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Big Fish, Small Pond Syndrome

Posted

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

I was talking to a nurse friend of mine yesterday. We were discussing the dynamics of a big hospital vs a small hospital. Also we discussed bigger units vs smaller since we've worked in both.

I got tired of working in the small hospital. There were some big fish there who had carved out niches for themselves, had never experienced a larger pond, and definitely had grown to be big fish in that small pond by eating smaller fish. But, in a smaller hospital, there are fewer places for us little and medium sized fishes to hide.

Some nurses stay forever in a unit or hospital, and they literally create an ecosystem that supports themselves and the validity of their worldview of both themselves and others. It's similar to the Emperor's New Clothes. Who's going to challenge the Emperor when he can condemn you to the dungeon or the gallows? He and his advisors will continue to perpetuate their illusory world no matter how inaccurate it is. The Big Fish of nursing also must have his or her political allies in order to be successful.

All of this is accentuated in a small hospital. I'm finding where I'm working now has a healthier dynamic. I've been working on a large unit with many busy nurses and one personality is not able to dominate the workplace as easily. People seem less ensconced in their social roles. But, even so, this same dynamic can occur in any hospital unit, since most of them are relatively small social units.

leosasha

Specializes in medicine and psychiatry. Has 13 years experience.

Can agree with what you say. Have always been fascinated by the group dynamics within nursing. I am most amazed when a unit secretary is the fearless leader behind poor dynamics. Have seen this in small hospitals as well as large.

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

Yes, unit secretaries can have an amazing amount of social clout. Ingratiating oneself to her is vital to survival on any unit.

I worked at a LTC facility where the med rcds lady was the behind the scenes tale bearer. She prided herself on being the eyes and ears for the DON and administrator and made no effort to hide the fact that she roamed the hallways and nurses' stations looking for info. I was conversing with another nurse at the med cart one day about something very important. She walked straight up to us and stood there listening to the other nurse talk. I got nervous and tried to clam up. She wasn't the only person in the facility that wielded unofficial power, but certainly was the most important in the power structure. I always prefer to avoid workplace politics, not always an easy endeavor.

loricatus

Specializes in ED, ICU, PACU.

This is a bit off topic: but, reading your initial post reminded me of this song and I thought I would share

One thing I liked about the last place I worked was that the unit secretaries were all excellent and excelled at their jobs and nothing else. In other words not a one of them was to big for their britches. The place I worked before that had a situation where the unit manager was not qualified to function in the positon. She totally had to rely on the secretary who had been the previous manager's secretary for five years to tell her what to do. Needless to say the secretary became quite puffed up with her own importance. She refused to take off an order or do anything that you would normally expect a secretary to do. She spent her days kissing up to high levels of managment, glad handing doctors, leaning on the desk tallking to her friends and on the phone chating to friends and family. It was an absolutely awful situation but you could do nothing because she was in so tight with the manager. Actually, the higher levels of managment were ultimately responsbile for the situation. They are the ones who hired a person who had no acute care, inhospital experience what-so-ever to run a big hospital unit. The manager of which I am speaking had 20 years of home care experience and that was it. No wonder she had to rely on a secretary to run the unit for her. However, dealing with the manager's inexperience and the secretarie's ego was not the reason I eventually left that job. The reason that I left was that having never worked as a bedside nurse, the manager had NO idea that 10 to 12 patients represented a unsafe work load. She kept cutting staffing inorder to come in under budget and could not understand why anyone would object to that many patients.

Scrubby

Specializes in Operating Room Nursing. Has 6 years experience.

jlsRN you have really hit the nail on the head when you talk about the bigger fish maintaining their illusionary pond. Although I work in a large hospital, the OR department where I work is so isolated from everywhere else that it is a smaller pond environment. The big fish have been there so long that going to work sometimes is almost like going back in time. Their ways of managing the place is still the same as 20 years ago, which is bad because things have moved with the times everywhere else.

moongirl

Specializes in OB.

I left a small hospital for a bigger one and actually found the opposite. The smaller unit I worked in was a team atmosphere and everyone really got along. You kinda gotta when you count on each other to have your back in an emergency, or in just plain ol day to day stuff.

This larger hospital i am in is... sigh. triple the amt of employees on the unit, triple the work and triple the bitchin, backstabbin, cliquey-ness. One would think that in a busy unit there wouldnt be time to try to throw weight wround, complain about others, make others feel bad in order to bring themselves up etc etc. but good gravy, it is a nightmare.

Give me a small unit anyday. The more people you work with, the more people you have trying to assert themselves as top dog.. or big fish

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

Oramar, I can so visualize that situation, you describe it perfectly!!! I've seen similar dynamics!

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

Moongirl-

Interesting. What about that dysfunctional unit do you think contributed to its toxicity?

moongirl

Specializes in OB.

Moongirl-

Interesting. What about that dysfunctional unit do you think contributed to its toxicity?

I am so not sure. I have only been there a few months so I am still trying to figure it out!!! I dont know how much longer I can take it, but I live in a rural area where there are not alot of options for working...

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

I am so not sure. I have only been there a few months so I am still trying to figure it out!!! I dont know how much longer I can take it, but I live in a rural area where there are not alot of options for working...

That is a big factor I faced at my last job. People were very tenacious and held on to their jobs for dear life because it was the only hospital in town. There were few options, I think that people get trapped. I was feeling that way.

The politics there were horrible and the negativity was unreal. The paranoia was constantly hanging around like a dark cloud. Then, you had to deal with people who had been there forever and had carved out feifdoms for themselves.

EJSRN, BSN, RN

Specializes in Med Surg, ICU, Tele. Has 2 years experience.

I was talking to a nurse friend of mine yesterday. We were discussing the dynamics of a big hospital vs a small hospital. Also we discussed bigger units vs smaller since we've worked in both.

I got tired of working in the small hospital. There were some big fish there who had carved out niches for themselves, had never experienced a larger pond, and definitely had grown to be big fish in that small pond by eating smaller fish. But, in a smaller hospital, there are fewer places for us little and medium sized fishes to hide.

Some nurses stay forever in a unit or hospital, and they literally create an ecosystem that supports themselves and the validity of their worldview of both themselves and others. It's similar to the Emperor's New Clothes. Who's going to challenge the Emperor when he can condemn you to the dungeon or the gallows? He and his advisors will continue to perpetuate their illusory world no matter how inaccurate it is. The Big Fish of nursing also must have his or her political allies in order to be successful.

All of this is accentuated in a small hospital. I'm finding where I'm working now has a healthier dynamic. I've been working on a large unit with many busy nurses and one personality is not able to dominate the workplace as easily. People seem less ensconced in their social roles. But, even so, this same dynamic can occur in any hospital unit, since most of them are relatively small social units.

Did you find you gain more experience from a bigger hospital? I work in a small hospital, and I am afraid that when I go to travel nursing I wont know a thing because I havent really seen much (or at least I feel that way)

Did you find you gain more experience from a bigger hospital? I work in a small hospital, and I am afraid that when I go to travel nursing I wont know a thing because I havent really seen much (or at least I feel that way)

I think you're going to gain experience no matter where you work, but it's definitely going to be different kinds of experience. A bigger hospital, especially with a lot of medical teaching, is going to have lots of cutting edge technology. Of course, if it's the place to go with no insurance, you're going to learn to make do without the "luxuries" (pill cutters, supplies in general) that other hospitals have. I think the thing I gained the most from at a small hospital was the variety. Bigger hospitals can specialize the units. A smaller hospital won't be so specialized, so you won't just get respiratory or renal, you'll get everything, even if you won't see the higher level of care you'd get at a bigger hospital. So to me, bigger hospital, you'll get a more specialized but higher knowledge, but at the smaller hospital you'll be more of a "renaissance" nurse, with a little knowledge about everything.

FireStarterRN, BSN, RN

Specializes in LTC, Med/Surg, Peds, ICU, Tele. Has 15 years experience.

Did you find you gain more experience from a bigger hospital? I work in a small hospital, and I am afraid that when I go to travel nursing I wont know a thing because I havent really seen much (or at least I feel that way)

At a small hospital you are a jack of all trades and have to be very flexible. I got good experience there, but limited in some ways. At a bigger place they do more variety of surgeries and procedures, which is great to know. So I got good experience at both. Definately at a small hospital you have to have a lot of independence. We were our own charge nurses and unit secretaries often.

moongirl

Specializes in OB.

Did you find you gain more experience from a bigger hospital? I work in a small hospital, and I am afraid that when I go to travel nursing I wont know a thing because I havent really seen much (or at least I feel that way)

In a small hospital I got more exp. with the scary stuff. At 0200 you are "IT" and you have to handle whatever comes down the pipe, often stablizing/keeping someone alive until the copter shows up.

Jules A, MSN

Specializes in Family Nurse Practitioner.

As everyone has said there are pros and cons to both. I have either the best of both or the worst, lol. One of my jobs is in a rural area where everyone knows everyone else, their kids etc. It kind of creeps me out but since I'm a transplant I get to enjoy the family atmosphere without them really being able to be all up in my business. :) We all know what to expect from each other, our strengths/weaknesses and for the most part everyone works pretty hard. If you are able to fly under the radar and stay out of the gossip mill this is a great spot.

My other job is in the city. There is way more money, technology, supplies and a variety of people which is nice. The bad thing about city nursing, imo, is that since there are so many opportunities in such a close proximity people tend to come and go quicker. At my facility I don't think they screen new hires really well and we end up having to weed out quite a few doozies and there are also the perpetual orientees. I swear some people just show up for the week long 9-5 paid orientation. :)

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