Do I have to get my first nursing job in a hospital?

I've been a nurse for over 20 years. You know how many days I've worked in a hospital? Exactly zero. Never had any interest in the hospital setting.  There's plenty of nursing opportunities outside the hospital setting. If you are interested in community health start looking for positions in that field. I suppose it depends on the job market where you live but around here community health nursing positions are fairly easy to find.

I think you can start working anywhere in nursing you don't necessarily need hospital work experience. I know a few nurse who started their nursing career working outside hospital settings and they have been okay.

I took my first job in a clinic and have stayed in the outpatient setting ever since. One thing to mull over... when Covid happened, I was unable to take advantage of the lucrative travel contracts available to those with inpatient experience. I became a RN later in life, so my financial goals were different than those I had in my younger years (I was already a homeowner, car owner, etc). If you think you may want the opportunity to travel, I would first get inpatient experience or even LTC. Had I been younger as a RN, I think I would have enjoyed the Emergency Department setting.

No, you do not need to work in a hospital. I have never worked in acute care except for a few months, and during that time I was super unhappy. My specialty has been community/ public health.

Things to consider

After about 1-2 years, the door to getting a new grad acute care job may not close,  but it becomes less open. If you ever choose to work in acute care in the future, you will both struggle with finding work and adjusting to the new setting and fitting in. I managed to get an acute care job years after nursing school and when I went to work, I struggled a lot and ended up finding a new job and leaving within months. I think things would have gone better had I worked acute care fresh out of school.

So if you have any doubt and believe you may want to work acute care in the future, then do it and work it for a year  

Next, some nurses will doubt your skills and abilities without acute care experience. Some nurses will look down on you or think you aren't a real nurse or a good nurse.   I have an ex nurse friend who openly expressed contempt for me for not working in acute care  

Lastly, acute care tends to be more lucrative than community health. Acute care experience opens more doors and opportunities  

I am happy with my job and life and career, and I don't have acute care experience. But the tradeoffs are listed above 

No, but depending on your ultimate goal in nursing it may be necessary.

Depends on the area of nursing you wanna pursue. For example, if you want to be a ER nurse, but you spend your 1st 2 years in nursing working for an LTAC or SNF, you might find the transition difficult. Let me explain why! A new grad will spend time in a new grad residency. Their floor orientation with a preceptor is longer (8 weeks, 12 weeks, I've seen 6 months). In this time, they learn (with a coach) how to use the equipment (IV pumps, Pyxis, phones, bladder scanner, EKG machine, etc), EPIC narrators (ED, code, stroke, sedation, trauma), LOTS of flowsheets, not to mention how to be an ED nurse running (fast-track, pods, triage, etc), how to run insulin drips & heparin drips, labs to order & when, using ED pre-order sets. A manager looking to hire an "experienced" nurse will typically give you a 3-day orientation. If you are NOT already familiar with the above, you will be 2 years behind in your knowledge/experience. Managers can't justify paying you as an experienced ED nurse w/ new grad knowledge. They will just pass on you. Of course, you will bring knowledge from an LTAC like assessments, med pass etc. BUT my point is that you will need a lot more coaching before you can be on your own. That's just an example. Now keep in mind that there is always an exception, and you can definitely do it! Just stating an example of how NOT starting in acute care could hurt you "IF" that's what you wanted to do. I know a nurse now who started in plasma, transitioned to working remotely for insurance companies and now wants to do pediatric ICU. She was been a nurse for 7 years and no system in our area will hire her. 

~Shrek~ said:

No, you do not need to work in a hospital. I have never worked in acute care except for a few months, and during that time I was super unhappy. My specialty has been community/ public health.

Things to consider

After about 1-2 years, the door to getting a new grad acute care job may not close,  but it becomes less open. If you ever choose to work in acute care in the future, you will both struggle with finding work and adjusting to the new setting and fitting in. I managed to get an acute care job years after nursing school and when I went to work, I struggled a lot and ended up finding a new job and leaving within months. I think things would have gone better had I worked acute care fresh out of school.

So if you have any doubt and believe you may want to work acute care in the future, then do it and work it for a year  

next, some nurses will doubt your skills and abilities without acute care experience. Some nurses will look down on you or think you aren't a real nurse or a good nurse.   I have an ex nurse friend who openly expressed contempt for me for not working in acute care  

lastly, acute care tends to be more lucrative than community health. Acute care experience opens more doors and opportunities  

I am happy with my job and life and career, and I don't have acute care experience. But the tradeoffs are listed above

IMHO, acute care nursing is a great experience to take to public health.  The majority of you patients are coming home from a hospital.  Just like my public health semester made me understand what happens when patients get home from the hospital (do not place those swollen post-partum boobs on the stove  to keep them warm, regardless of what your father says!) and what happens to people in a wheelchair who have to live in a building with no elevator.  It's true that you don't absolutely need to work in med-surg first but you will learn much more about pathology and disease in the acute care setting that you can carry with you to public health.  No one can take that experience away from you.