The Shift in Nursing Employment from Acute to Ambulatory Settings: Implications for Education, Regulation, and Practice

Product type: poster presentation, 2020 AcademyHealth Annual Research Meeting.

Authors: Erin Fraher, PhD, MPP, Esita Patel, PhD, RN


  • We assessed the growth of RNs and LPNs in ambulatory care, the proportion of nurses moving from acute to ambulatory care settings, and the characteristics associated with working in ambulatory care vs. other settings and with moving from acute to ambulatory care settings among North
    Carolina (NC) nurses between 2015-2017.
  • We used NC licensure data to conduct an analysis of actively practicing RNs and LPNs between 2015-2017.
  • Results:
    • Between 2015-2017, RN employment in hospitals declined by 0.2% (LPN by 14%) and grew by 15% (LPN by 39%) in ambulatory care.
    • 24.3% of RNs and 6.9% of LPNs who worked in ambulatory care in 2017 worked in hospitals in 2015.
    • ¬†Ambulatory care RNs vs. other settings were more likely to be female, practice in a metro area, less likely to be a new-grad, be non-white, or have a doctorate or Masters. Ambulatory care LPNs vs. other settings were more likely to work in a metro area and less likely to be non-white. LPNs and RNs had increasing odds of working in ambulatory care in each year (Table 2).
    • Nurses who switched from 2015 hospital to 2017 ambulatory care were
  • Conclusion: there is a decline in RNs & LPNs in hospital and a growth in ambulatory care settings. Among RNs actively practicing between 2015-2017, 1/4th of 2017 ambulatory care RNs were employed in hospitals in 2015.

Check out the full presentation here.