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out of the box

Out-of-the-Box Nurses Setting the Pace

By: Keith Carlson, BSN, RN, NC-BC

If you ask the average American on the street what a nurse does, the answer will most likely involve hospital-based patient care. While that characterization is indeed a major aspect of 21st-century nursing strongly ingrained in the public consciousness due to nurses’ contributions during the coronavirus pandemic, according to the Bureau of Labor Statistics approximately 40 percent of nurses are employed in non-hospital settings.

Aside from nurses working in other traditional settings such as nursing homes and assisted living facilities; home health and hospice; outpatient dialysis; clinics; higher education, physician offices; and ambulatory care centers, a growing number of nurses have broken free of labels and boxes to blaze previously unrecognized or unknown trails with intellectual curiosity, ambition, and a sense of purpose.

The Nurse Iconoclasts

While nursing may be a profession, it is also frequently seen as a calling, a vocation, and a personal identity that nurses can take deeply to heart.

Unfortunately, the aforementioned limited public understanding of nurses’ true capabilities is not relegated to laypeople alone. Many professional nurses themselves hold equally narrow views of their own profession, which are only reinforced by nursing academia, movies and television, the media, and widespread public ignorance. Thus, a significant change in viewpoint may not occur without direct exposure to the depth of breadth of the possibilities being realized by nurses willing to take such a leap.

As a nurse choosing to work outside of the widely agreed upon norms of what being a nurse means, it is sadly commonplace to be on the receiving end of judgment, and even ridicule, for “abandoning” the profession or somehow no longer being a “real” nurse.

Breaking the shackles of a narrowly held definition of nursing is not for the faint of heart, and such endeavors require significant temerity, as well as personal and professional self-confidence and the ability to maintain focus despite the many obstacles that may arise. The path can at first be a lonely one; however, such a mold-breaking nurse can find their iconoclast brethren along the way.

Where There is No Box

A growing cohort of nursing professionals continue to create career paths for which there are truly no boxes. Meanwhile, certain well-worn paths previously blazed by nurse pioneers offer an entryway with a more welcoming framework from which to develop a professional identity and practice.

Some of the areas where out-of-the-box nurses are currently making inroads include:

  • Podcasting
  • Freelance writing and blogging
  • Filmmaking, visual art, and dance
  • Theater and performance
  • Motivational speaking
  • Consulting
  • Inventing and product development
  • Digital technologies, apps, and software development
  • Coaching (health, life, recovery, career, etc)
  • Legal nurse consulting

Most of these nurses must undertake the process of learning what is not addressed during nursing school but is essential to the world of nurse entrepreneurs and thought leaders: the rudiments of business; website development and maintenance; organization development; accounting and bookkeeping; marketing ad branding; social media; and sales.

Rising to the Challenge

Luckily, nursing education’s focus on critical thinking, the nursing process, and creative problem-solving can powerfully serve nurses who are pushing the boundaries of the strictures placed upon their careers by narrow views of the profession.

In the worlds of business, marketing, and consulting, critical thinking is essential for tackling the unique concerns that will arise, and many nurses are naturally equipped with flexible and intellectually curious minds that readily rise to such challenges.

Nurses’ ability to gather data, assess, diagnosis a problem, develop a plan, and evaluate outcomes is central to success in the unusual fields in which out-of-the-box nurses find themselves. The business world often necessitates collaboration across disciplines, and nurses’ highly developed skills in communication, delegation, and negotiation can serve as powerful tools of persuasion and insight. The all-important and finely honed nurse’s intuition may also play a role, lending itself to prudent assessment and decision-making.

Nimbleness of Mind

As mentioned above, being a nurse iconoclast is not for the faint of heart. Starting a business, learning new skills, and navigating brave new worlds can be disconcerting and overwhelming at times. For a nurse breaking into podcasting, social media, coaching, or inventing and product development, the learning curve may be steep.

Think of a nurse well-versed in emergency nursing or critical care. Flexibility, adaptation, just-in-time learning, and the ability to pivot at a moment’s notice based on new incoming data is standard. This awesome nimbleness of mind can be leveraged by the nurse seeking fulfillment and adventure in an out-of-the-box endeavor, translating beautifully into myriad roles, responsibilities, and discoveries.

The nurse iconoclast and trailblazer can courageously strike out into the unknown, meet like-minded rebels, and create community in seemingly unlikely places. Success can be defined in multiple ways, and such nurses are indeed meeting with success in a wide range of undertakings that are far from what was originally learned in nursing school.

Regardless of the challenges, the nurse who breaks the mold of what a nurse can be is setting an example that others can follow, and there is no doubt that numerous 21st-century nurses can visualize enormous opportunity beyond what they could ever have imagined when they first earned the title of nurse. The sky’s the limit, and stratospheric heights are decidedly within reach.

Keith Carlson, BSN, RN, NC-BC is a holistic career coach for nurses, award-winning nurse blogger, writer, podcaster, speaker, and author.

With two decades of nursing experience, Keith understands the issues faced by 21st-century nurses. Keith’s podcast, The Nurse Keith Show, offers inspiration and practical support to nurses seeking to create meaningful lives and careers.

Keith’s message of savvy career management reaches nurses worldwide and he can be found on social media, as well as at

The views and opinions expressed by My Nurse Influencer contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

1 Comment. Leave new

  • Rion Stallworth
    May 20, 2021 8:12 am

    Thank you for this post! As a senior nursing student, I have constantly felt like just following the “in the box” way of nursing. Where as, before I started nursing school I thought so “outside the box” of what I would do with my nursing career.

    This blog has reignited my thoughts and ideas of being outside the box with nursing!


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