When I graduated nursing school, I thought I had a fairly clear picture of what my career would look like. Like many new nurses, I imagined providing direct patient care, advancing my clinical expertise, and perhaps moving into management someday. I never envisioned a path that would include population health/value-based care, health insurance, healthcare finance, executive leadership, and ultimately the CEO role of a healthcare organization. Based on what I understood then, I struggled to connect nursing to those roles.

One of the perceptions is that leaving direct patient care means leaving nursing or that one is no longer, or moving away from being, a nurse. I suspect many nurses who’ve pursued nontraditional roles have experienced a similar feeling.

Over the years, I’ve been asked if I miss nursing or if I regret no longer being a nurse. I even once received a “Happy Administrative Professional’s Day” card, instead of the usual Happy Nurse’s Day card, after I assumed my first executive role in “administration.” Over time, I’ve been able to understand that being a nurse isn’t defined by the work setting or job description, but rather it’s a way of thinking, a way of solving problems, and a commitment to improving outcomes for others.

I also didn’t understand then the significance of how my nursing career would progress because of defining moments or encounters with others that invite us to grow, reconsider what’s possible, and take the next courageous step. 

Nursing can take you places you never expected—if you’re willing to let it.

Generally, I’ve had four pivotal career transitions that have provided practical career lessons. 

• Pivot #1: Inpatient nurse → utilization/quality review
  • Identified opportunity outside traditional clinical practice
  • Discovered and learned quality and utilization management
  • Transitioned from individual patients to systems of care
• Pivot #2: Review services → health plan leadership
  • Learned healthcare economics
  • Developed business and finance acumen
  • Gained confidence in nonclinical settings
• Pivot #3: Population health leadership
  • Managed outcomes at scale
  • Leveraged physician partnerships
  • Led change across organizations
• Pivot #4: CEO role
  • Appreciated organizational and board governance
  • Focused on strategy and client engagement
  • Relied on the enduring value of nursing leadership

My career was never guided by a detailed roadmap.

Instead, I followed opportunities to learn and contribute. Over time, those opportunities exposed me to healthcare from entirely new perspectives. I became involved in medical economics, risk adjustment, Medicare operations, population health, and clinical integration.

With every transition, I found myself stepping into unfamiliar territory. There were no guarantees. Every move involved leaving behind something comfortable in exchange for uncertainty.

Looking back, I realize nurses are uniquely prepared for this kind of challenge. We rarely have perfect information. We assess, prioritize, make decisions, and adjust as new information emerges. Those same skills helped me navigate career opportunities that were never part of my original plan.

Some of the most important nudges came from other people: an instructor who asked if I planned to always provide direct patient care, a former Girl Scout leader who wondered aloud why I had not yet pursued my master’s degree, leaders who saw potential in me before I fully saw it in myself, and an executive coach whose simple question—“Isn’t that exhausting?”—made me pause and examine how I was leading. Those moments mattered because I was willing to receive them.

One of the biggest mindset shifts occurred as my responsibilities expanded.

As an inpatient nurse, I cared for patients one at a time. Later, I found myself working on programs designed to improve outcomes for populations of patients. I began to understand that improving healthcare doesn’t always happen one patient at a time. Sometimes it happens by redesigning a care management model. Sometimes it happens through quality improvement. Sometimes it happens by reducing barriers to care or creating systems that help clinicians succeed.

The faces become less visible, but the impact remains deeply personal.

There were moments when I felt like an outsider or that my nursing background was the least impressive credential in the room. I frequently found myself in rooms filled with finance professionals, actuaries, attorneys, physicians, and executives whose educational backgrounds looked quite different from mine. Many of those discussions focused on data, operations, strategy, and performance. All of those things matter.

What I gradually realized was that nursing brought something unique to those conversations—an ability to connect operational decisions back to people. 

• How will this affect patients?
• How will this affect caregivers?
• What unintended consequences could occur?
• How do we improve outcomes while preserving integrity, quality, dignity, and compassion?

I also learned that we don’t have to grow alone. Mentors gave me perspective, honesty, and advocacy when organizational politics felt complicated. Executive coaching gave me structure, challenge, and tools for seeing my own habits more clearly. Both mattered: Mentors helped me understand the landscape, while coaching helped me understand myself.

People frequently assume leadership begins with a title. Nursing taught me otherwise. The following competencies have carried through every role:

• Advocacy
• Collaboration
• Communication
• Critical thinking
• Leading through ambiguity
• Prioritization
• Relationship building
• Systems thinking

Resilience became part of my foundation. I learned through workforce reductions, job uncertainty, and seasons of frustration that leaders are watched most closely during difficult times. It sounds simple, but there’s wisdom in blooming where you’re planted. Learn all you can, stay focused, do the work in front of you, and remain open to the doors that may eventually open.

When I became a CEO, many people congratulated me on reaching a destination that appeared far removed from my nursing roots. But that isn’t how it felt. What I felt most strongly was gratitude. Because by then I had come to realize that nursing had been preparing me for every role along the way.

The responsibilities were different. The scale was different. But the underlying questions remained remarkably familiar:

• How do we improve outcomes?
• How do we serve people well?
• How do we build systems that work better?
• How do we create environments where others can succeed?

Those are leadership questions. They’re also nursing questions.

Each one requires humility and the courage to accept feedback, own what needs to change, develop and commit to an action plan, and to re-evaluate when the plan isn’t enough. Feedback—whether positive, constructive, solicited, or unexpected—has been one of the most important instruments of growth in my career.

Our profession needs exceptional nurses providing direct patient care. It also needs nurses in quality management, utilization review, informatics, health plans, population health, compliance, strategy, executive leadership, and countless other settings.

If I could offer advice to nurses who are contemplating opportunities beyond traditional clinical roles, it would be this:

• Don’t let anyone define the boundaries of your career.
• Learn the business of healthcare.
• Be curious.
• Say yes to learning opportunities.
• Develop new skills.
• Seek mentors from different disciplines.

Most importantly, trust that the strengths nursing has already given you are more transferable than you may realize. Today’s nurses have even more opportunities available to them. My hope is that we stop asking nurses where they want to work and start asking how they want to make an impact.

And when life or career creates an “in between” season, don’t rush past it. Some chapters require or may allow for an intentional pause—time to reflect, recover, recognize what you’re grateful for, and listen for what the next chapter is asking of you. Clarity sometimes arrives only after we’ve given ourselves permission to stop striving long enough to hear it.

I never could have predicted where my career would lead when I graduated nursing school. But after nearly three decades, I know this for certain: I may have worked in many different roles, but I never stopped being a nurse. My next chapter began with one courageous step, and I believe the same is true for every nurse willing to honor the moments, receive the feedback, seek the right people, and keep growing.

April Vogelsang is CEO at CIMRO in Champaign, Illinois.