A New Era For Nursing: How non-traditional roles are reshaping nursing careers
PAM BURNETTE & GRACE PARANZINO
roles are reshaping
A NEW ERA
Today, nursing is no longer solely about caring for
patients. It’s about technology, community-wide health
management, and consistently improving the overall
outcomes of a growing industry.
Over the next 10 years, the United States will need more registered nurses
than ever before.
In fact, employment of registered nurses is projected to grow 19 percent from 2012
to 2022—significantly above the average growth rate for all occupations.
Clearly, much of this growth will occur in response to the expansion of preventative care
initiatives; the increase in rates of chronic conditions, such as diabetes and obesity;
and demand for healthcare services from an aging population.
There is growing demand for registered nurses outside hospital settings too,
calling for an altogether new kind of nurse.1
Here, we outline the social and community trends that are shaping a new world of opportunities
for nurses, and also shaping the skill sets and opportunities of tomorrow’s nurses.
In this ebook, you
will learn about:
• Growth and demand
on the increase
• Big data and how it
continues to shape the
• The skills new
In the wake of the Affordable Care Act, the role of the
nontraditional nurse in the community has changed.
The value of nurses’ work in delivering the right messages at the right times to vulnerable
and at-risk groups is now a key focus for communities that are seeking to lower the cost
of acute healthcare delivery, and this is only going to increase.
Now more than ever, governments, businesses, and communities understand that
prevention is far better, and far cheaper, than the cure. As a result, the focus is on patient-
care specialists who can deliver proactive outreach care to individuals in hopes
of alleviating more costly hospital visits down the road.
Educational facilities, corporate settings, and even government-funded initiatives to
support the elderly in their own homes, all require specific expertise that only registered
nurses can deliver. The focus on positive lifestyle changes is leading to more consultative
work for nurses outside healthcare facilities, and there is evidence to suggest that there
are qualified nurses not currently employed in hospital settings that could be leveraged
for this kind of work:
In 2013, there were more than 2.6 million registered nurses employed across the United
States, yet there is a total of 3.1 million registered nurses nationwide. There could be up
to 500,000 licensed nurses that these new fields could re-engage.2
THE FUTURE OF AFFORDABLE CARE /04
Nurses have always been important. But in the battle to deliver
preventative care on a grand scale, nontraditional nursing roles
are now more important than ever.3
Consider the top five reasons students say that they choose the field of
nursing as a career:
• Personal satisfaction and growth
• Career mobility
• Job security
• Scheduling flexibility
• Competitive salaries4
These drivers, such as growth, mobility, and security line up nicely to the benefit of
emerging nontraditional nursing roles.
THE FUTURE OF AFFORDABLE CARE
“Nontraditional nursing careers have
emerged due to technological growth
and healthcare reform.
Areas such as patient safety and
quality of care, informatics, behavioral
modification, and care coordination
have become areas where nursing
is at the forefront of integrated
Grace K. Paranzino, EdD, RN, CHES, FAAOHN
Chief Clinical Officer, Healthcare Product,
Centers of Excellence, Kelly Services, Inc.
NURSING IS ALREADY A VARIED ROLE
“Occupational health nursing is an
expanding field as employers strive
to demonstrate ROI on preventive
care and create a culture of
wellness for employees. In addition,
occupational health nurses are
well-positioned to coordinate care
and provide expertise on work and
non-work related medical concerns.
As workers spend most of their day
in a work environment, occupational
health nurses have a perfect setting
to positively impact behavior change,
and provide a safe workplace.”
Grace K. Paranzino, EdD, RN, CHES, FAAOHN
Chief Clinical Officer, Healthcare Product,
Centers of Excellence, Kelly Services, Inc.
A registered nurse is already a varied and flexible resource
working inside many different clinical and non-clinical settings.
Some of the nontraditional nursing roles that fall underneath the category of
registered nurse include:
1. Occupational health nurses: professionals in these roles are tasked with
independently observing and assessing workers’ health status with respect to job tasks
and hazards. Using their specialized experience and education, they recognize and
prevent health effects from hazardous exposures and treat workers’ injuries and illnesses.6
2. Case management nurses: these professionals provide services to help
individuals and families cope with complex and difficult health-related situations. Their
aim is to assist people and their support networks to achieve the best possible quality
of life. They are goal oriented and help patients to identify their own version of success
in their lives. “From an assessment, the case manager and the client—whether an
individual or a family—together formulate a plan to meet those goals. The case manager
helps clients to find resources and facilitates connection with services. Sometimes she
or he advocates on behalf of a client to obtain needed services. The case manager also
maintains communication with the client to evaluate whether the plan is effective in
meeting the client’s goals.”7
“A registered nurse requires a large
base of knowledge to assess, plan,
and intervene to promote health,
prevent disease, and help patients
cope with illness.
Registered nursing roles range
from direct patient care and case
management to establishing
nursing practice standards,
developing quality assurance
procedures, directing complex
nursing care systems, conducting
clinical research, and teaching in
/08NURSING IS ALREADY A VARIED ROLE
nurses: HEDIS nurses are responsible for scheduling and performing on-site
medical record reviews at physician offices. People in these roles work to ensure specific,
measurable service standards, and assist in developing process improvement initiatives where
required. A HEDIS nurse “provides oversight in the planning, implementation, and coordination
of HEDIS healthcare audits to ensure high-quality, cost-effective care.”8
4. Quality assurance (QA)/process improvement nurses: nurses in QA roles
“evaluate the work and behavior of employees in their departments, whether at a hospital,
doctor’s office, or healthcare facility. By monitoring their colleagues, they can ensure qualitative
requirements are being met as specified by the hospital or state.” The goal of a QA nurse is to
deliver best practice approaches in healthcare facilities. They focus on continuous improvement
and take a data-driven and measurable approach to achieving improvements.9
5. Nurse in-service educators: these nursing roles are designed to deliver “training
support on the features, benefits, and use of medical devices. Typically in a hospital setting,
nurses educate other medical professionals on medical devices that are new to the market or
have been updated or modified. Device training is an integral part of overall patient safety and
is designed to increase the skills and competence of the staff in a specific area.”10
SALARIES FOR THE FIVE NONTRADITIONAL NURSING AREAS:
Occupational Health Nurses $63,472
Case Management Nurses $69,00012
HEDIS Nurses $67,000
Quality Assurance/Process Improvement Nurses $61,23613
In-service Education Nurses $83,000
earn on average
Almost one-quarter of
all registered nurses are
55 years of age or older.
YEARLY SALARY GUIDE
FOR TODAY’S NURSE
NACE Salary Survey
Nursing graduates have an
average starting salary of
nurses with advanced
education can earn
of job growth over
the next decade will
be in these cities:
LOS ANGELES, CA
PHOENIX, AZ DALLAS, TX
NEW YORK/NEW JERSEY
WHERE THE JOBS ARE:
TOP METROPOLITAN AREAS FOR NURSING
Of them all, Houston, Texas, is
expecting the strongest growth,
projecting an increase of 32%
between now until 2023.
How fast is the number of nursing jobs growing?
Over the next ten years, there will be more than
432,000 registered nursing jobs available in the U.S.
There will be excellent job opportunities in nursing in the coming years, according
to the BLS, due in part to an aging population and an increase in long-term care
facilities for patients.
Hospitals and national security will dominate in the hiring of nurses; the statistics
show just how significant the number of nurses being hired by organizations in the
administrative, insurance, and home healthcare industries will be, as demonstrated on
the following page.
GROWTH AND DEMAND ON THE INCREASE /13
“With the rollout of the Affordable
Care Act many more Americans
are insured and have access to
healthcare. This has driven up the
need for healthcare professionals,
especially in nontraditional
nursing roles. The health insurance
industry is one more example,
as more Americans are insured
there are more opportunities for
case management, utilization
review, and HEDIS nurses. What an
exciting time to be a nurse in the
healthcare profession, as we watch
opportunities for career growth
and patient care, as well as access
Pam Burnette MBA, BSN, RN
Director of Kelly Services Healthcare Product
Kelly Services, Inc.
General Medical and Surgical Hospitals 62,290
National Security 35,098
Offices of Physicians (except Mental Health Specialists) 33,723
Temporary Help Services 21,284
Home Healthcare Services 16,112
Nursing Care Facilities 14,846
All Other Miscellaneous Ambulatory Healthcare Services 13,636
Employment Placement Agencies 12,945
Direct Health and Medical Insurance Carriers 5,974
Office Administrative Services 5,560
Despite peaks and valleys in demand, the
overall trend line for nursing skill sets has
been on a steady incline for some time.
“Staffing agencies will need to demand
strong, skilled nursing professionals
moving forward. The demand for these
highly skilled nurses will increase 26%
by 2020. Most of these increases will be in
healthcare offices and community clinics
with the implementation of the ACA.”14
Spetz, J. How Will Health Reform Affect Demand for RNs? Nursing Economics. 2014; 32 (1): 42-43.
“In every healthcare environment,
there is a growing need for care
coordination. The role of care
coordinator may take many forms.
It may involve providing coordination
directly in complex or rapidly
changing situations, supervising
other team members when care
is relatively predictable (tiered
coordination), or advising entire
communities (populations) on the
best choices for the highest levels
/16BIG DATA WILL SHAPE NURSING TOO
California Institute for Nursing and Health Care. (2013, September). Nurse Role Exploration Project: The Affordable Care Act and New Nursing Roles.
Available online at: http://cinhc.wpengine.netdna-cdn.com/wp-content/uploads/2013/09/CINHC WhitePaperNurseRoles-100420131.pdf
Over the decades ahead, it is likely that registered
nurses will be increasingly involved in large-scale
population health management programs.
The growth of big data opportunities will impact the nursing profession too. It is likely
that a stronger connection between data and analysis will drive longer-term, large-
scale health improvements.
In many areas, there are shortages of qualified nursing professionals. There are
growing opportunities for nurses to work remotely, particularly as Internet connectivity
becomes more widespread and e-health initiatives benefit from improved validation
and testing capabilities. In fact, nursing is no longer a job that is tied to a hospital
or clinical setting—it is benefiting from trends in flexible working and
telecommuting, as are many other professions.
“There is a need for a shift toward RNs playing critical roles in the development
of software and its application. The roles envisioned included informatics design,
application, and interpretation across settings. Many opportunities will be in
community settings, as RNs use technology to provide one of the most critical
components of care: touch. Although it would be a ‘virtual touch,’ when
combined with an occasional physical presence, it could be very powerful in
supporting successful independent living.”
Clearly, changes in nursing education are critical to realizing the new roles aligned
to the skill set, and in developing registered nurses that are prepared to deliver
care outside the acute care setting.
/17BIG DATA WILL SHAPE NURSING TOO
Employers today are looking for healthcare professionals that can demonstrate skills and
expertise beyond patient care.
They must express themselves clearly and professionally, display strong teamwork and
project management abilities, and work collaboratively to solve complex problems that
may not always have technical causes.
When applying for roles, registered nurses need to focus not only on technical skill but
soft skills as well—this is often the differentiating factor between job candidates.
We surveyed our healthcare
recruiters and the top five
soft skills they look for in
nursing job candidates are:
ARE LOOKING FOR
As nurses become more pivotal to preventative care initiatives,
they are in higher demand and will command higher salaries, too.
With just a few years of experience under their belt, registered nurses can begin to
practice within specialty areas of nursing where they can find a niche outside of a
A nursing qualification no longer limits candidates to one specific role in one specific
setting. And there are more jobs available than there are qualified candidates to fill
the growing demand for nontraditional nursing roles.
With the right mix of technical skills and soft skills, nurses have a diverse and
rewarding career ahead of them.
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