Big hospital or small hospital?

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    I work in a "medium" size hospital now and I think that it may be time for a change. I could go to a large hospital in the area, or a smaller hospital that does low risk births, similar to a birthing center but does c sections etc. So, I would like input, do you prefer large hospital, small hosptial, etc and why. Thanks so much for the input!!!!!
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    In OB/GYN, I have no desire to work in a large hospital. Too often the areas are separate, e.g. labor and then postpartum; and GYN is entirely a different area. I like the variety working in a small hospital gives me. For example, some days, I am IN NO MOOD to deal with labor patients, but would do fine w/ a GYN surgical load. Others, I want not to deal with breastfeeding problems and postpartum issues for 12 whole hours but AM in the mood for a labor patient. Most of the time, I LOVE the continuity of care ony a small hospital seems to provide by following my labor patient to postpartum and beyond in my shift.. We also circulate our own csections, providing an even better opportunity for continuity and variety. I don't want to give up my options and it seems in all the big hospitals here you get stuck in one area, and it's like an assembly line..... my idea of a fast-track to burn-out. NO thanks.
    Last edit by SmilingBluEyes on Oct 10, '02
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    I have been at a small, medium and large hospital. I started out at a medium hospital It was busy enough to learn and see alot but you never felt like you were all alone. I moved to Tennessee and worked at a small hospital for a few months and hated it. I had seen enough to know all the horrible things that could happen and hated not having any back up....no in-house anesthesia, no in-house ob.....half the time, I was the only labor nurse working! I remember sitting at the nurses station, which was right next to a set of elevators. I would hear the elevator coming up and imagine every possible complication and wonder what was going to be wrong w/ the patient coming off the elevator that I was going to have to handle all by myself. I didn't last long at that hospital. Now I am in charge at a night at a large hospital and love it. I love working w/ a large group of nurses. I also like the in-house anesthesia, 24 hour ob coverage, level 3 nursery....everything!
    But, that kind of atmosphere is not for everyone. We are almost always busy, w/ very little downtime. And there is a lot of division between the units as Smilingblueeyes pointed out. I guess you have to ask yourself what you do and don't like about the hospital you are currently at and then go from there. Good luck!
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    It could be I was wrong in what i posted. The hospitals I work at now are not that small that we don't have IN- house anesthesia and OB support. I would NEVER work that way, I agree. I did that in Oklahoma and will never go back to that. It IS dangerous. I believe when we do OB we MUST have ready access to anesthesia personnel and OB and PEDS at all times! We do.......We do about 70 deliveries a month. Perhaps that is more medium. Reading sleepys' post I realized my error. Anyhow, She is right, you have to decide for yourself what is best. I wish you well.
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    I currently work in a very small rural "women's health unit". I love the atmosphere. I guess you could say that it is all I know as the hospital I came from was also very small, about 10-25 deliveries per month. We are called a womens health unit bc we do L&D, postpartum, antepartum, and nursery, all low risk ofcourse. We at night have no in house anesthesia or OB docs, but they all live within 10 min. I can see the risks of not having them readily available if problems were to happen, but I have never run across it. Our unit also deals with gyn surgery, and also "clean" female medical patients. I like the variety, and the fact that I can stay brushed up on my med surg stuff.
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    well Iworked at small medium and very large hospitals all have its good and bad points. the large one I kinda got the feeling we treated patients like cattle. just one big cattle call it was hard to get to know the patients as well as i like. the little hospital had no in house anesthesia or OB you were alone. It was a challenge you had to spot things early. I liked the care we were able to provide but we also got cut a lot do to low census. and when things were slow a lot of gossip and bickering would start.
    the hospital i am at know does 50-70 a month we are small enough to provide the care i like but not big enough to have the cattle call feeling. we also do not do high risk ob here. which i kinda miss.
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    Small hospital.
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    Some people like the support of the large hospital, but I like being a jack of all trades. You must be confident, and able to coordinate many people/services around the patient in a crisis. You need to know everyone's role because inevitably there will be someone who hasn't worked an emergency before and needs coaching. Also need to be ready for anything supply wise and knowledge wise because there won't be an extra person to run for something or go look up a policy in a small hospital esp on the night shift.
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    I work at a large hospital (800+ births/month) and LOVE it. I was previously at a smaller (50-100/month) hospital. I found it to be slightly boring. In the smaller, I was split between nursery, postpartum and L&D. I found that frustrating. Here, I am strictly LDR, which is what I wanted to be doing. It all depends on your activity level. Yes, it is very busy, but that is what I like. We still work on a one to one ratio 99% of the time. That is something very important you should look into! No more than 2 in early labor, 1 in active!
    Good luck in whatever you decide!
    Joyce
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    I have worked in both. In the big hospital, I didn't feel any kind of bond with my coworkers and it was kind of like an asssembly line- free up a bed for the next one. In the small hospital it was rather scary, because I was the only labor nurse, and the dr and anesthesia were sometimes at least 20 min. away. I also had to clean the room after deliveries including cleaning the jacuzzi tub, and mopping the room! lol!


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