There are huge differences between inpatient and outpatient nursing. It can be hard to pick where you want to go, especially if you’re a new grad or working within your comfort zone. In this post, I am approaching inpatient vs outpatient nursing from a new grad perspective.
After recently graduating, I decided to go into outpatient nursing. This is something I wouldn’t have considered just a year ago. Nursing schools push students toward inpatient nursing. It makes it hard to know what to expect in outpatient. Inpatient may feel like the safe choice in this instance. Ultimately, inpatient or outpatient nursing is a personal decision with the ‘right’ answer being different for everyone. Some of my “pros” might be “cons” to you or vice versa since it’s all subjective. If you’re considering inpatient vs outpatient nursing, I hope this post helps you see the pros and cons, as well as my perspective, to help you decide where you want to work!
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Inpatient vs Outpatient Nursing
Inpatient Nursing
Pros
Options for Day Shift or Night Shift
New-grad nursing positions used to be limited to the night shift. However, with the current staffing issues, it’s now easier to find both day and night-shift positions (depending on specialty). If you’re someone who needs or wants to work the night shift, it is going to be much harder to find an outpatient position that can accommodate your schedule. Working in inpatient nursing can give you more freedom to work night shift if that’s what you want to do!
3x 12s
It’s nice to work 3 days a week versus the typical 5x8s that outpatient is. There are outpatient positions that can be 4x10s or even 3x12s, however, they are much harder to come across. If you are someone who wants to only work 3 days a week, you can easily find an inpatient job that fits this schedule.
Residencies
If you’re a new grad, when going into inpatient you typically get a residency. The residency program is usually around a year and you get extra support and education to transition you onto the floor. If you decide to go into inpatient later on and start in outpatient, you can’t apply for residencies if you aren’t a new grad. If a residency is important to you in your success working inpatient, it might be the best decision to start working in an inpatient and move to outpatient later on. In the event you do start in outpatient and want to transition to inpatient with more rigorous training, there are sometimes fellowships.
Pay
Working inpatient usually makes more than outpatient (but not always!) especially if you are a new grad. My position is $7- 10k less than if I would’ve gone into a residency, not including any overtime I would’ve had. Pay can be an important deciding factor since chances are you’re not just working for fun and need money to survive!
Opportunity for Overtime
Generally working inpatient there is more opportunity to work overtime and get that OT money versus working outpatient. You are also more likely to get weekend and night differentials, as well as holiday pay since not many inpatient positions, give you holidays off (unless you’re working in OR or the like).
Higher Acuity Patients
This can be a pro or a con depending on whether you like high acuity patients. You also need to spend more time with your patients who typically have some level of dependence on you. Outpatient often has more independent patients who are just coming in for checkups or have minor acute or more chronic conditions. The difference in patient populations can be a big factor in deciding where you want to work.
More Variety in Using Skills
This is dependent on where you are working both inpatient and outpatient. However, if you are on a general med-surg floor you are probably going to be using a variety of different skills every day like catheters, injections, IV infusions, IV insertions, etc. This varies even in inpatient because chances are if you are working in L&D, for example, you probably won’t ever come across the need to insert an NG tube. In outpatient, you still can use your skills (against popular belief), but it is also dependent on your specialty and there is less variety. If you work in urology you will probably be doing a lot more catheters than someone working in family medicine. If you are in infusions, you are going to be doing IVs and infusions all day, but likely not catheters or wound care.
Cons
Floating to Units You Are Unfamiliar With
Overtime that you pick up can be in units that you are unfamiliar with and that are more daunting to work in since the patients have higher acuity than in an outpatient setting. You can also be floated to other units that are short-staffed and you may not have much experience while working inpatient.
Working with Different People Every Shift
If you’re someone who wants to get to know your coworkers and have consistency in this area, floor nursing isn’t the best for it. You and your coworkers are cycling through since everyone has different shifts for the week. While you will see familiar faces, there are also a lot of people that come and go like students, float staff, and agency nurses.
Disjointed Teamwork
While you are working as a team in inpatient with other disciplines, you may only see a doctor or PA once a shift. In a clinic setting, you are working within the same office as the providers every day and can build closer connections with them. This helps a lot with teamwork and feeling able to ask questions, advocate for patients, and give/receive constructive criticism.
Burnout
While burnout can happen in any nursing specialty (any job in general), it’s not a secret that bedside nursing has crazy high rates of burnout, especially during the pandemic. During my final quarter of nursing school, they told us that 30% of nurses leave the profession within the first year, and 50-60% leave within two years. I feel like it is really easy to get overworked in bedside nursing, especially with the temptation of picking up overtime. This might not be sustainable for everyone.
Pre-Shift Anxiety
Pre-shift anxiety is basically expected for most new grads going into bedside nursing and is considered the norm for at least a year, if not longer. That’s a huge adjustment period and can also take a lot of energy out of you. There is also increased stress working at the bedside. It can be an overstimulating environment with all the people running around, alarm fatigue, and constantly being on high alert. It can be emotionally and mentally draining and result in constant fatigue, anxiety, and stress, even when you’re not working.
Feeling Like Problems Aren’t Heard
Clinics are generally smaller than hospitals unless you’re working in an outpatient clinic connected to a hospital. Working at a smaller to mid-sized clinic, feedback from upper management is asked for constantly and they are always trying to rework the system to make it better. In the hospital, problems can get swept under the rug, especially if it requires money. I feel like this can create more safety hazards, liability, and a toxic atmosphere. There have been so many issues in recent years where hospitals aren’t held accountable for their part in errors since it can be pushed onto the healthcare staff because the hospital can just pay a fine and not fix the root of the problem.
Outpatient Nursing
Pros
Less Stress
Probably one of the top reasons that I personally choose outpatient! Outpatient nursing is much less stressful than inpatient nursing. There is less overwhelm, burnout, and fatigue. Knowing the type of person you are and whether you will be (or are already) affected by the demands of inpatient nursing can be an important determination.
An Hour for Lunch
When you are working 12s at the hospital, you are hardly getting to take a bathroom break, let alone your 30-minute lunch. Getting two 10-minute breaks and a full hour for lunch is a game changer. Living so close to where I work, I am able to go home for my lunch, let my dog out, take my time eating… It’s so nice! Having an hour off for lunch can allow you to run errands for things you might otherwise not have time for, and break up your 8 into two 4-hour chunks.
Holidays, Nights, and Weekends Off
If your friends, family, and other loved ones work the typical 8- 5, you’ll be able to share similar work hours with them. You will then be able to spend the weekends/nights/holidays with them rather than working. There’s also no working “every other weekend” or the like.
Consistency in Routine
As someone who thrives with routine and consistency, this was also important to me. Each morning I can go to the gym, walk my dog, stretch, and write blog posts, all before I go to work. Each night I can maintain my same skincare routine and have the energy to cook a healthy dinner. Post-clinical take-out and skipping the gym was the death of my health working 12s. On Sunday I can grocery shop and meal prep for the week.
My personal health really thrives on consistency and routine. That just falls off my plate when I am working different days each week and long hours that leave me exhausted. This isn’t the same for everyone, I realize. However, it is something to consider that you might have less energy to do the things that keep you healthy. Your shifts also change week to week so it’s harder to block your weeks. If you are someone who is indifferent about routine, working inpatient 12s might be nicer. If you are also someone who thrives in routine, working a more consistent schedule may pay off.
Variety of Specialties
While it might feel like there isn’t as much of a variety of specialties, there are so many options for outpatient nursing! You can do home health, infusion, mental health, primary care, school nursing, infusion clinics, outpatient surgery, aesthetics, etc. There are just as many options as working in an inpatient setting.
Cons
Less Money
The money isn’t as great as working inpatient, for the most part, as a new grad nurse. If you have the experience, you are more likely to get a job with pay equivalent to inpatient. Some examples would at an outpatient surgery center or infusion clinic. Some clinics also pay better than others.
Working 5 Days/Week
Working 5 days/week, like most outpatient positions, can suck. Most days of the week you are working. If you don’t plan your time out, it can feel like your life is slipping away. The feeling of being crushed by the 9- 5 is real!
Limited Overtime
As I explained above, overtime is harder to come by while working outpatient. This is true especially if your clinic sticks to the same set of hours. Not getting the holiday pay or weekend and night differentials can also suck. There is still some opportunity, just no incentive pay for the OT.
Why I Choose Outpatient Nursing
Background
Although I already went into it a little above, I will explain my perspective a little more. I didn’t think it was beneficial for me personally to lead a healthy and happy lifestyle. For example, I would forget to eat or didn’t have time for breaks. I was also solely on my feet for most of the day. I’m not the type to be able to go work out after my 12 and the next day. I was usually feeling too exhausted (both mentally and physically) to work out or do the things I love to do. After working a 12 and being exhausted, I would usually end up getting takeout or eating junk food because I didn’t want to spend time cooking.
Before nursing school, I had never considered inpatient. In nursing school, that’s all you’re really exposed to, so that’s what I had been leaning toward. Between the increased liability, rate of burnout, pre-shift anxiety, and disruption in routine, I thought it wasn’t for me right now. I might consider it in the future and there are so many different specialties that you can go into while working inpatient with not all being on the floor. But I’m only 24 and have the entire rest of my career to explore different specialties (which is why I choose nursing over PA school and med school anyway!).
Outcome
I am so happy with my decision to go into outpatient and I already feel it was the healthier decision for me right now. While I do make less than others in my nursing program who went into residencies, I feel excited to go to work instead of being stressed. I genuinely couldn’t imagine feeling excitement and no stress going to work in inpatient at this time in my life. It was the right decision for me since I already had a lot of anxiety and was feeling a little burnt out after nursing school. I will be starting my RN to BSN bridge program in just a couple of weeks. I know I will also be thankful for my choice when I have school added to my plate.
Final Thoughts
If you’re deciding between inpatient vs outpatient nursing, you have to think about your values and want from your job. For example, if you value high-acuity patients, higher wages, flexible scheduling, and working fewer days in the week, then inpatient may be more suitable for you. If you value consistency, less stress, holidays/weekends/nights off, outpatient may be for you. Each position, both in inpatient vs outpatient nursing, can be so different. By reflecting on your values and how they align with the position, you can make the best decision for yourself.
I hope this post has helped you weigh the pros and cons of inpatient vs outpatient nursing. Ultimately there is no right or wrong answer and you should choose your happiness above all else!
Thank you so much for reading! If you would like to be alerted of future posts, you can follow my Instagram here, or like my Facebook page here. Good luck with your decision and you can always DM me if you have any more questions about working in outpatient!
