Ruffell began her stand-up comedy career in November 2008[5] and has been performing stand-up full time since 2012.

Before she began touring as a solo performer, Ruffell had supported Alan Carr, Kevin Bridges, Josh Widdicombe, Joe Lycett, Romesh Ranganathan, and Katherine Ryan on national tours.

Ruffell's stand-up comedy tours include: Social Chameleon (toured in 2014–2015), Common (2016–2017), Keeping It Classy (2018, her first headlining tour), Nocturnal (2019), and Dance Like Everyone's Watching (2019–2020). After a year and a half hiatus due to the COVID-19 pandemic, Ruffell resumed the Dance Like Everyone's Watching tour in autumn 2021.

Keeping it Classy was recorded for Live from the BBC and aired on 11 July 2018.

In 2017, Ruffell and her friend Tom Allen performed across the UK on a double-bill tour titled Hit the Road!

In 2018, Ruffell toured Australia as a performer with the Melbourne International Comedy Festival Roadshow.

Also in 2018, she had a leading role in the short film Foreign, directed by Mark Pinkosh.