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How nurses adopt distinct approaches for different care environments

While most registered nurses find employment in a general hospital, this is far from the only option available to them when choosing a work environment. Non-hospital settings, from community clinics to private surgeries and nursing homes, offer opportunities to nurses at all practice levels. Many nurses start out working in a hospital and then look at other settings for variety, or to pursue specialist interests. Others may choose to work in a non-hospital environment from the very beginning of their careers.

Different roles in hospitals

Even within the typical hospital, nurses can take on a variety of different roles in various departments. Each role has its own diverse duties and requirements and needs to be approached in a distinct way. These range from the high-pressure, fast-paced, and varied environment of the emergency room to the no less demanding but more long-term-focused setting of an intensive care unit.

Elsewhere, nurses on the maternity or children’s wards must practice a high level of empathy and personal care when dealing with their patients. Nurses working in radiology or in a hospital research laboratory may have less direct contact with patients. They will need to have the appropriate technical knowledge and scientific skill to conduct examinations, analyze results and work alongside the latest computer technology. Many hospitals also employ nurses in administrative and supervisory roles.

Ambulatory surgical centers

Some hospitals may have their own outpatients’ department, but outpatient care centers and clinics, also known as ambulatory surgical centers, may equally function as separate institutions. These provide services for patients who do not need to stay overnight, and nurses here will attend to non-life-threatening injuries and routine preventive care, as well as assisting with minor surgical procedures.

While hospital nurses can expect to see the same patient over a series of days, and sometimes over a longer period, outpatient nurses will typically care for many different patients throughout a single day, with appointments lasting from a few minutes to several hours. Nevertheless, nurses will see some patients on a regular basis, such as those with ongoing or chronic conditions who return periodically for checkups or routine treatment.

The responsibilities of outpatient nurses

Most outpatient nurses will assist doctors in their duties, but some nurse practitioners in this setting may have greater authority than their hospital counterparts and will be expected to take on more responsibility and make their own decisions. They may be able to diagnose, prescribe medication and administer treatments independently of a doctor. This role therefore requires excellent critical thinking skills.

Ambulatory surgical centers are becoming increasingly busy as more procedures can be carried out without requiring an overnight stay. Unfortunately, a shortage of beds and other long-term facilities in hospitals means that patients are encouraged to seek outpatient treatment if possible. More positively, many conditions that would once have required longer-term hospital care can now be managed on an outpatient basis, giving patients greater independence and quality of life.

All of the above means that outpatient nurses are in great demand. While outpatient nursing is a challenging and highly responsible role, often requiring multi-tasking and quick decision-making under pressure, outpatient nurses generally enjoy more regular shift patterns than hospital nurses alongside a varied and fast-paced working day.

Physician’s offices

Doctors and physicians employ nurses to assist them in their private offices, carrying out procedures, updating patient records and putting patients at ease. Nurses in this setting will usually be faced with non-emergency cases, ranging from patients coming in for routine examinations to those who need to be referred to a hospital or specialist for further treatment.

As well as working alongside primary care physicians and family doctors, nurses may work with specialist physicians such as family dentists, dermatologists and pediatricians. For these roles, nurses would be expected to have equivalent specialist training – for instance, as a dental or pediatric nurse.

The nature of working in a physician’s office

Working in a physician’s office will suit nurses who want a regular routine and an environment where there is less pressure and less demand than in many other healthcare settings. Nurses in these surroundings will work fixed office hours, with evenings and weekends free. This could suit both younger nurses while they study for further qualifications, as well as older nurses who want to work somewhere less hectic than a busy hospital.

A physician would look for a family nurse to work in their office. Family nurses will get to know regular patients and may see the same individuals through various stages of their lives. This kind of long-term relationship with a patient can be extremely rewarding. Typically, all the members of a family will see the same physician and nurses can go on to build relationships with the whole family.

Home healthcare

For nurses who enjoy building a close relationship with patients over an extended period, and who are resilient when it comes to the heavy emotional demands of the role, home healthcare can be an attractive option. Nurses care for patients in their own home for a range of reasons. These could include long-term chronic conditions or a post-operative period requiring short-term home healthcare.

Home healthcare nurses often work with the terminally ill, meaning that they must be prepared to help patients near the end of their life to die with as much dignity and as little discomfort as possible. Some home healthcare nurses assist the elderly and the disabled with routine tasks and personal care, such as washing and bathing.

The qualities needed to work in home healthcare

As more people with long-term conditions prefer to be treated in their own homes rather than in professional care facilities, the demand for home healthcare nurses has increased. Technological advances have also widened the possibilities for assisted living, but human care is still essential. Some home healthcare nurses may be employed on a full-time, live-in basis, while others will have several patients or clients who they see on a regular schedule. They may share their duties with other carers who attend to the same patient at different times of the day.

To succeed in this role, home healthcare nurses need effective communication skills and a great deal of patience and empathy. Cultural awareness is a key factor, as home healthcare nurses will frequently work with patients from different ethnic or cultural backgrounds from their own. It is vital to be a good listener, paying attention to what your patient wants rather than deciding for them based on your own cultural assumptions. The work can also be physically demanding as patients may need to be lifted or supported frequently.

Long-term care facilities

Nursing homes, hospices and other long-term care facilities employ registered nurses alongside other medical and care work professionals to look after their residents. These residents may be elderly, chronically ill, or severely disabled. Depending on their qualifications, nurses may find themselves in a supervisory role, working with a team of nursing assistants and care workers.

As with home healthcare, the long-term relationships that qualified nurses develop with residents and service users in care facilities are among the most rewarding aspects of the job. The role can also be extremely varied, as nurses become involved in every aspect of their patients’ lives. As well as providing medical care, duties can include organizing and supervising other services and even entertainment for residents.

The requirements to work in long-term care facilities

There are several routes to becoming a fully registered nurse. The most widely accepted study route is to take a Bachelor of Science in Nursing (BSN), which typically takes several years to complete. An alternative is an Accelerated Bachelor of Science in Nursing (ABSN).

The choice between ABSN vs BSN programs depends on multiple factors, including personal circumstances and career goals. An online ABSN program, such as the one offered by the Holy Family University in Philadelphia, can be completed in less than two years, so is a great choice for ambitious students. ABSN graduates also have access to a high salary potential, and many opportunities for career advancement.

In any case, patience, empathy and cultural awareness are once again essential requirements to work in a long-term care facility, as service users will come from a variety of backgrounds, all with different expectations and requirements.

Community health nurses

Community health nurses can be a vital lifeline for those in rural areas or low-income neighborhoods with scant local resources. Some population groups may be less able to access healthcare services than others due to factors such as location, ethnicity, income, or physical and mental disabilities. Community health nurses may work with organizations such as churches and prison services to bring medical attention and information to overlooked and vulnerable groups.

Within the community, public health nurses focus on disease prevention and health promotion, often responding to local or national events and emergencies. Public health nurses were on the front line during the COVID-19 crisis, administering vaccines and providing medical advice and support. Immediate local issues, such as poor nutrition or the effects of environmental pollution, may also be addressed by community public health nurses. As well as providing on-the-ground medical intervention, they may also lobby the national government on behalf of the community for action to resolve these problems.

The responsibilities of a community health nurse

Community health nurses work in a variety of settings, from community clinics to churches and prisons. Their role is to serve the community in a public health capacity, filling the gap between family doctors, hospitals and other healthcare services in meeting the needs of underserved populations.

As well as providing medical treatment, community health nurses engage in education and rehabilitation to a greater degree than nurses in other settings and may also contribute to research intended to improve medical care overall. They also frequently act as advocates for their patients, helping them to access the services they require or the assistance to which they are entitled.

Community clinics

Community clinics serve individuals and families with limited access to other healthcare services. They operate in a similar fashion to other primary care settings, such as ambulatory surgical centers, but there may be a greater emphasis on health education and ways to prevent or manage illnesses and conditions. The main difference between a community clinic and other healthcare settings is that patients will generally come from low-income or otherwise disenfranchised groups. Often, they will have worse overall health than the general population and face specific health challenges.

Nurses working out of community health clinics will see many patients with chronic conditions as well as injuries and illnesses. Often, there are environmental factors that contribute to these conditions, such as poor housing or lack of nutrition. This is where the community health nurse’s role as an advocate may come in as they seek to tackle the root cause of recurring and widespread problems as well as treating the symptoms.

Schools and universities

Most high schools employ at least one nurse to oversee the health of their students. The work may range from treating minor injuries incurred during school hours to collaborating with a school social worker to address mental health issues among the young. School nurses may also work alongside teachers and students on health awareness projects and health education on such subjects as sexual health, teenage pregnancy, and prevention of alcohol and substance abuse.

The duties of a school nurse will include maintaining immunization records and monitoring students with known conditions such as diabetes or asthma. Screening for infectious diseases and advising on nutrition and healthy lifestyles are also part of a school nurse’s role.

The advantages of working as a school nurse include only working school hours, with weekends free and long vacations, and the rewards of caring for children all from your local community throughout their school years. School nurses will take full responsibility for the healthcare needs in the school and may collaborate with local doctors and hospitals to provide integrated, community-wide care.

Working as a nurse in a college or university involves similar duties to a school nurse, with the difference being that you may be working as part of a larger team with greater resources. College nurses may combine their duties with work as a nurse educator or in the university research laboratories. Another difference is that you will be responsible for a body of young adults rather than children, most of whom will be living away from home for the first time. With many opportunities among the student body for misadventure, the role of a college nurse is never dull!

Commercial settings and the military

Nurses may often find work in commercial settings such as insurance offices or legal departments. Although these are not care-based roles, they may still involve carrying out examinations and assisting with diagnoses. Government agencies on both a local and national level also employ nurses in a research or advisory capacity.

Another nursing role with opportunities for travel is working on a cruise ship. These huge vessels can be out at sea for months on end, and their passengers are frequently at the older end of the age spectrum. For these reasons, cruise ships employ a full complement of medical personnel, including nurses, to take care of any injuries or illnesses that may occur during the cruise. Cruise ship nurses also monitor and meet the needs of those passengers with chronic conditions such as diabetes.

More so than in other professional environments, nurses on cruise ships must rely on their own resources. They cannot consult a local hospital before making a diagnosis but will need to make their own decisions and judgments based on the immediate evidence and their own knowledge and instincts. They will also need to make the best of the resources available to them on board ship and to get used to being permanently on call for the duration of the cruise.

There are also many active nursing opportunities to be found in the US military. Working as a military nurse can be extremely rewarding. Not only do you enjoy the job satisfaction from helping people that every nurse experiences, but you also get to serve your country, caring for members of the armed forces whether they are in the army, navy or air force. Military nurses can have their education paid for by their employer and often get to travel the world in the course of their duties.

Choosing the right setting for you

As we have seen, the range of possible nursing environments is wide and varied, from the hustle of a busy hospital to the more predictable routine of a physician’s office. Each setting requires a different approach from nurses, so when deciding which one is right for you, it is worth looking at your own strengths, weaknesses and inclinations to determine where you can make the best use of your abilities.

Whichever setting you choose, it is clear that there is more to nursing than working in a hospital. Once you are fully qualified as a registered nurse, you can take your pick of care settings as you progress in a rewarding career.

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