Local Community Hospital

The level and types of services will not be as acute. For instance, I would not expect a burn unit, transplant unit, even heart unit. I would expect general surgical and medical, maybe a few pedi and perhaps maternal-child.

some community hospitals are teachng hospitals, but most aren't in my experience. that means no residents, and may or may not mean that there is a hospitalist to take after-hours calls.

they are neither more nor less holistic in approach. their patient-satisfaction focus will probably depend n how much competition there is in the area.

it is also my experience that small community hospitals are more prone to the political dramas that affect all nursing services, and because they are small it's harder to keep your head down and stay under the radar. if you are shy or don't want to stand out, that will be harder to do. the flip side is, if you are outstanding, gregarious, very bright, or otherwise above the mean, everybody will know who you are pretty soon. that can be good if you are looking to advance to larger fish in smaller pool, or it can be bad, if it engenders gossip and jealousy from the less-able.

and classicdame is right; many clinical services may not be offered, and you'll never see big major trauma trainwrecks or burns, because your er will stabilize and ship, or maybe ems will just bypass them. ask whether they are a level 1, 2, or 3 center.

In a big hospital, nurses tend to be pigeonholed -- you're an OR nurse or a burn nurse or a XYZ nurse, from the ones I know who've worked at the huge flagship hospitals. In a small community hospital, you don't have all the bells and whistles, but you can end up floating or being PRN staff to other departments. We've got some that split between the cath lab and the ICU, between ICU and ER, between OR and med-surg, between tele and ICU. Some will PRN to the health department. You get to know (and be known) by freakin' everybody.

If you work in a rural ER, the really horrible stuff tends to get flown straight from the scene, but we've had people in our ER with dueling chest tubes after they were ran over by their travel trailer (died before flight crew could get there), cracking the chest for open cardiac massage (lived to fly out, don't know about after that), working get a living baby out of a dead mom who threw a massive PE. In our ICU, we've had people with everything from "political-itis" (not really sick, just very politically connected) to assault and MVA victims with open abdomens and slices you could put a hand inside, to necrotizing strep, huge MIs and evolving CVAs.

While I'm not in a level 1 trauma center by any means, we can do a lot with a little; we're used to being understaffed, under supplied, and underpaid. I think it tends to make me flexible. Or crazy. Possibly both.

I worked at a community hospital as an aide and now work at an academic medical center as an RN. I am guessing the DON wants to know why you want to work at a community hospital because she wants to make sure you're a solid investment and that you're not going to get experience under your belt and immediately take off for a bigger, teaching hospital.

Community hospitals are usually A LOT smaller and less specialized. For example, the community hospital I worked at had one maternity floor that was antepartum, labor and delivery, post-partum and newborn nursery. At any of the larger hospitals in my city that care for adults, the maternity department would have separate antepartum, L&D and post-partum floors as well as a NICU. A community hospital would usually only have one small ICU while a teaching hospital would have many specialized ICUs- some having Cardiac, Neuro, Trauma/Surgical and Medical. For inpatient units, the community hospital I worked at had 2 medical floors, 1 surgical floor, 1 telemetry floor. The hospital I currently work at has something like 16 inpatient units and they are all very specialized.

And then, as others mentioned, community hospitals are less likely to be teaching hospitals which means you'd have less contact with Residents, Fellows, Med Students and (possibly) Nursing Students. Whether or not that's a good thing depends on your perspective. I have never worked as a nurse at a community hospital but I would hazard to say that nurses at community hospitals potentially have better relationships with their Attendings. I've been at my job for almost 5 years and I am sure that the majority of the Attendings I work with don't know who I am... that's also because there are SO many of them that for 2 of our services, the Attendings may only need to cover the floor 2 weeks a year.

To answer your questions: No, they are not more "holistic" in approach. Yes, they very much depend on patient satisfaction scores. I have worked at several over the years, and what I found was that in the small community hospitals, everybody is kin to everybody, and you will find yourself catering to more "VIP's." Since most of the small hospitals do not offer extensive services, you may find you have lots of pneumonia, GI problems, etc., but if it doesn't have a cath lab or anything other than a general ICU, most of the really ill patients will be shipped out. Many no longer have a maternity floor, either. If it is close to your home, and gas prices are a consideration, go for it. You might find you enjoy working at a small hospital. In this economy, any job is better than none.

I have worked large - and I have worked small hospitals. From Level 1 trauma centers, NICUs, etc to Critical Access Hospitals. And - I will take small over large any day of the week. Yes, small hospitals aren't going to be on the "cutting edge" of medicine with Residents, and Fellows, and med students driving you nuts and writing silly orders all day long and that will require you to chase them down and get corrected! Just starting out as a new RN, I can tell you, that smaller community hospital is going to care about you. The working relationship is much closer and you will be exposed to a bunch of different experiences. We all have to pitch in together at times - there is no pigeonholing - you can get pulled to the ED to help with an MVA. ICU to help with a code, etc.

Nursing in a community hospital is a kinder, gentler venue for nurses. I have worked in all kinds of hospital settings, much prefer the community setting.You wont be on the cutting edge of technolgy .. if that is what you are looking for.

And yes... make sure it is a teaching facility!!! Otherwise you will be the one to make the call on off shifts... too much responsibility for ANY nurse.

Good luck!