teaching hospital vs. community hospitals and the rn

[anotherone]

Currently I work in a big teaching hospital and have never worked in a community hospital. My experience with them is limited to some clinicals I had at one. From what I remember the doctors were around a lot less, the patients were also not as sick, since that hospital at least tended to transfer the really sick patients to their "mothership" teaching hospital. Since I work at a teaching hospital there is usually always a doctor in house for almost every service. ( aside from derm/ophto etc but rarely do rns need to page those). Working nights, many issues come up that require me to page the doctor, it is a lot easier if the doctor is already there to write orders, maybe come see the patient. Many of the nurses seem to page even for things that can wait until the day, especially if the service is covered by a night float. I imagine that working at a community hospital, esp at night, requires much more rn discretion on when to page or not page. My question is what are some of the differences for a nurse working in a community vs teaching hospital? what have been your experiences, which do you prefer, recommend? any comment or advice is greatly appreciated.

[RNperdiem, RN]

I remember community hospital on weekend nights.

There was one doctor who worked in the ER, there were 2 security guards and 1 housekeeper in the building.

The pharmacist locked up the pharmacy at 10pm and went home. If you needed meds after hours, you searched the place with the house supervisor.

The patients did tend to be less complicated, but they are still sick enough to require a hospital stay. The nurses sometimes did have to call the doctors at home, but they would ask all the other nurses if they needed to speak to the same doctor too. I don't know if docs still have answering services these days.

[vashtee, RN]

I work in a community hospital now, and had clinicals in both types of places. I LOVE my community hospital. Sure, you don't get as many critical patients (such as MIs or stroke or trauma victims).

I work in a community hospital, and we definitely treat tons of these. In fact, I work on a floor that takes all the stroke patients.

We get lots of "ordinary" diagnoses where I work. The thing we DON'T get are *unusual* chronic diagnoses or pediatrics. When we get these kinds of patients, we stabilize them, and transfer them out. We also transfer out when insurance (or lack thereof) require it, but only after the patients are stable.

[elkpark]

I've done both, and there are pluses and minuses to both. Different people prefer different settings.

[dudette10, MSN, RN]

here we have 1 overnight hospitalist which is great but he does not cover private physicians' pts unless it is a code. And they are hard to get ahold of at night and/or angry and/or very hard to understand when they are half-asleep (98% have heavy accents...)

Same where I work.

To the OP...You have to use discretion when calling at night. As a newbie, here is my line of thinking: you call for what can and will be/should be immediately taken care of after you have done what you can do with PRNs and nursing interventions. Depending on the situation, you also need to consider calling a rapid response.

About the sleepy doc thing...if they give you orders that don't make any sense, you have to question it! Sometimes, they aren't thinking clearly or they will get their patients mixed up.

As for the less-critical patients, it depends on what your community hospital is certified for. We get MIs and strokes all the time.

FWIW, the change from a teaching hospital to a community hospital will probably take some getting used to. I've thought a lot about switching from my hospital to a teaching facility in the future.

[rustynail]

Walter Reed split into 2/3 teaching hospital (Bethesda) and 1/3 community hospital (Ft. Belvoir) in August. I will be starting in Bethesda but from what I keep hearing, Belvoir is not a bad place to start either.

[Good Morning, Gil]

Interesting post. I could have written your post! I was interested, too, and it is nice...if I want something (non-major for my patient), I don't call them for it, but wait for them to come around (because I know someone will be around during the night! :)). I like that because I prefer getting everything done during my shift and not pass it off to the next shift if possible (not always possible lol, but I like doing things myself so I know they get done, bit of a control freak lol). I leave knowing that they got what they needed, even if it was just the special wound care product the family wanted for them lol.

I remember when I did my clinical at a community hospital, it seemed like that would be nice in a way, too. Because there are only attendings, no residents, etc, so you don't have to guess which one is right out of med school, and which one has been there for 3 years lol. And, the nurses do more in community hospitals (maybe not as acute of situations), but they act as RT's in a way, too, because the RT may not be immediately available, whereas the RT is always on our unit at the teaching hospital.

[Good Morning, Gil]

Oh, I love the teaching hospital, though because of the many frequent educational opportunities to improve my knowledge base. I believe this is the better fit for me overall, probably why I was hired there lol. Nurses at community hospitals know their stuff, though....they have to be a lot more independent, I think....

[wooh, BSN, RN]

my cousin is a 3rd year resident in psychiatry. She always posts on FB about this nurse who purposely harasses her, and will call her at 3am to tell her the patients temp is 98.9. She'll call back 5 min later for something else non-significant. Do that to an attending and you'll hear it!

I wonder what your cousin did to that nurse. (Or at least what that nurse thinks your cousin did to her.) Because that's REVENGE right there.