Where Do Nurses Work? A Breakdown of the Various Job Settings for Nurses
For prospective nurses or nurses just entering the field, it can be helpful to identify possible nurse job settings and the expected roles and responsibilities associated with different nursing work environments.
This guide describes some of the most common registered nurse (RN) work environments, including employment levels, the kinds of duties prospective nurses can expect, and the pros and cons of working in each setting. The information presented here can help new nurses evaluate their available options and make decisions about intended workplaces and specializations.
The Top 10 Most Common Work Settings for Nurses
Nurses can expect to find the greatest employment opportunities in general medical and surgical hospitals, followed by physician offices. However, many work environments offer employment opportunities for nurses at all practice levels in a variety of hospital and non-hospital settings.
Nurses might find work in outpatient and skilled nursing facilities, in-home healthcare, government agencies, schools, or employment services. The following sections provide specific information on some of the most common work settings.
|Work Setting||Total 2019 Employment|
|General Medical and Surgical Hospitals||1,863,700|
|Offices of Physicians||409,750|
|Nursing Care Facilities (Skilled Nursing Facilities)||361,950|
|Home Healthcare Services||271,850|
|Outpatient Care Centers||200,060|
|Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly||88,230|
|Specialty (except Psychiatric and Substance Abuse) Hospitals||72,640|
|Elementary and Secondary Schools||66,150|
The majority of nurses work in various hospital settings that offer general medical, surgical, psychiatric and substance abuse, and other specialty services. Over 60% of RNs work at hospitals, making them the largest group of all nurses employed in this setting.
RNs perform duties related to their specializations. Emergency room RNs must cope with the fast-paced environment and unpredictable conditions. In intensive care units, nurses deal with an array of challenging medical issues, from cardiac arrest to injuries caused by accidents or burns.
Maternity and pediatric nurses provide care and comfort to women and children in routine and complicated cases. Oncology nurses, who specialize in patients with some form of cancer, must keep up to date with the latest treatments.
RNs working in radiology or labs need technological and assessment skills to conduct specialized exams and analyze the results. Hospitals also employ RNs in administrative and education roles, which often entail supervising the nurse workforce, overseeing admission and discharges, and providing professional development.
Hospital-based nursing comes with personal and professional pros and cons. Nurses often cite the fulfillment they experience from helping patients cope with serious medical conditions among the factors that keep them motivated and interested. Hospitals often require 12-hour shifts, which tend to be a positive for many RNs. It is often one of the driving forces behind choosing a hospital-based career.
However, since hospitals are open 365 days a year, nurses must be willing to work weekends, holidays, and overnight. Plus, dealing with the constant loss of life, debilitating illnesses, and unrelenting stress can lead to emotional challenges and burnout if nurses do not make time for their own health and self care.
Outpatient Care Centers and Clinics
Outpatient care facilities provide routine preventive care, noncritical acute care, and minor surgical procedures. Nurses in outpatient settings treat patients who do not need an overnight stay, in contrast to hospital nurses who typically care for patients over several days.
Outpatient clinics employ licensed practical nurses or licensed vocational nurses (LPN/LVNs), RNs, and advanced practice nurses such as nurse practitioners (NPs), but their roles and responsibilities differ according to their scope of practice. While outpatient nurses work under the supervision of doctors, RNs and NPs in this setting sometimes exercise greater autonomy and decision-making authority than hospital-based nurses. In addition to providing preventive services and monitoring patients before, during, and after surgical procedures, NPs may prescribe medications while RNs can administer vaccines and other injections.
Outpatient clinics offer nurses expanding employment opportunities as hospitals move to shorten patient stays and as more people opt for outpatient procedures. Outpatient nurses enjoy the role’s autonomy, diverse tasks, and fast-paced environment. Many nurses switch to outpatient clinics after working in hospitals because the schedule is more predictable and typically does not require working over weekends or holidays.
However, the large volume of cases and patient care responsibilities can overwhelm even the most seasoned nursing professional. Nurses in outpatient settings must often deal with the pressure of performing their healthcare roles while also providing office services, managing files, and handling patient phone calls and emails.
Offices of Physicians
Physician offices provide routine, non-emergency healthcare. These medical settings often offer a specialized branch of medical care such as pediatrics, dermatology, dentistry, and women’s health. Depending on the type of office, nurses greet patients, ask questions about the purpose of their visit, record medical histories, and assist the doctor with procedures.
One of the most popular office settings focuses on family medicine, treating patients of all ages, from children to the elderly. These medical offices often employ family nurse practitioners to assist physicians.
Although physician offices offer less competitive pay and fewer opportunities for advancement or professional development, they provide several advantages over other work settings. These offices adhere to a more normal 9-to-5 office schedule, without evening or weekend shifts. Because patients make appointments, the day-to-day routine is less hectic than hospital or urgent care settings.
Office nurses rarely deal with emergency situations. Instead, they assist patients with mostly routine conditions such as colds or allergies, checkups, and adjustments to medication. Many patients have established long-term relationships with their healthcare providers, including nurses.
Home healthcare nurses work directly with patients in their homes. They care for chronically or terminally ill patients, those recovering from surgery, or people with developmental or physical disabilities. Home healthcare nurses not only provide medical care but they offer essential services to the elderly and others who need assistance with personal care and daily living skills.
Home health and personal care aides, nursing assistants, and psychiatric aides make up the majority of all nursing personnel in this setting. However, the increasing demand for home nursing care has led to expanding opportunities for RNs, who currently comprise just under 12% of the home healthcare workforce.
Nurses who choose to work in home healthcare rather than hospitals, clinics, and other facilities appreciate the independence, slower pace, and rewarding personal relationships they develop with their patients. Nurses in this field must develop strong communication skills and a level of comfort working with patients and their families from diverse cultural and social backgrounds. Home-based nurses also need to handle the physical demands of this kind of work, which often requires lifting and moving patients.
Nursing Homes and Assisted Care Facilities
RNs and LPN/LVNs often find employment in nursing homes that offer 24-hour care and provide many of the same services as hospitals. Besides medical care, nursing homes may offer physical and occupational therapy and palliative, end-of-life hospice care.
Assisted care facilities provide services to patients who need support with daily living. This setting primarily serves elderly residents or people living with disabilities who maintain some independence but require help with personal care such as bathing or dressing. Certified nursing assistants often take positions in assisted care facilities working under the supervision of RNs and LPN/LVNs.
Nurses who provide comfort and support to the elderly, chronically ill, or disabled in these settings often derive a sense of gratification from their work. Unlike hospitals where patients stay for a limited time, this workplace promotes lasting relationships between nurses and patients.
However, nurses must cope with stressful conditions, especially in facilities that care for immobile patients and those with dementia or other mental conditions. The heavy workload and lower pay compared to other work environments contribute to a high turnover rate.
Elementary and Secondary Schools
Nurses play a crucial role in elementary and secondary school settings. They deal with illness and injuries during the school day, assessing the need for urgent care, monitoring students with chronic conditions like diabetes or asthma, maintaining immunization records, and conducting screenings for infectious diseases and other conditions. School nurses counsel students about healthy lifestyles, nutrition, and sexual health, coordinating with teachers, staff, and families.
Nurses in K-12 settings must hold LPN/LVN or RN licenses. Many school systems require bachelor’s-trained RNs who have earned specialized certification through the National Board of Certification for School Nurses.
School settings offer a rewarding career for nurses who want to promote health and wellness among children and teenagers. Other advantages include regular daytime schedules, the variety of daily tasks, and summers off. While school nurses experience less stress than those in clinical settings, they earn less and may feel isolated in workplaces where they serve as the only healthcare professionals.
Community colleges, universities, and vocational schools employ nurse educators to train future nurses. Nurse educators, who usually earn a graduate degree after obtaining their RN license and clinical experience, can broaden their career prospects by pursuing the certified nurse educator credential. Universities and hospital-affiliated nursing schools increasingly fill faculty positions with nurse educators who hold a doctor of nursing practice degree.
Nurse educators teach didactic classes, supervise clinical training, and prepare students for the National Council Licensure Examination for RNs (NCLEX-RN) and certification. They also design curricula, advise students, and work with faculty and administrators on program development and budgets.
This career offers considerable fulfillment to nurses who feel passionate about the importance of training nurses to provide quality healthcare. Depending on education, experience, and location, nurse educators may earn higher salaries than RNs working in clinical roles.
Although not as hectic as clinical settings, the academic environment poses its own challenges. Nurse educators must maintain a research agenda to achieve tenure and constantly update lesson plans and laboratory demonstrations to reflect developments in the field.
Other Nurse Work Settings
Nurses seeking alternatives to traditional clinical practice may pursue an array of non-hospital employment opportunities. Nurses in the insurance industry administer claims and benefit packages. Law offices rely on nurses to research malpractice, disability, and personal injury cases for legal proceedings.
Government agencies have become major nursing employers. At federal agencies, nurses conduct disease control and epidemiological research. Nurses in the armed forces provide essential care at military bases, in war zones, and in disaster areas. Nursing professionals might find positions treating incarcerated patients in correctional facilities.
Changes in healthcare delivery have created a demand for telehealth nursing. These nurses offer remote services by phone, email, or live online chats, assessing symptoms, scheduling appointments, and counseling patients about medication.
Nurses who want to avoid the long shifts and constant trauma of hospital settings will find a growing number of job options. Those seeking a change of pace may take temporary contracts as travel nurses or working in underserved communities. Aesthetic clinics selling cosmetic services such as laser treatments enable nurses to provide elective, nonsurgical procedures in a relaxed setting during normal business hours.
Elizabeth Clarke, FNP, MSN, RN, MSSW
Elizabeth Clarke, FNP, MSN, RN, MSSW is a board-certified family nurse practitioner. A native of Boston, Massachusetts, Clarke tired of the cold and snowy winters and moved to Coral Gables, Florida in order to complete her undergraduate degree in nursing at the University of Miami. After working for several years in the UHealth and Jackson Memorial Medical systems in the cardiac and ER units, Clarke returned to the University of Miami to complete her master of science in nursing (MSN). Since completing her MSN degree, Clarke has worked providing primary and urgent care to pediatric populations.
Feature Image: Jose Luis Pelaez Inc / DigitalVision / Getty Images
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