The difference between a teaching hospital and others?

Ruby Vee, BSN · Mar 4, 2010

years ago, when i started a job in a teaching hospital after five years in a community hospital, my preceptor told me "part of our job is to keep the residents from killing the patients." in that time and place, i think that was true. i work with some great residents these days, and some world famous physicians. they all put their pants on one leg at a time.

if you work in a teaching hospital, there will be teaching. there will be student nurses, pharmacists, rts, pts, ots -- you name it. there will be teaching rounds every morning and a big emphasis on research and evidence based practice. and you'll have a large part in shaping the expectations that future physicians will have of the nurses they work with. it's an awesome responsibility, it's a fabulous learning environment and the pay (i've found anyway) isn't all that much different.

there are advantages to working in a community hospital as well -- they're usually smaller and friendlier. there isn't as much drama and they ship their sickest patients off to the teaching hospital, so they don't make as many chronics. the equipment is better, the food in the cafeteria is better and sometimes -- although i haven't found this -- the money is better. they're often closer to your home so your commute isn't as awful, and you take care of your neighbors there. you probably won't meet any world famous physicians, but presumably the physicians you do meet know what they're doing. and if teaching isn't your thing, there won't be as much of it. you cannot totally escape it, but there won't be as much.

good luck, whatever you decide.

juliaann · Mar 4, 2010

I'm not a nurse (yet!), but I LOVE working at a teaching hospital. I love the environment, I love (most of) the residents, and I love the attitude our staff has. Everyone is willing to teach anyone willing to learn. We are a clinical site for tons of programs in our city (PCT, CNA, Radiology Techs, Scrub Techs, LPN and RN programs, and of course the medical school), so everyone is used to having students around. I absolutely love walking into the ICU, because the nurses all know that I'm in school to be a nurse and love to observe/assist with anything and everything, so they will tell me if anything interesting is going to be happening soon with their patients. They also don't look at me crazy when I start asking questions about IV drips and wounds. There is an environment of learning here, and I'm soaking it all up! I'm counting on a job here when I get done with school, and I don't want to get my first few years of experience anywhere else. :)

zahryia, LPN · Mar 5, 2010

It really depends on the hospital. My experience in the teaching hospital was relatively good. I really liked having a doctor close. I also liked working with the interns as a new nurse, because we felt like we were in it together and we would REALLY work together and learn things together.

The residents for the most part liked teaching the nurses. As long as you stroke their ego a little, they don't mind teaching you. Even if I know the answer, I like to hear where they're coming from in their clinical thinking. You'd be surprised the different angles they're coming from.

Now, in my non-teaching hospital, I'm really forced to think on my own more. And the doctors are well established (at least in their minds), so I have to know my stuff as they're not so inclined to teach.

So personally, I'd do the teaching hospital first. They are so many opportunities to learn during the rounds, seminars, and one-on-ones with the docs. I also think teaching hospitals tend to have stronger nursing internships/orientations.

Oh one more thing. You get to work with nursing students! What a wonderful way to learn when you have to teach someone else. When I was a first year nurse and had a student, it was really great opportunity to 'give back'. I got to be the nurse I wish I had when I was a nursing student. It was great.

AllAngelsRN · Mar 5, 2010

" I got to be the nurse I wish I had when I was a nursing student. It was great." Well said zahryia, well said. One of my goals in my chosen profession is to teach the passion I have for nursing to other young nurses. I love to teach and help people grow. It's an honorable task.

Sometimes I wonder how come the "old timers" or the one that "eat their young" don't think things through. one day they will be in my bed and I will be taking care of them. Whatever they taught me or not taught me (good or bad) I will do to them. That's why I make sure I teach anyone who wants to learn well. It's crucial component of the life cycle (gave and take).

Ruby Vee, BSN · Mar 6, 2010

" i got to be the nurse i wish i had when i was a nursing student. it was great." well said zahryia, well said. one of my goals in my chosen profession is to teach the passion i have for nursing to other young nurses. i love to teach and help people grow. it's an honorable task.
sometimes i wonder how come the "old timers" or the one that "eat their young" don't think things through. one day they will be in my bed and i will be taking care of them. whatever they taught me or not taught me (good or bad) i will do to them. that's why i make sure i teach anyone who wants to learn well. it's crucial component of the life cycle (gave and take).

i've never believed the "nurses eat their young mantra" -- i think the basis of that is that new nurses just do not understand the realities of caring for a patient assignment while trying to teach a student or a new grad -- and that sometimes the patient has to come first. but i'm beginning to wonder if there's a theme on this board of "young" snacking on "old timers."

whatever made you think that "old timers" (there is no such thing as a nurse who eats her young) don't think things through? we all realize that one day you will be caring for our siblings, our husbands, ourselves. that's why we're trying very hard to teach you everything we can -- so that one day we can trust you with care of our spouses when we're not there to answer our questions. sometimes, however, it just isn't possible to teach a new grad or a student in the manner they envisioned. sometimes our communication styles don't mesh with yours, sometimes we get tired or overwhelmed or irritated by what we view as constant pestering and you might view as asking intelligent questions (where the reality lies somewhere between) and snap at someone who may or may not deserve it. that's just human nature. we aren't perfect, we know that. but most of us do the very best we can to teach new nurses. sometimes it doesn't come across that way. but why not assume that we're having a bad day rather than we don't care to teach you? or perhaps we're having a bad week.

talaxandra · Mar 7, 2010

Ruby, I could not agree more. There are times I'm endlessly patient and supportive, encouraging and informative. But it doesn't come from nowhere and it doesn't come without a price. Shift after busy shift without respite, coupled with students, new grads, and inexperienced preceptors, takes its toll on even the most understanding of people.

Yesterday I was pleased that I could keep my head above water. I was working with an inexperienced agency nurse on her second shift on the ward - she did what she could wiht her relatively light four patients, but wasn't able to help me much. In the space of fifteen minutes I had: a postop donor nephrectomy with a SBP of 75, an elderly postop open appendectomy tachy at 138, and a subtherapeutic patient having a fullblown generalised seizure with compromised airway.

So when, in the midst of trying to catch up on the rest of the shift's work an hour later, I was approached by one of our less sterling junior nurses (now in her third year out) to whinge about how she has to find people to double check with her, I had no patience. She failed the annual calcs assessment, she hasn't kept a log book, she hasn't done the two practice tests or the retest needed, and she seems to think the supervised drug round is an onerous burden placed on her by people who don't like her, instead of the mandatory competency it is.

I get that she didn't like me telling her that I'm not interested in, and don't have time for, her complaining to me about a situation that's her own making. I appreciate that it's annoying having to walk around the ward to find someone to check with. And I'm sure that, on a different day, I would have been more pleasant about it. But I actually quite like her, and I wasn't "eating" her - I was exhausted, saw the hours of work ahead of me (I left work two hours after my shift finished), and knew she had no bigger picture.

The fact that I'm still finishing 5PM meds, am chasing hypotension with half hourly half litre boluses and still need to get that phenytoin dose given, and am juggling the needs of my neutropenic psychotic patient with those of my three physically ill patients isn't on her radar. For her the issue is that it's 6PM, her patient needs insulin, and she's not getting it checked by me even though I'm working virtually next door and now she'll have to find her buddy or (god forbid) the less approachable resource nurse. And now I'm just yet another unsupportive bi-... biddy, an older nurse who's deliberately obstructive for no good reason.

netglow, ASN, RN · Mar 7, 2010

I don't think she was referring to the two of you. I think you guys are who many would want to hang with. I do know the type she refers to. I noticed that I had the chance to learn from only say three nurses during all my clinical time. Most literally disapeared. The great nurses get the most critical cases and too many of them all at once. I've seen this many times. I can always tell who I want to be with to learn, but also easily sense when the addition of "me" would totally jeopardize that nurse. It seems few places are good teaching sources during this economy and short staffing.