When Christina Manheimer, DNP, APRN, first considered working outside the hospital, getting comfortable with the idea was a process.
“It took me a long time to get to the place where I felt ready to transition,” she said. “I was very scared.” She regularly talked to colleagues who worked in the community health setting she was interested in, spent time shadowing other nurses, and scoured job openings to find the right one.
Manheimer now works as a family nurse practitioner in the Office of Faculty Practice at Rush University College of Nursing in Chicago, where she found a role in which “you can practice as a provider and get your toes wet with teaching.” Manheimer, who has worked in neuro ICU and urgent care, is among a growing number of nurses who have moved outside the traditional hospital setting.
According to 2021 data from the Bureau of Labor Statistics, at least 33% of RNs now work outside the hospital setting with nearly half of those in ambulatory care.
"That's the beauty of nursing to me," she said. "It seems like there's a million pathways to go. I don't think you have to be locked in to one thing specifically."
Finding a good fit outside of the hospital
After experiencing "intense burnout" while working as an ED nurse, Ellen McCarthy, RN, began working part time at Restore Hyper Wellness, which provides IV therapy, cryotherapy, and mild hyperbaric oxygen therapy among other services at over 225 locations nationwide.
McCarthy was unsure if she wanted to stay in nursing, but helping patients with what she calls preventative and adjunct therapies has been gratifying. "Nursing is such an incredible career," she said. "There are so many opportunities. I kind of pigeon-holed myself at first."
As a nurse at Restore, she quickly rose from a part-time nurse to a full-time role as Lead Nurse, then as the company's first Manager of Nursing Education.
Today, she still maintains contact with patients, but does so from Restore's corporate office based in Austin, Texas, within the role of Franchise Business Consultant, which focuses on business operations and growth opportunities. The company finished 2021 with about 115 locations. According to its website, it plans to surpass 500 locations by the end of 2024.
What does it take?
Clinical experience is helpful for nurses seeking roles outside the hospital, though new grads with strong work histories also can be attractive candidates, according to McCarthy. Being an RN is preferred in many settings.
“Strong IV skills and passion for patient education are critical (at Restore),” she said. “We have a network of nurses from a variety of clinical backgrounds, experience levels, and personalities. Some traits we look for include being personable, independent, organized, driven, adaptable, collaborative and tech savvy.”
In her career outside the hospital setting, Manheimer said that building a rapport with patients, other healthcare professionals, and interdisciplinary teams is essential. She regularly leans on her “NP friends” and other community organizations and service providers for support.
Manheimer, who works at a clinic located in a building in which some clients live, said some patients visit the clinic just to talk or have a morning cup of coffee, and that’s when being a good listener is extremely important.
"They don't always come in for healthcare needs," she said. "Being really empathetic is important. Humor is a big one, and I use that every single day with everyone I come in contact with."
Some of her students didn’t even know community clinics exist, but they appreciate the bonds they can build there with those they serve.
“The majority of students love it because it kind of takes away a little of the red tape of the healthcare system,” Manheimer said. “You’re really connecting with people.”
Training for roles outside of the hospital largely depends on which patient population you’ll be working with, according to Manheimer. “Nowadays, knowing mental health first aid is really important,” she said, in addition to Narcan and first aid training, strong communication skills, and being a self-starter.
McCarthy and Manheimer agree that working outside the hospital offers nurses the opportunity to have more one-on-one time with patients and provides valuable health education.
"We get a lot more time to look at a bigger picture of their overall health," said McCarthy, which is a contrast to her time in emergency nursing. "You just didn't have time to educate people. So, you'd have a lot of patients come back a week later with the same complaint, and that could've been avoided."
Manheimer sees the appreciation for nurses during patient care. "You feel their sense of gratitude for us being there and taking our time," she said. "To me, that's very rewarding."
A positive change
Before shifts in the ED, McCarthy admits she would regularly cry. “I thought that was normal. I almost quit nursing completely because I was so burned out.”
But her role with Restore has revitalized her love of nursing. “It has been so refreshing to be in a job that I truly love, and I still get to be a nurse. I interact with patients almost every day,” she said.
Manheimer began her role at Rush in 2019 and had some initial struggles. “Once I took that leap of faith, I had a lot of imposter syndrome,” she said. “But that went away. A transition is always going to bring fear and change. But I’m so happy to know that what was pulling me toward this fits my personality,” she said.
The rewards also far outweigh the challenges in communities with vulnerable populations. “People will say to me, ‘Isn’t it kind of sad to work in the setting that you’re working in?’ That would be the last word I would use to describe the work we do,” she said. “There are serious moments where you’re worried about a patient’s health and their outcomes and what they’re going to do next. In the middle of it is more good than not and more hope than sadness. I think it would be hard for me to leave.”
Whether you’re actively seeking a new role or assessing your next steps, explore Nurse.com’s job marketplace to help match your experience and skills to the best-fitting role.
