"Big city" hospitals vs smaller community-based facilities?

  1. Has anyone noticed if there is a difference in working conditions between big city hospitals, teaching hospitals and smaller community-based hospitals? Rural areas? What about quality of care and availability of support from other staff (physios, RT's, etc)?

    Just wondering if there are visible trends or if it is really just as random as who your employer or your manager is.....

    Are nurses in smaller cities and towns more/less likely to have poor working conditions, or is there no connection?
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  2. 8 Comments

  3. by   CANRN
    I live in a rural area, and work for large medical group (HUGE..many hospitals in many states). I worked in one of the smaller hospitals and it was rated one of the top ten hospitals of it's size in the state of Ohio. Everything we had was state of the art, services offered were varied (mostly out-patient) and the staff was family like. The problem? LOW CENSUS!! I averaged one to two days a pay period called off for low census. Most of the patients from ER were transferred to one of our larger 'sister' hospitals or the major medical center. So, I transferred to one of them! I love workiing where I am and have never been called off for low census! Now I wish from time to time I would get called off! LOL I wouldn't change my decision and still feel like I'm part of a 'family' even though I work in a larger facility. Our nurse manager is awesome!
  4. by   allevi
    I work in a small rural hospital and i think that the advantage is that eventually you learn all areas med surge, ob, er, and there is also the home health, surgery, and other areas. You get to use all of your skills.

    As far as call time, if they limit it to no more than one shift per pay period, you are protected from too much cancel time.
  5. by   lmbv55
    I have worked at both large metro hospitals and now a small community hospital.

    The larger hospital gives a wider scope of pt. care and more unusual cases.

    In the small hospital I am in now it's nice that you know your co-workers kids, mama's, dogs etc. But the small time politics and back stabbing is disgusting. Especially of the mnedical staff. I hjave never seen a bigger bunch of spoiled rotten doc's in my life ;and unfortunatley , your stuck with them. There are one or 2 that I wouldn't let touch my dead cat, so if i need medical attention in an emergency I gotta go 30 min. up the road.

    Over all I'd say a big hospital is best, yes they have poiltics and spoiled doc's but at least you have a little buffer.
  6. by   Zee_RN
    All depends on what you're looking for. I work community hospital in the suburbs but it's a relatively big community hospital (350 beds). There are 1400 employees. We are just on the outskirts of the city (13 miles from downtown Pittsburgh) so we're kinda in-between things.

    The pace is less frantic from the big city hospital and we don't get any GSW or big trauma/accident/killer-stabbing kinda thing. Everyone still knows most everyone. From talking to my fellows at our sister "big city" hospitals, there is no more or no less politicking. Our doc's are definitely more catered too than the city doc's.

    If you want to move around and try new things, there are more opportunities at a big hospital; for example, they've got several ICU's; I have one. We're both teaching hospitals but they have more residents and in different specialties--we just have family practice residents.

    So, it's all in what you want. One is not better or worse than another.
  7. by   pebbles

    Thats what I was looking for. Not "better", but just different. I'm interested in what the differences are, and if it's an local thing, or if people all over the continent notice the same differences. Makes me wonder why the differences exist.

    Why are community docs more likely to be pandered to, I wonder?
  8. by   aus nurse
    I work in a 65 bed rural hospital with a huge catchment area. We have far less equipment and stuff that the metro hospitals get. Staffing is even more of a problem to recruit and retain in the country. We are a very stressed and burnt out staff here. On the positive side I love the work I do, you have to be ready for everything and must rely on your own skills. We have no on site docs at all so we must be good at recognising and diagonising whatever happens. We manage ventilated patients for the short term, all with docs, path xray on call. No allied health, office or cleaning staff after hours, so guess who does it??? Wish there was more money in the system. Sorry about the whinge, been getting to me lately. Must be getting too old!!! The docs only get pandered to by certain nurses. I'm pretty candid with them and tell them when they have gone too far down the "too important' track. It helps that we all know each other pretty well. Who you work with today you may well see in the supermarket or at the kid's footy match tomorrow. Smalll town. however it also means you know many of your patients and in tragic times this can be hard going. But that's nursing.

    Wow, never realsied I had so much to say!
    Cheers, thanks for listening
  9. by   maikranz
    Originally posted by pebbles

    Thats what I was looking for. Not "better", but just different. I'm interested in what the differences are, and if it's an local thing, or if people all over the continent notice the same differences. Makes me wonder why the differences exist.

    Why are community docs more likely to be pandered to, I wonder?

    Because they're the ones who admit their patients. The more admissions, the more "red carpet" treatment, the more revenue for the hospital.
    But, as aus nurse says: "... (I) tell them when they have gone too far down the "too important' track. It helps that we all know each other pretty well. Who you work with today you may well see in the supermarket or at the kid's footy match tomorrow. Smalll (sic) town. "
  10. by   askater11
    My 1st job was at a suburban hospital. I knew all the Dr.'s. I didn't know all the nurses by name but by face.

    In the suburban hospital on nights we only had one in-house Dr., so if you needed the patient to be seen by the in-house Dr. hopefully you don't need it too fast. I agree there's less medical equipment in our smaller, suburban hospital. We had some prehistoric equipment as compared to the city hosp.

    The city hospital you can get a hold of a Dr. within minutes. Though working with Resident's you can see more complications. (e.g. Dr.'s at the suburban hospital got central lines in first try;where I work now it takes quite a few tries/especially in July when the new group of resident's arrive)

    I worked step-down for both hospitals. On nights if I needed something stat I had to go down 2 flights of stairs to get my stat medication/central supplies. At the hospital I work at now they have a elevator/dispensor that comes directly from pharmacy/central to all units.

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