Big city hospital vs. smaller rural hospital

NurseLatteDNP, MSN, DNP, RN · Jun 23, 2017

I can't speak for all rural hospitals and all big city hospitals but here is my personal experience.

-I worked in a rural 250 bed hospital for 10 years. It was easier to move up in the system if you had good collaborative relationships with other departments. No unit was a dedicated unit for cardiac, renal, oncology etc. but all units accommodated overflow patients. Staffing was harder, open positions were harder to fill. Doctors ruled and did what they wanted. Senior administration did the same. On the positive side, people were honest and friendly. Friendships were easier to make. I miss that part.

-In comparison, I work in a 1000 bed urban trauma 1 center now. We have dedicated units for each disease process...cardiac units have cardiac patients, oncology units don't have med/surg patients on them. Staffing and hiring was much easier. There are always nurses who want to work. Hiring new RNs or CNAs takes days and not weeks. The hospital is much more nurse friendly because decisions are made with input. Senior leadership and doctors do not dictate as much what happens at bedside without nurses' input. Moving up in the system is harder because there are at least 10 other internal people wanting the same position. But you never feel stuck. It was the reason why I left the smaller hospital. I felt like there is not much else for me to do. On the negative, people seem to have a wall because everyone is there to learn and to advance. But the opportunities are endless at the big hospital. My commute went from 10 minutes to 45 minutes, but it is so worth it.

brownbook · Jun 23, 2017

Very generally speaking, smaller hospitals have less support staff. Nurses learn to, are expected to, draw their own labs, do their own EKG's, administer breathing treatments., etc.

None of these activities are rocket science, but many nurses who have only worked large hospitals have no need to, and never learn to, do these "chores". It just might come in handy one day to say, "I know how to do that."

RNperdiem, RN · Jun 23, 2017

If a nurse called out at the small hospital, the department would have a harder time filling the spot. At the big university hospital I work at now, there is a large flex team of nurses who are deployed to fill empty spots. Working short-staffed is rare here.

We also have transport nurses for ICU patients, an IV team and patient transport for floor patients.

At the smaller hospital, the med-surg nurses had a wider variety of patients. For example one might be an orthopedics patient, another a GI surgery patient. There were no specialized floors outside of L&D and the 4 bed ICU.

Getting hold of a doctor was a big issue in the small hospital. This was before the days of hospitalists, so you would likely be calling a doctor at home if you worked nights. In the university hospital, the residents are on the unit day and night, so contacting a doctor is simpler.