Adjusting from Teaching to Non-teaching hospital

[Kayla.J.RN]

I have been working full-time for about a year in L&D at a large teaching facility in an urban area. I'm used to working with residents and midwives who are always readily available. Although I have gained a lot of valuable experience working here... I am unhappy with the management at this hospital and want to leave eventually.

I recently applied for a per-diem job in L&D at a non-teaching facility closer to home and was happy to accepted the job offer. I am both excited and nervous about working at a new hospital.

Does anyone have any useful tips or advice on how to make the adjustment?

[DalekRN]

My husbands dad is an attending obgyn at a non teaching hospital. Honestly I think it might be nicer- he knows the nurses, the nurses know him, they know he will want labs and a urine dip in triage with high bps, etc. They are a close knit team. The nurses don't have to deal with twentysomething nervous residents who are really just middlemen. I hope to work in a smaller hospital like that someday, especially with a combined L&D and mother baby unit.

[Aristillus]

Ohboy! I've worked for all but a year of my 30+ years at urban teaching hospitals. The one year I worked at a small (~25 deliveries/month) non-teaching hospital was the most miserable experience of my life! My hat is off to the nurses who can do it but it's not for me. I pretty much managed the labor through phone calls with the doctor. Shame on me if I called them in too soon and double shame on me if they didn't make the delivery. Have an emergency? There might or might not be anesthesia in house. On one floor was L&D, nursery, postpartum and GYN. It was just overwhelming. I sure did learn a lot during that year and fortunately our patients were healthier than the population of an urban teaching hospital but I'll take my annoying residents, Level II NICU and in-house anesthesia ANY day. Your mileage, of course, may vary. My tip would be try a few share shifts before you make your decision.

[klone, MSN, RN]

If you're working nights, be prepared for the fact that you will manage the entire 1st and 2nd stage by yourself, up until crowning. You will have to learn impeccable timing, because the docs don't like to be called too early for a delivery (honestly, as long as it goes well, I think they actually PREFER walking in after the baby has been delivered). Be ready to grow a thick skin as you call physicians at home at 2am. If they're ****, they'll yell at you. Sometimes, they go back to sleep and totally forget that you called them.

It's SO different from working at a teaching hospital. You will become VERY skilled at your job, because it will be YOU doing everything, not the docs/midwives. Not only the technical aspects (vag exams, SSEs, SROM checks, etc), but also the intangible aspects - critical thinking, triaging a woman and puzzling through her symptoms to try to figure out what's going on with her. You are doing much of the thinking and assessing FOR the doc, rather than just putting a person on a monitor and letting the doc come in and figure it all out.

There really are good and bad things about both. I agree with a PP who said that you will get to know the docs really well. If it's only 25 deliveries/month, I'm guessing they only have a few OBs. Once you have a doc's trust, s/he's your best ally. But darn, having to argue with an anesthesiologist at 2am who doesn't want to come in for an epidural, and thinks that if she's only 3 cm, it's too early and he shouldn't have to come in, it gets tiring. Trying to balance the exact perfect time to call a doc in for a delivery so s/he doesn't have to sit around while the patient pushes for another 30 minutes and get all huffy about it, that's tiring too.

ETA: I worked the first 5 years of my nursing career on nights at a smallish community hospital (so you could say it was baptism by fire), then went to a large urban teaching hospital for 2 years, so I've really seen both in action.

[Kayla.J.RN]

Thank you for your responses. I know that working at a non-teaching hospital will be quite an adjustment. Luckily starting out per diem will be a way to test the waters and see if I like the autonomy. For the most part I think I will.... but I am nervous about emergencies and not having a NICU team readily available, or anesthesia. I will be working night shift for the most part although I might work a day shift here and there to fill any holes in the schedule. I currently work full-time nights at the teaching facility so already have a bit more autonomy than nurses on day shift since residents aren't always there when you need them.

The hospital where I will be working per-diem has 6 LDR rooms.. no triage area... and 2 ORs. Where I currently work, we have 8 LDRs, 4 triage rooms, and 3 ORs. We usually have 6-7 nurses staffed on night shift (8 on day shift). But at the new facility there will be 3 nurses in L&D (day and night).

I anticipate that the workflow won't be as hectic as where I currently work and less high risk patients. But I'd like to hear some more of your experiences at non-teaching hospitals.

To anyone who has made the transition... what was your biggest challenge and how did you overcome it?

[klone, MSN, RN]

Are the ORs designated labor ORs? Where I worked, we did not have a separate OR, so the OR team took over for C/S and recovery. That was the biggest transition for me going from community hospital to teaching hospital - I had to learn the whole circulation thing.

[Kayla.J.RN]

Are the ORs designated labor ORs? Where I worked, we did not have a separate OR, so the OR team took over for C/S and recovery. That was the biggest transition for me going from community hospital to teaching hospital - I had to learn the whole circulation thing.

There are ORs on L&D at both places. There are also scrub techs available. I will be circulating c/s and recovering the pt on L&D.