[beepers40]

Hi all,

I just accepted a position with a teaching hospital run by a well-known university in my area. My current job is at a community hospital in a high-risk L&D unit where we do about 700 deliveries a month. My new boss at the university hospital says her nurses tend to do less independent management of patients than most of us who've worked at my current hospital are used to, and that that sometimes poses some problems--for example, we are used to doing SVEs, placing scalp leads, etc whereas at the university hospital the residents do these things since they need to learn them and so the university nurses are less skilled . I'm just wondering, for those who have worked in both kinds of environments, whether they found this to be a generally true state of affairs and what they did to keep up their competencies if so. I know nurses who have left and then come back because they feel like their skills were not being maintained at the other hospital. I really don't want this to happen to me, and I really want to stay with the university hospital for other reasons. Thanks!

[AmberL&D/RN]

I have worked in both types of environments. In a teaching hospital I have found that you have to call the residents for EVERYTHING!! I prefer a non-teaching hospital over a teaching hospital for this reason. Maybe it is just the residents at this particular hospital but it is like you can't win. These residents believe they know everything about everything and if it is not in the books then it doesn't work or isnt the right thing to do. If you give a ivf bolus for a decel without an order then you were wrong and trying to induce pulmonary edema. If you don't you should have.
They have to be backed up by the books for everything they do...For example measuring fundal height on a prom that started bleeding out. Stating that the "books say" that with an abruption the fundus will rise, despite that the blood is escaping, therefore, no rise in fundal height.
They don't have the experience to fall back on that a certain intervention works so the only resources they have to fall back on is the books. We all know... L&D is not always black and white.
In the time at this particular teaching hospital I do feel like some of my skills are going to the wayside. I am currently looking to get out of the teaching environment. But as I said before it may just be these particular residents, so if you really want this postion, give it a try and decide for yourself. If it is not for you, there are other jobs out there. You may actually like it better due to the fact that there is always a doc in house,. That in itself is always reassuring.
Good luck in your ventures!

[NICU_Nurse]

It's funny that you should post this, because I've noticed this very thing recently. I moved from a large, community-based teaching hospital that was just TEEMING with residents to a smaller, semi-private hospital with less university-affiliation (basically all of our hospitals here have SOME type of university affiliation).

I work NICU, but this is not applicable to one unit- I've found that what you're saying is correct on ALL units. I have discovered that I was actually (and this is my personal opinion, honestly) doing myself a disservice by working at my old facility for as long as I did. I've only been a nurse for 2 years, and I really missed out on a lot of learning opportunities by working with so many residents. This is precisely why (I had a hunch...) I moved to another facility; for me, being as "new" as I am, I wanted to get the most experience I possibly could and boy, let me tell you, I've been flung in there at this new hospital.

In fact, at my old teaching facility, we had this same situation with the RT's as well. They had trainee RT's and RT students in DROVES and managed respiratory care fairly independant of the nursing staff, which I personally didn't like.

Howver, there were benefits as well- the atmosphere is nice, conducive to learning (but you'll have to self-start; it's easy, it seems to me, to rely on the residents and others to do certain aspects of care and then you would, in fact, lose your skills), and having resi's on call was wonderful. They had a real presence on the unit, so you never felt like you were alone.

Pro's, con's. Hard to say. Hopefully you'll love it! Good luck!

[renerian]

I have never worked anywhere other than a teaching hospital. It can be frustrating but I liked to work with the residents. Yes I have had to **** a few off by not letting them touch my patients after lots of unsuccesful sticks for lines or spinals BUT I did like it.

renerian

[BETSRN]

I know that after working in three non-teaching facilities (where we nurses have a LOT of autonomy) I would have a very difficult time working with interns and residents if I was not allowed to paractice as I have been used to doing. I love learning but that would drive me nuts. What would bother me the most would be to see the OVERUSE of unnecessary technology (like scalp electrodes and IUPC's) just so a resident or intern can get more practice. The higher c/section rate would also bother me.

[AmberL&D/RN]

The other night the residents did a forcep delivery because "somebody" needed practice. YIIIIIIKES!!!

[renerian]

OMG that is horrible amber. I had a natural forceps birth for my first son, with no anethesia and it hurt like well........you know what........poor woman.

renerian

[Ruby Vee]

I've worked in both community and teaching hospitals, and I've found that there are plusses and minuses to each. In the teaching hospital there are lots of residents around, but you get the chance to help them learn to be physicians. You can be as independent as you in a community hospital, but you DO have to at least run things by the resident and perhaps explain to them why you did it this way. So they learn.

In the community hospitals, we had a lot more standing orders. But when you needed a doc (and this was before the advent of cell phones) it was damned hard to reach them at the golf course! One thing about the residents -- you can always find one.

Personally, I found I learned more in the teaching hospital. There are more "zebras" there than in the community hospitals (where if you hear hoofbeats, you assume it's a horse), and the need to teach residents makes you really learn the subject thoroughly yourself.

[SmilingBluEyes]

(((((((((((((((shuddering here)))))))))))))))

glad i have never practiced in a teaching hospital...had the opportunity not too long ago....decided NOPE.

lack of autonomy and deference to residents who practice *needless* (and perhaps dangerous) interventions would drive me NUTZ

no thanks, i will stay in the little community LDRP venue...

[RN~in~CT]

I've worked in both, and I must say that I prefer teaching hospitals.

The small community hospital I worked at had NO standing orders... and everything had to be run past the MD...and I mean everything. Plus attendings tend to have that "I am doctor, therefore I am God... bow down to me now" attitude. (at least the group that I prev worked with did)