age in place,” she says. Retirement communities, which are growing in number, frequently contract with NPs to manage on-site clinics established to provide easy access to medical care, she adds.
NPs are critical providers for healthcare programs driven by the principles of value-based care and population health. “Take heart failure,” Bowers says, “I’m going to track my patients, manage their symptoms well, and put systems in place so I can really focus on keeping them out of the hospital.” Telehealth, she adds, will be part of practice for many NPs, regardless of specialty. And she believes NPs will think creatively. “What we observe in someone’s home is not just about listening to the heart, [for instance],” Bowers says. “It’s about [asking your patient], ‘Can you walk around the kitchen a few times and then come sit down and we’ll see how out of breath you are?’ Or, ‘Can you take your phone to the fridge or your pantry and let me see what you’ve had to eat this week?’”
Bowers tells her students, “I don’t unbecome a nurse when I become an NP. I just build on that nursing foundation with an expanded scope of practice.”
Public health nursing
Public health nurses were the original analysts of what are widely known today as social determinants of health, and the pandemic has further illuminated the crucial role that public health nurses play in assessing risks, needs, and barriers to wellness and healthcare at both an individual and population level.
“We’ve been working with people who are the most challenged in terms of accessing care” and having basic needs met, says Denise Foster, DNP, RN, PHN, NE-BC, chief nursing officer of the County of San Diego Health and Human Services Agency. Many of her agency’s nurses have worked out in the field to reduce SARS-CoV-2 virus transmission, identify mental health needs, provide education, and respond quickly to the needs of the homeless population.
Healthcare professionals and the public have “all learned more and more [during the pandemic] about how the disparities in our system have impacted our well-being,” Foster says.
Public health nurses know well how to identify and reduce disparities by assessing and understanding social determinants of health and the needs of individuals and populations. These skills are integral to crisis response and to preventing disease and promoting good health—and they’re in demand by local and state governments and some hospitals and health systems.
Value-based care and the goal of keeping people healthy and out of hospitals “dovetails perfectly” with public health nursing, Foster says. Opportunities vary—from providing care and education in clinics and schools to performing risk assessments in homes—and many public health nurses “have a lot of autonomy,” says Foster, a board member of the Association of Public Health Nurses (phnurse.org). Addressing racism and climate change are both priorities for public health nursing, she notes.
State requirements for public health nurses may vary. In California, a public health nurse is an RN who’s received a public health nursing certificate from the board of registered nurses. RNs are eligible to apply for the certificate if they’ve completed a BSN program that includes qualifying public health and community health courses.
Traditionally, associate degree programs haven’t provided exposure to public health, but some programs—in rural areas, in particular—are now encouraging trainees to gain experience by taking some elective public health coursework. Opportunities also exist throughout the country for graduates of both associates and BSN programs to complete additional coursework and become eligible for public health nursing certification.
A growing number of public health nurses have been seeking advanced degrees in nursing and public health—not only with leadership positions in mind but also for continued work on the frontline. In the past several years, programs have begun offering MSNs with an emphasis in public health. Foster sees this as a positive development because they enable nurses to build public health knowledge while maintaining a nursing focus. In addition, a number of DNP programs have an emphasis on public health.
“Government and public health are very much like academia—they’re very into science and data. So having the credibility of an advanced degree is important for nurses to get a seat at the table [and be part of] planning and problem solving,” and not only implementation, Foster says.
Critical care nursing
The pandemic has opened an “incredible window into our world as critical care nurses,” says Beth Wathen, MSN, APRN, CCRN-K, a clinical practice specialist in the pediatric intensive care unit at Children’s Hospital Colorado in Aurora. “It’s a unique profession in that you bring the elements of humanism, caring, and compassion, and you also bring this incredible expert knowledge and critical thinking component,” she says. “Every day there’s intricate interplay between [the two].”
Critical care nursing covers a variety of specialty areas—including medical, surgical, cardiac, and neurological—for adult, pediatric, and neonatal patients. The American Association of Critical-Care Nurses (AACN) (aacn.org) offers critical care certifications for all three of these patient populations.
Increasing numbers of RNs are choosing critical care as their entry-level practice environment, Wathen says. And a growing number of organizations, including her hospital, have implemented nurse residency programs to prepare new graduates for the intensive care unit (ICU).
Progressive care and critical care are tightly aligned and require distinct but similar skill sets. Shifting to a progressive care unit is a “great option for ICU nurses looking for a change of pace,” says Wathen, president-elect of the AACN. And on the flip side, “progressive care nursing may be a stepping stone to transition into the ICU environment as well.” (Progressive care covers acutely ill adult patients who are moderately stable with an elevated risk of instability. AACN offers a progressive care nursing certification.)
Clinical nurse specialists (CNSs) have long played a key role in ICUs to facilitate and lead evidence-based practice, quality improvement, and research, Wathen says, and the past decade has seen significant growth in another type of advanced practice nurse—the acute care NP.
Although “some [advanced practice RNs] may move into manager and director roles, I think the majority fill critical roles as providers on the ICU team,” Wathen says. “They’re ideal partners for nurses, CNSs, and other [team members] in advancing quality improvement and evidence-based practice at the bedside.”
Overall, she emphasizes, increasing opportunities exist for critical care nurses to lead programs and initiatives while continuing to practice at the bedside. For example, a certified critical care RN in her hospital leads the ICU’s medication error prevention taskforce and is allotted 12 hours per week for advancing medication safety. Another ICU bedside nurse with a passion for technology serves as the unit’s informatics resource liaison to the organization.
During the pandemic, many ICUs upstaffed to handle the influx of patients by shifting to team-based nursing models, in which critical care RNs led teams of several acute care RNs and other assistants in caring for three to five patients as a team (rather than caring for one to two patients alone). The new staffing models allowed critical care RNs to “jump in as leaders in critical care,” Wathen says.
In some organizations, a shift toward team-based models had already begun before the pandemic, and experts will study its pandemic-related use. “I think it will stay in some format or another,” Wathen says. The same is true of teleICUs, which offer new opportunities for experienced nurses who want to transition away from the bedside and assist critical care nurses in rural areas, she says.
The pandemic caused many nurses to consider their future career paths. Some will choose to stay in their current roles, but many others are likely to explore new opportunities. This article has highlighted some of those opportunities, but many others exist. Learning more about their options will help nurses ensure they achieve career satisfaction.
