The times—and the nursing job market—they are a changin’


By: Donna Cardillo, RN, MA

The job market for nurses has shifted permanently. Not only is care, and the relevant jobs, moving out of hospitals and into alternative inpatient care settings, the home, and the community, but our health system is moving from an illness treatment model to a prevention and maintenance model. The bottom line is that nurses need to look in new directions for employment, must learn new ways to find and get those jobs, and will have to take steps to get and stay competitive in a new job market.

I receive many calls and e-mails from nurses of all ages who have been in the profession for awhile but have been away from the hospital and want to get back in. They send their résumés to area hospitals and get either no response or a reply that indicates they don’t have recent experience. They often assume it’s age discrimination because “I’ve always gotten any job I applied for in the past.” I also hear experienced nurses say, “Hospitals are hiring new nurses, but they won’t hire the experienced ones.” Tell that to the droves of new nurses who remain unemployed for a year or more after graduation because most hospitals aren’t hiring them.

What many experienced and new nurses don’t realize is that traditional bedside hospital jobs are decreasing as hospitals across the country close inpatient units and convert that space into primary and ambulatory care. In fact, entire hospitals are closing as inpatient stays diminish because of the cost, inherent risks of hospitalization to the patient, and expanding home, outpatient, community, and alternative inpatient care settings, such as long-term care, rehab, and subacute care resources. Some experts predict that one-third of all hospitals will close by 2020. Others predict that hospitals will evolve into one big intensive care unit, treating only the most acutely ill patients, while all others will be treated in other settings.

So what does this mean for new and experienced nurses alike? It means that hospitals will no longer be the primary employer of nurses in the future. It also means that the majority of new nurses will no longer need—or even be able—to start their careers in a hospital. And this won’t matter because most future care will be delivered outside of the hospital.

Schools of nursing are already reevaluating and revamping their curriculum and their focus from largely hospital care to primary and ambulatory care as well as wellness promotion and management of chronic disease. But this process will need to be ongoing.

We also need to stop telling new nurses that they must get hospital experience before seeking employment elsewhere. That has been the standard for more than a century but the times, they are a changin’. For the most part, this advice is outdated, impractical, and was never true for many of us anyway. There are many paths to follow in nursing, and new ones are opening up all the time.

Additionally, all employers—hospital and nonhospital alike—need to broaden their view of what a new nurse is capable of doing and learning and stop making 2 years of hospital experience a prerequisite for hiring. (See my pervious post, “Are we jeopardizing healthcare’s future by not hiring our new grads today?” There’s no reason why a new nurse can’t start in public health, case management, nursing informatics, home care, or any ambulatory care setting with proper support, mentoring, and ongoing education and training—currently being provided by many progressive and future-minded healthcare employers. And for those who are reading this with mouth agape thinking, “You’ve got to have hospital experience first to do those things,” you may be shocked to learn that new nurses have been successfully starting their careers in alternative settings and specialties for years. We’ll simply see this on an expanded scale in the future as the role of the nurse evolves.

Beyond all that, every nurse—novice or experienced—must take steps to keep up with the complexities of health delivery in any setting, stay on educational par with other healthcare professionals, and learn self-marketing skills in an increasingly and permanently competitive job
market. This includes furthering our formal education, joining and staying active in nursing professional associations, developing excellent communication and professional development skills, and boosting our emotional intelligence at every level. Clinical skills and knowledge alone won’t carry any nurse.

Is all of this a reason to get depressed? Not at all! In fact, nurses will be taking on a more expanded and significant role in the future. We need to wake up—individually and collectively—to a new reality in nursing and health care. We have to open our minds to new and different ways of seeing and doing things, including where and how we’ll be working and finding jobs. It’s time for a paradigm shift at every level. Dig in your heels and get left behind or create a new vision for your/our career and move forward with the times. The choice is yours.

Donna Wilk Cardillo is the Career Guru for Nurses and “Dear Donna” columnist for Nursing Spectrum, NurseWeek, and Donna is also an ‘Expert’ Blogger at She is author of The ULTIMATE Career Guide for Nurses, Your 1st Year as a Nurse, and A Daybook for Beginning Nurses. Ms. Cardillo is creator of the Career Alternatives for Nurses® seminar and home-study program. You can reach her at or

The views and opinions expressed by Perspectives 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.


  • heathersmith
    May 13, 2014 8:03 am

    San Diego RN Jobs available at Scripps

  • I’ve been blessed as a new graduate RN with a BSN got hired at SNF, hospice agency, Eye surg. CTR and now as a Home Health RN. Don’t worry about the pay just cause you have a BSN, get the experience first and the money will come later…Be blessed this coming new year.

  • Thank you Donna for your uplifting article. My daughter just recently graduated with her BSN in nursing and cannot find a job anywhere here on Long Island because she does not have nursing experience. She also has a BSN in Biology. Her experience in healthcare was as an aide in a Neuro Unit and in homecare. She keeps sending out her resumes with no luck. In the meantime, she took a job at a gym, but continues to send her resume to hospitals. I will tell her to branch out to other areas also

  • WOW this article hit home for me. Just because I took some time off to take care of family(almost a year) It is not easy to find a job,because i am asked “What have you done in the last 6 mo.? I have 12 years in nursing,from ICU to PICC nurse. I am back in school getting my BSN. Thank you for this article!! For giving us hope!!

  • Hospice has been hiring more than home health. In California most home healths require a year of experience. what is the future of traditional OasisC based home health RN

  • Excellent article! This is the most realistic synopsis of the market that I have seen. I, personally, have never felt my oats as a nurse more than when I left the hospital milieu 5 years ago… feel so very empowered and so much more fulfilled. I love being a nurse… again!

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