Vertical and horizontal progression in nursing

Many people aspire to grow in their profession, and nurses are no exception. Depending on the kind of career growth you wish to see, however, you should be selective with your jobs. Many people think of professional progression as a straight line from the “bottom” (entry-level employee) to the “top” (CEO or other executive). The reality is that there are two main types of progression to consider. Horizontal growth and vertical growth are both kinds of professional growth, but they address different things.

Vertical growth is very different from horizontal growth and is likely the success progression that comes to mind when you think about advancing in a career. It encourages people to use existing skills to climb up the corporate ladder. The goal is to become so good at the same set of skills that you can prove yourself a worthwhile asset. In that sense, progressing vertically is akin to mastering people. Horizontal progression, on the other hand, is more focused on expanding knowledge and mastering ourselves.

But what exactly is the difference between horizontal and vertical growth? Don’t worry if you’re still not sure of the difference between the two — we will go into more depth below. Let’s take a closer look at each type of growth and why one might be preferred over the other.

What is horizontal growth?

Horizontal growth is focused less on climbing up the promotion ladder and more on developing your skills and talents to improve your value. Instead of refining the same set of skills and using them to convince people you deserve a promotion (although you might!), horizontal growth expands your knowledge. The goal is to learn as much as possible and acquire as many skills as possible.

Consider horizontal growth like a lattice and vertical growth like a ladder. Instead of having a very defined goal and a narrow skillset to get there, horizontal growers expand outward rather than upward. This doesn’t mean that horizontal growers don’t land promotions or climb upward in the company, of course. The difference between advancing upward and advancing outward lies in the approach and, often, the speed of that ascension.

What are the benefits of horizontal growth?

Horizontal growth presents an almost limitless possibility to grow as a professional. This is in stark contrast to vertical growth, which tends to have a hard ceiling beyond which you cannot progress. When you expand outwards, you grow your knowledge and abilities into something all-encompassing. These are the experts in their industry who understand its ins and outs.

Here is a more concrete example. Think about that one person in your office who seems to have an answer for everything and can help other coworkers no matter their concerns or needs. That employee has been expanding horizontally. They understand how most things in the workplace operate and can fill in for anyone at a moment’s notice. This kind of employee is priceless and their absence in the office is typically felt keenly and immediately.

One of the main benefits of horizontal growth is the sheer amount of knowledge it grants. When you expand horizontally, you stop focusing strictly on your own goals and instead focus on learning enough to be valuable to the people around you. It’s a “focus on the whole” rather than a “focus on the individual” mindset and might soon become the “new normal” in corporate culture.

The increased focus on expanding outward rather than upward makes sense if you consider the mobility of today’s workforce. A few decades ago, it was difficult to pack up and find a new job if the old one didn’t work out. Depending on the field, it often necessitated a move and was a major life decision to make. That is no longer the case. It is possible to transition to a new job with a new company with ease for much of the workforce. This increased ability for employees to get new jobs and leave old ones relatively quickly is putting businesses through quite a bit of financial hardship. It costs money to train people, and if those people leave after going through the time and effort of training, the company’s in for a net loss.

Expanding across the company and becoming integral to the workforce is becoming the most preferred growth option by businesses around the world. Instead of promoting employees upward and risking them leaving for greener pastures, gradually increasing employees’ knowledge and ability in many different areas of the company is a far more lucrative approach. It is a net positive for employees, too, as they can become true experts in their field with a wide array of information at their fingertips.

Consider today’s employees and how well-rounded they have to be to find success. It is not always enough to have experience in a certain aspect of your field. Today’s employers often look for employees with experience in different areas. Candidates that have a solid grasp of technology and social media in addition to their job-specific skills, for example, are often more appealing than those without.

What is vertical growth?

Vertical growth will be far more familiar to most readers than horizontal growth, so we will spend comparatively less time exploring it. To put it simply, vertical growth is growth that sees employees expanding upward rather than outward. Instead of expanding their knowledge and skills, workers determined to climb the corporate ladder will typically become hyper-focused on their performance in a specific area of the field.

Consider a company executive who spent years working their way up the ladder. Perhaps they began working as a data analyst, for example, and over the years propelled upward through multiple companies. They can eventually become a leader in a company focused on data analysis — and their growth potential officially came to an end. If they could no longer work specifically in data analysis and instead had to expand into related fields, employees specializing in upward growth would have a difficult time adapting. If their limited skills are no longer relevant, they will need to begin all over learning new skills and abilities.

With all of this said, vertical growth isn’t inherently a bad thing. There is nothing wrong with wanting to excel in your job and take it as far to the top as you possibly can. It’s just a more limiting trajectory than horizontal growth.

What are the benefits of vertical growth?

The benefits of vertical growth include career ascension and mastery over a specific set of skills. If your goal is only to ascend to the top of your company without rocking the boat or taking on new responsibilities beyond management, vertical growth might be the perfect fit. If you are more interested in expanding your skills and becoming a knowledgeable and valuable employee, on the other hand, horizontal growth might be a better choice.

What does vertical and horizontal progression in healthcare look like? 

As with other fields and sectors, healthcare allows employees to progress either vertically or horizontally. We’ll take a closer look at nursing particularly in this section and how progression in the profession looks.

Expanding vertically 

As we’ve explored above, vertical progression sees employees making upward, rather than outward, moves. Consider the move from CNA (certified nursing assistant) to RN (registered nurse) as one example of this growth. CNAs have limited responsibilities. This is typically a position that students interested in nursing accept to see nurses in action and “try out” the profession. They must complete a short program ranging from four to 12 weeks and pass a CNA certification exam before they begin working.

The next step in the hierarchy is the licensed practical nurse (LPN) position. LPNs complete one-year programs and pass an NCLEX-PN licensing exam before they begin working. These employees are technically nurses but have less knowledge and responsibilities than RNs. They tend to work in low-risk jobs such as performing vitals in smaller clinics or working as a classroom nurse to treat small issues like bumps and bruises.

The next step is working as an RN. Registered nurses must complete either an associate or bachelor’s degree in nursing before they can begin work. The former is most common, but the latter is becoming increasingly desirable in the field. These are the nurses you probably picture when you think about nursing. RNs are responsible for caring for patients directly, including administering treatment plans prescribed by doctors and, in some cases, making minor medication decisions on their own. RNs are most often employed at hospitals, although there are other options available.

In the CNA to RN journey, the same skills and knowledge are needed at every level. The difference lies in the breadth of those skills and knowledge. LPNs spend more time refining their skills than CNAs, for example, and RNs spend the most time out of all of them mastering the skills they need to thrive in the industry. There is little branching out in this pathway, however, and for the most part, all three employees are working in the same area and utilizing the same skills.

Expanding horizontally 

Nurses can also expand horizontally. Instead of using the same skills and foundational knowledge to progress in a straight line like that CNA to RN pipeline described above, expanding horizontally in nursing involves learning new skills and acquiring more specialized knowledge.

Consider an RN who works primarily with patients directly before and directly after surgery. There is a very specific set of skills and knowledge that this kind of nurse needs to have. Over time, however, the nurse considers expanding into NICU nursing. They gradually learn the skills and knowledge they need to succeed in a new specialization, eventually transferring to the department.

RNs who specialize in multiple areas are incredibly important to an efficient hospital environment. They can shift from job to job as necessary, even if they have a preference, to fill in for other nurses as needed and ensure that all patients are cared for. Over time, this same nurse might even become interested in another specialty. Maybe their time working in the NICU moves them to help adults going through hard times in their lives, and the RN decides to learn more about mental health nursing.

This is how nurses expand horizontally in the field. They don’t focus only on one set of skills but rather maintain multiple different sets of skills that allow them to thrive in diverse work environments. RNs with multiple specialties like this experience vertical progression, too, as they transition to lead nursing roles and perhaps even nursing management modes, where they can put their widespread skill sets to use.

How can advanced nursing programs help nurses transition into higher roles? 

A lot of attention has been placed on nursing education recently. From an increase in the demand for bachelor’s degrees in the field to increasing focus on diversity and inclusion in the workplace, for both fellow nurses and patients, the need for excellent instruction is critical in today’s society. The good news is that the right education can make it easier for nurses to transition into higher positions and make the most out of their skills. Let’s take a closer look at how they can go about this.

Fostering both general and specialized knowledge and expertise 

The first element to consider is how advanced nursing programs provide their students with both general skills and more specialized knowledge. This already empowers them to take on multiple roles right off the bat, but it also helps them become accustomed to learning very different and complex skills. The knowledge needed for mental health nursing is often very different from the knowledge needed for more general nursing, for example, which means that students learning both the general information and the more specialized knowledge are accustomed to balancing a wide variety of skill sets. This, in turn, sets them up for success in transitioning to jobs with even more specialized skills required.

Expanded scope of practice 

Related to the above, advanced nursing programs prepare nurses to take on more roles and responsibilities than general nursing education alone. Nurse practitioners, for example, are trained to provide primary care, diagnose and treat health conditions, and sometimes even prescribe medication. This is far beyond the responsibilities that general nursing requires. Advanced programs are committed to reinforcing educational foundations while building the framework for further expertise exploration. All of this prepares students to take on expanded roles and transition to higher roles in the workforce.

Providing progressive instruction 

When you’re researching how to become a family nurse practitioner, you’re probably making choices based on the length of time you’ll be studying, the reputation of the university, the types of modules you’ll learn, and from whom you’ll learn (experts in the field, lecturers, medics, etc.). Programs from schools like Texas Woman’s University, for example, are very clear in their intent to prepare students for progression in their careers. Take advantage of this increase in career mobility instruction and pick an educational institution with progressive courses.

Students should always be interested in researching the best way to excel in their career, their knowledge base, and their overall personal happiness — which is why so many people choose to further their education. The best way to prepare yourself for future success is by picking an excellent school with progressive programs. Today’s nursing programs from institutions such as Texas Woman’s University are increasingly focused on a well-rounded education that puts graduates on the fast track to career success.

Are you interested in learning more about how you can set yourself up for success in your nursing career? Use the information we outlined above and do some research into the best universities and programs for your area of interest. Remember to pay attention to both general and specialized information if your goal is to advance into new positions in the future.