The outpatient shift refers to the movement of medical procedures and services from inpatient hospital settings to ambulatory care facilities. Driven by technology advances, changing reimbursement models and patient preference, this trend is reshaping healthcare delivery and expanding career opportunities for nurses in community-based settings.
Over the past decade, procedures and services that have historically been performed on an inpatient basis have shifted to outpatient facilities, especially as technology advances and minimally invasive surgical procedures gain traction. For nurses interested in navigating these changes, the online Registered Nurse to Bachelor of Science in Nursing (RN to BSN) program from the University of North Carolina Wilmington (UNCW) provides the broad clinical foundation needed for today’s shifting healthcare environment. While there are certainly benefits to this new dynamic, there are challenges as well.
According to the Centers for Disease Control and Prevention, 85.2% of adults and 95.1% of children had a visit with a doctor or other health professional in 2024, including roughly one billion physician office visits, reflecting the continued scale of healthcare demand driving outpatient growth. The American Hospital Association (AHA) projects outpatient volumes will rise 17% over the next decade, reaching an estimated 5.82 billion visits annually.
What Has Prompted the Move to Outpatient Care?
Technology advances, shifting reimbursement models and growing patient demand each play a role in moving care out of the hospital. The rapid expansion of technology now allows many services to be performed in outpatient clinical settings, whereas traditionally, these were largely relegated to hospitals and inpatient care. Cardiac catheterizations and spinal, bariatric and cataract surgeries are just a few examples.
Telehealth, EMRs and mobile health applications have also simplified patient monitoring, particularly postoperatively and for chronic conditions, without the need for admissions. These advances also improve access to care in rural areas where physical medical practices are becoming rare.
As patients have experienced the convenience and accessibility of outpatient care, demand has grown steadily. According to AHA, the forecasted increase in outpatient volumes is a result of the aging population and the rising prevalence of chronic conditions, with patients aged 80 and older expected to see outpatient volume growth of roughly 65%.
In addition, health insurance reimbursement models changed, and insurers began to offer more favorable payment policies for outpatient services. This revenue pressure accelerated a broader trend of vertical integration, in which hospital systems acquire physician practices and outpatient facilities to expand their market share and capture a greater share of patient revenue as care shifts to outpatient settings. Inpatient services had previously been the main source of hospital revenue, though outpatient services have grown to generate comparable revenues in recent years.
What Challenges Has the Outpatient Shift Created?
The outpatient shift has placed real financial pressure on hospitals and accelerated consolidation across the healthcare industry. While the trend does offer benefits like streamlined coordination of care, it has also created challenges for healthcare workers and patients alike, such as:
- Market consolidation: The healthcare sector has significantly consolidated in recent years. More sizable competitors have purchased smaller hospitals. The remaining hospitals have acquired existing outpatient facilities, including urgent care, imaging locations and independent physician practices, or opened new ones. A 2025 report from the S. Government Accountability Office found that at least 47% of physicians were affiliated with hospital systems in 2024, up from less than 30% in 2012, reflecting the accelerating pace of consolidation across the healthcare industry. Research shows this consolidation has had mixed results in terms of health outcomes while consistently driving prices upwards.
- Lower inpatient days and higher costs: As outpatient care has become more popular, inpatient days and procedures have fallen. Lowered hospital revenues, coupled with higher overhead and labor expenses, have led to staff layoffs in some facilities and increased patient costs.
How Is the Healthcare Industry Addressing These Challenges?
The healthcare industry is responding through payment reform, workforce development and improved care coordination across facility types. As the preference for outpatient care continues to grow, providers and policymakers are pursuing several strategies to manage the financial and operational pressures it creates, including:
- Introducing site-neutral payments: Payer reimbursement models are typically based on the setting in which the service is performed. Site-neutral payments would reimburse the same regardless of setting. This lowers patient costs and allows patients the freedom to choose the setting that works best for them.
- Encouraging workforce flexibility: As demand shifts, hospitals are likely to hire fewer inpatient staff while expanding outpatient teams. It is important that nurses and other healthcare workers maintain some flexibility in their skillsets and perhaps seek specialization or further education in order to ease the transition to other care settings. Nurses enrolled in UNCW’s Online RN to BSN Program develop skills in population health, care coordination, transcultural healthcare and community-based practice that are directly relevant to the growing outpatient sector.
- Further streamlining care Hospitals that own a variety of facilities can manage patient care across the spectrum, from inpatient surgery to outpatient endoscopies to urgent care visits. Ideally, this can help optimize operations and efficiency, lowering total patient costs and improving outcomes.
Ambulatory Care Opportunities for RN-to-BSN Nurses
As outpatient volumes grow, so does the demand for nurses trained to work across a variety of non-hospital settings. The U.S. Bureau of Labor Statistics (BLS) projects registered nurse employment to grow 5% from 2024 to 2034, and advances in technology that move procedures to the outpatient setting are expected to contribute to that growth. The American Nurses Credentialing Center also offers an Ambulatory Care Nursing Certification (AMB-BC) for RNs who specialize in outpatient practice. Below are six common ambulatory care settings where RN-to-BSN graduates are finding career opportunities today.
- Physician and specialty clinics: Primary care and specialty physician offices are among the most common settings for ambulatory care nurses. These roles typically involve patient education, triage, medication management and care coordination for patients managing chronic conditions.
- Ambulatory surgery centers: Outpatient surgical centers handle procedures such as orthopedic surgeries, cataract removals and colonoscopies. Nurses in these settings support preoperative preparation, intraoperative assistance and postoperative recovery without the extended patient stays of inpatient surgery.
- Urgent care centers: Urgent care clinics serve patients with acute but non-life-threatening conditions. Nurses here often work at a faster pace, performing assessments, wound care and patient education across a high volume of daily visits.
- Community health clinics: Federally qualified health centers and community clinics provide primary care to underserved populations. BSN-prepared nurses are well suited for these settings, where population health skills and community outreach are central to the work.
- Dialysis centers: Outpatient dialysis facilities provide ongoing renal care for patients with chronic kidney disease. These roles require strong technical skills and the ability to build long-term patient relationships in a consistent outpatient environment.
- Home health organizations: Home health nursing is a growing ambulatory sector, particularly as aging populations require post-acute and chronic care management outside the hospital. According to AHA, home health volumes are projected to grow 22% over the next decade.
These six settings represent just a portion of the growing ambulatory care landscape, and nurses who invest in their education now will be better positioned to pursue the opportunities ahead. UNCW’s online RN to BSN program equips working nurses with the population health and care coordination skills that ambulatory employers increasingly expect.
A Critical Shift
The move toward outpatient services and away from inpatient care has altered the entire healthcare industry. As hospitals become bigger players in the outpatient market and patient preferences for ambulatory care continue to grow, restructuring reimbursement models and expanding the workforce into new settings will become increasingly important.
Throughout the healthcare field, nurses who expand their clinical scope and seek further education are better positioned to adapt. The outpatient shift is not simply a disruption to be managed but an opportunity to serve patients in meaningful ways across a broader range of community-based settings.
Explore how UNCW’s online RN to BSN program can help you build the skills needed for a career that reaches well beyond the hospital and into the clinics, communities and outpatient facilities where healthcare is increasingly happening.
Frequently Asked Questions About the Outpatient Shift
Understanding how the outpatient shift is reshaping healthcare can help nurses anticipate what lies ahead. Below are answers to questions that go beyond the basics, covering how this trend is evolving, what it demands of nurses and how education plays a role.
How did the COVID-19 pandemic affect the outpatient shift?
The pandemic dramatically accelerated the movement toward outpatient and remote care. As patients avoided hospitals, healthcare systems rapidly expanded telehealth and ambulatory services. Many procedures and follow-up visits that had been conducted in hospitals shifted to outpatient facilities, compressing years of gradual transition into a much shorter window and normalizing outpatient care for a broader range of patients and providers.
What is the difference between ambulatory care and outpatient care?
The terms are often used interchangeably, but ambulatory care is the broader category, covering any care delivered without requiring an overnight stay, including preventive visits, chronic disease management and routine office appointments. Outpatient care typically refers to procedures or diagnostic services performed at a clinical facility without admission, making it one component within the larger ambulatory care landscape.
How does the outpatient shift affect nurses?
The outpatient shift is changing where nurses work and what they are expected to do. As inpatient volumes decline and outpatient demand grows, nurses who can function effectively across care settings, from hospital floors to community clinics, are in greater demand. Those who seek additional education and develop skills in care coordination and patient self-management are better positioned for this changing landscape.
What is ambulatory care nursing?
Ambulatory care nursing is a specialty that involves caring for patients who receive medical services without an overnight hospital stay. Ambulatory care nurses work across a wide range of settings and take on responsibilities that often require more independent clinical judgment than hospital-based roles, since patients are not under continuous monitoring between visits and must be prepared to manage their own care at home.
How is telehealth changing outpatient care delivery?
Telehealth has expanded what can be accomplished outside the hospital, allowing nurses and providers to conduct follow-up visits, monitor chronic conditions and support patients remotely. According to AHA, nearly one in four evaluation and management visits are projected to be delivered virtually by 2034, reflecting how significantly technology is reshaping the outpatient care model.
Do outpatient nurses need different skills than inpatient nurses?
Outpatient nursing places greater emphasis on patient education, care coordination and supporting self-management, since patients are not under continuous observation between visits. Inpatient nurses often focus on acute and rapidly changing conditions in a monitored environment. Both settings require clinical expertise, but outpatient roles demand stronger communication skills and the ability to help patients understand and manage their health independently.
About the University of North Carolina Wilmington
The University of North Carolina Wilmington is a nationally recognized public university offering undergraduate, graduate and doctoral programs across business, education, science and the health professions. UNCW is accredited by the Southern Association of Colleges and Schools Commission on Colleges.
The UNCW Department of Nursing is accredited by the Commission on Collegiate Nursing Education (CCNE) and prepares students to deliver evidence-based, patient-centered care across diverse clinical and community settings. UNCW’s online nursing programs are designed to serve working healthcare professionals seeking to advance their education while continuing in their current roles.
