Community hospitals????

The greatest difficulty I had in changing from large teaching hospitals to a small, community hospital was the lack of immediate medical back-up. I realize that residents are not always the cat's meow in emergency situations, but they are licensed physicians, who in my experience, are open to suggestion when the you-know-what is hitting the fan.

In a small, community hospital, you must have the experience and confidence to act definitively in an emergency while your co-workers and supervisor call in the reinforcements.

That took some getting used to for me, and solidified my opinion that nurses in outlying hospitals often have a tougher job than their colleagues in tertiary care centers with 24/7 resources.

Don't blame you for not wanting that long commute which translates into many unpaid hours of travel, not to mention the cost of fuel. You might be disappointed in what I find to be a lack of professionalism in some ways in a small hospital. Of course we have bright, educated and devoted nurses but there is a lot of politics in a small facility. One often assumes positions of authority simply through longevity and not education or preparation. You will find less of a willingness to change. Also, prepare to be terrified when you may be the only labor nurse on duty and an emergency arises. One of our OBs lives 15 miles away. We can summon the ER doc and pray that he or she is able to leave whatever they are involved with. We recently hired hospitalists but they do not do OB. On the off shifts, we have no anesthesia in house and the docs are all home. Since a labor check must now be seen by a midwife or physician prior to discharge, often they are forced to spend the night til morning when the careproviders round as they don't want to leave their comfy homes to come in. I choose to tolerate a lot as the next closest place would be 35 miles in any direction and I don't like being that far from home. I do feel often that boundaries are stretched and many moms shoud not be delivered at our hospital and certainly not by the midwives.

I went from a larger, although by no means a large teaching hospital, to a small community hospital. It is true that there is less back up, hesitancy to change, and politics involved in a small hospital, but I absolutely love where I work. It is a very small 100 bed facility with a level I nursery. We have 15 PP rooms, 3 L&D suites and use the hospitals main OR downstairs. We rotate through L&D, PP and nursery. I really enjoy that part because it's not the same thing everyday. Our unit all together so when we rotate we are still in the same location. Our PP rooms are the perimeter of the floor with L&D suites, and nursery in the center of the unit behind the nurses station. Even though there isnt MD back up available in house at all times, the MD's live fairly close, and the nurses are wonderful. They work as a team and I would trust their judgement much quicker than some MD's i've worked with! I think the hardest thing when you go anywhere different is getting past "the way we did it where I worked before"! AND of course the charting depending on if the charting program is different. There are good differences and not so good differences everywhere you'll work! I think it's worth it to work closer to home.

I love it; I do LDRP and GYN surgical and never get bored. YES, you do have to maintain proficiency in all areas, but you are not "stuck" in one area or another as you do it all. Another advantage is you get to know your patients as smaller hospitals like mine have less volume and you tend to see them through their whole course, e.g. from LD to PP and then home. And being able to care for GYN surgical patients is nice; it breaks up the boredom. I would say, go for it. It sounds good, esp the shorter commute.

PS we do run into the whole no OB or MDA in-house 24/7 but they are able to be called in and be there pretty quickly. We rarely have any issues there. But autonomy is a key; you have to be ready to act fast and know what you are doing before the MDs get there....esp at night! Ask about this in the interview process; how reliable is your backup?!

Then, what you need to do, is interview and see if it's a good fit! It sounds very promising.

Elvish - one issue to discuss in the interview is "Low Census". I once tried switching to a hospital closer to my home (before I became a traveler) and found it wrecked my budget because the so often put staff off/on call for low census. You may also want to find out what the policy is on floating - if census is low, will you be expected to float to other departments? If so, will you take a patient assignment or simply be an extra set of hands so that you can go back to OB if needed?

That said, I really prefer the smaller facilities, working all aspects of OB and the autonomy that comes with it.

Low census is a very strong possibility in a smaller community hospital for sure. You need to know; is the unit "open" or "closed" to floating and if you are unwilling to deal with low census days off or floating to other units, this would be real negative aspect to working there. Baglady brings a good point.

Fortunately, when I do get "low-censused", I deal. When the time comes to work extra to make up for it, I do. It evens out in the end, if and only if, you are very flexible.

I work at a small community hospital and I like it. I do mostly L&D because we are short on RNs but depending on census some nights i do PP, help be baby nurse for a delivery, etc. I would love to work at a large teaching institution but the closest one is 3 hrs from me. It is either feast or famine and I am ok with that. And I love my co-workers. When we moved to this town we are presently at I was so scared I wouldn't find nurses as good as the ones I had worked with, but I did and I am really enjoying everyone I work with. Good luck!