teaching hospital vs. community hospitals and the rn

Nurses General Nursing

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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.

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

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 nights and I never worry about paging a doctor, they do rounds every morning or come up and see their post-ops. Never have any problems about getting pages answered either.

Personally, for me, I really like where I work. When I had clinical at a large teaching hospital (and maybe this is just my experience), I felt like you never saw the same nurses twice. Same with MDs. Maybe it's a comfort zone thing :icon_roll

ETA: I never worry about paging a doctor AS LONG AS it's not for something silly. Pain meds, critical values, low BPs or heart rates, bleeding through a dressing, no urine output, etc., are all things I've woken up doctors for. Especially for pain meds, patients will say "oh no don't wake him up! I can make it till morning" and I always say, that's what they get paid the big bucks for!

Specializes in Cardio/Pulmonary.

I work at a community hospital and our dr's are very cranky when you have to page them through the night! Its just loads of fun to use my discretion and get yelled at in the wee hours of the a.m. :/

Specializes in ICU.

I've only done community hospital ICU and i also worked nights. If you are calling an attending/consultant you better use some discretion! It better be soemthing worth waking up the Dr. However, for certain things, there was one hospitalist in the hospital for the nights. They were both great and would be proactive. Some things they would tell you to call the primary for, if they didn't want to step on toes.

I would say to do nights in a community hospital, especially ICU, you do exercise a lot of autonomy and don't always have that MD to bounce things off of or to place the onus on.

Specializes in ICU.

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!

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!

That wouldn't go over well where I work at all. No one pages for anything like that at all. wow.

Specializes in Emergency & Trauma/Adult ICU.
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!

Hmm. Either that nurse is on a power trip ... or the resident has really peeved off the nurses somehow.

Specializes in nursing education.
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!

You're kidding, right? Why would a nurse unless she anticipated an order or a change in therapy? Why would she be checking a psych patient's temp at 3am, for that matter? Wow. That's a disgrace to nursing as a profession.

Oh wait. You were kidding, right?

Specializes in Pedi.

As an RN, I have only ever worked at a large teaching hospital. Our services have residents in house 24/7. If they don't answer my page and it's something that can't wait (a patient is leaking CSF, has a new weakness/droop, has a concerning change in VS, etc), I'll go knock on the door of their call room to wake them up. We have a few services that are not in house overnight (Plastic Surgery and Endocrine being the ones I deal with the most) but they still have to have their pagers signed in and I expect them to answer if I call them. If it's something non-urgent (like an order that was never officially changed but should have been), I just wait until the morning.

I worked as an aide in a community hospital and, though I never worked nights there, I frequently saw the RNs calling the attendings at home on eves and I'm sure they did the same thing overnight if they needed something. My grandfather passed away in the same hospital I am talking about here and I know they had a hospitalist in house to come pronounce when he passed at 5am though.

I've worked at a small rural hospital (125 beds) and also (in the same city) a community hospital (with 300+ beds) and a medium sized hospital of 400+ beds. Loved them all. Paged docs appropriately- and had ER docs for codes along with code team.

I came back to a different state and worked at a "local" hospital (Level I Trauma, Level III NICU, regional pediatrics and PICU).... docs around everywhere. Lousy place to work. Royally sxxxxd. BUT gave good care.

I think it depends on the place.

As a patient- my most frustrating experience was at a big teaching hospital w/university ties- could NOT get that dxxn intern to focus on why I was there- he liked my other diagnoses more- and wanted to repeat tests I repeatedly told him I'd had years ago TO GET THE DIAGNOSIS!!! Totally batshxt. He wasted 2 of 5 days of video EEG monitoring by not lowering meds.

Specializes in ICU.

i worked at a huge teaching hospital fresh out of school. Now work at a tiny (150ish beds) community hospital, and cannot WAIT to get back to a teaching hospital. Residents there ATC, call room door to knock on if need be...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...)

Specializes in Med Surg.

I work nights at a small (125 bed) community hospital and love it. We have a pretty broad range of care for such a small hospital. We do treat strokes, MIs (we've got small ICU/CCU units), etc, as well as regular med/surg, ob, peds. We also have 24/7 RT available. Anything beyond a certain acuity does get sent to the bigger hospitals up north, though.

We use a hospitalist system and most of our night hospitalists are good. There are specialists that take call each night, but usually the hospitalists manage care. Some of our docs, especially the orthos, will automatically put in a consult to the hospitalist service so if we need something not related to the ortho concern (say r/t DM), we can page the hospitalist rather than waking up the ortho guy. I've generally had good experiences in getting needed care/new meds at night. The biggest frustration I have is that are pharmacy closes from 2300-0600 and has even shorter hours on weekends. Usually I can get what I need, but every now and then a med will have to wait until am to be given. They're talking about making it 24/7--I'll be thrilled when that happens.

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