The traditional nursing career ladder—advancing linearly within one specialty or facility—no longer fits the realities of modern healthcare. Today, nursing career advancement requires a flexible, adaptive approach that values experience across a variety of settings.

A new model is emerging: a competency-based structure where professional development and nursing skill development are achieved not just by climbing vertically, but by expanding horizontally. Alternative nursing career pathways value adaptability, deep nurse competencies, and broad cross-setting nursing experience.

Are you considering how to advance your nursing career? The answer lies in actively building nursing skills across facility types.

Why experience across settings matters more than ever

Healthcare is advancing toward an integrated care model where patients transition rapidly between acute care, subacute rehabilitation, and home settings. Consequently, the industry is shifting toward adaptable, multi-setting nurses who understand the full continuum of patient care.

Building nursing skills across facility types does more than just fill a resume; it fundamentally changes how a nurse approaches patient care. The type of facility you work in dictates the specific clinical muscles you exercise daily. 

When you step out of your primary specialty, you gain exposure, for example:

• Skilled nursing facilities (SNFs): Working here sharpens time management and prioritization skills. Nurses in SNFs often manage high patient ratios and must become experts in chronic disease management and wound care.
• Hospitals: Acute care settings provide exposure to higher acuity patients, rapid status changes, and specialized interdisciplinary teams.
• Long-term acute care hospitals (LTACHs): These facilities are excellent settings for mastering ventilator management, tracheostomy care, and complex patient management for those with multi-system failure.
• Home health: This setting cultivates distinct autonomy, relying heavily on independent assessment skills and environmental adaptability.
• Behavioral health: Experience in this area enhances de-escalation techniques and therapeutic communication, which are applicable in every healthcare setting.

This cross-setting nursing experience is becoming an increasingly key differentiator. When hiring managers look at a candidate who has successfully navigated working in both an emergency department and a long-term care facility, they see a professional who is versatile and unlikely to panic when faced with the unexpected.

Benefits of flexible nursing

Embracing flexible work models, such as per diem nursing, offers tangible benefits that directly contribute to nurse career progression and the growth of nurse competencies. 

Flexible roles enable nurses to tailor their own learning experiences, far more quickly than traditional full-time positions allow, which is a powerful tool for rapidly addressing knowledge gaps and boosting confidence.

• Exposure to different clinical workflows and technology: Learning diverse electronic medical records (EMRs) systems and charting practices
• Building confidence by adapting to new environments: Quickly mastering new facility policies and procedures
• Expanding your professional network across facilities: Creating connections that can open doors to future full-time, specialized, or leadership roles
• Filling knowledge gaps faster than in a single full-time role: Actively seeking shifts in areas where you lack experience

How to build your skills across settings

Building robust cross-setting nursing experience requires intentional strategy, not just luck. Nurses must actively choose environments that provide the necessary challenges and learning opportunities.

Join a float pool to try out other units

If you prefer to stay within one hospital system, joining an internal float pool is another method. While this limits you to one organization’s protocols, it still offers variety in patient acuity and team dynamics. It serves as a good intermediate step for those looking to expand their comfort zone.

Test out per diem nursing

Per diem nursing, where nurses pick up shifts as needed, is the most direct and flexible way to achieve broad exposure to various settings. 

For many, combining per diem with full-time work strategically provides a safety net while allowing for exploration. To leverage this for career recognition, you must meticulously document your per diem experience for career ladder recognition, noting the facility type, patient ratios, and specific skills utilized or learned.

Furthermore, per diem roles are excellent for using short-term assignments to explore settings before committing to a full-time transition. Platforms like Nursa make it simple to browse available per diem shifts across various facility types in your area, giving you full control over where and when you gain experience.

Steps to take to create your career ladder

Moving away from the traditional nursing career ladder means actively designing your own path. This requires foresight and deliberate planning to ensure every shift contributes to your long-term goals.

1. Select facility types that align with your goals

If your ultimate goal is to become a critical care nurse, focus your flexible hours on higher-acuity settings like emergency rooms or step-down units. If you are aiming for a management role, consider seeking out shifts in smaller, long-term care facilities to practice leadership skills under charge nurse responsibilities.

2. Choose per diem shifts that build desired competencies

Don’t just pick shifts based on convenience. Look at the specific patient population and required skills listed for the shift. If you want to improve your intravenous (IV) insertion skills, choose a unit known for high IV starts.

To enhance your understanding of complex disease processes, consider choosing an LTACH shift. This focused selection accelerates the development of critical nurse competencies.

3. Tell your “cross-setting experience story” in resumes and interviews

When applying for promotion or a specialized role, don’t list your diverse experience as a collection of jobs. 

Instead, frame it as a coherent story about your adaptability and comprehensive clinical ladder in nursing. For instance, you can explain that your experience in home health refined your autonomous assessment skills, while your per diem work in the acute hospital setting ensured your procedural skills remained sharp, making you a more resilient and prepared candidate.

Take the reins of your nursing career

Don’t wait for a supervisor to hand you a promotion. Today, moving your nursing career forward is up to you. The best way to do this is by using flexible work to gain experience in different kinds of settings.

Manage your own career growth by identifying skill gaps and choosing experiences to close them. Whether through per diem shifts or floating, diversifying your experience keeps you competitive in a changing healthcare landscape.

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