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Differences b/w rural hospital vs. a large city hospital

Specializes in Medical/Surgical, L&D, Postpartum. Has 8 years experience.

Hi everyone!!

I have a question for all you guys. I would like like to know what different experiences you have had working in either a rural hospital (i.e. 59 bed facility) vs. a large city hospital (i.e. 200+ bed facility). I may have an opportunity to work in a small rural hospital as a new grad in med-surg. I was wondering if I would be getting the same experience there as I would at a larger hospital? What is your opinion on the pros and cons of each? If later in my career I decide to work in a larger hospital, would my experience be up to par with the others who have always worked at larger facilities? I would really appreciate any insight you may have on this subject. Thanks! I look forward to any replies!


icyounurse, BSN, RN

Specializes in MICU, SICU, PACU, Travel nursing.

I would think the skills you learn would be pretty comparable at either place. Nursing is nursing whether you do it at a large or small hospital.

At the larger hospital: you may see a bigger variety of procedures offered (i.e. heart caths, radiation therapy, ect) and have more opportunity to transfer within the facility if you dont like your first job there. Like if you worked med surg for a year and wanted to do something else, there would be a bigger variety of places to transfer (CCU, SICU and NICU instead of just one small ICU for example) and likely more jobs to choose from.

At the smaller hospital: You would get to know your co workers real well and probably know everyone and alot of things about the facility which may increase your comfort level after a shorter time period.

It comes to down to what type of atmosphere you are looking for and whether each facility has the job that you are looking for.

BinkieRN, BSN, RN

Specializes in Med/Surg.

The basic nursing skills are the same but in a large hospital you have more opportunities to experience other floors and departments and the more unusual patients can be found in the larger hospitals.

I have worked in both and work in a rural facility now. I wouldn't trade the experiences I have in the rural place for anything. There are definite disadvantages to working in small places such as not seeing the more unusual and critical patients. If they come to us, we ship them to the bigger tertiary care facilities. The smaller hospitals offer the opportunity to experience more autonomy at times. You really learn to rely on the skills and experience of your coworkers.

I agree that the basic nursing skills are the same, but in a rural hospital there aren't separate units for everything. You may be taking care of a COPD'er in one room and a 1 year old with febrile seizures in the next.

On a more personal level, the emotional support from peers in unbelievable in a rural facility. When one hurts, we all hurt. We cry together and we laugh together as a family. I have had the opportunity to work in large facilities but never got comfortable with it.


Specializes in Rural - we do it all!!!.

Hi 3kittiesRN,

This is my first position as a new grad. In a small, 22 bed, critical access, rural hospital.

I love it!!! Hospital was always my first choice, but I was scared to jump into the world of nursing.

But, this position has been a great learning experience.

You never know what will come in thru the er door...

A snake bite?



Sore throat?

And, if there is trouble, there is no one else to call. Pulling a bell to notify of a code blue? Nope, you and your colleagues are the code team, trauma team, and whatever else is needed.

I would not trade the experience for anything else!!!

If you're in the ED you'll see everything, and if it's serious enough, stabilize and ship via chopper.

In the hospital side, you'll have exacerbations of COPD, CHF, diabetes, pneumonia, and lots of demented LOL's there on "swing bed" status- can't send them home, they're no longer acute, but we can't find a nursing home to take them.

You also won't be working with DRG's - we couldn't survive off of them.

And HIPAA is a joke. The whole town knows who came in when because you get the local news by listening to the police scanner when the civil defense whistle blows.


nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

I'm in a rural hospital (84 beds) and we see a good mix, and like others have said, we "bag'm and drag'm" up the road to Duke if things go bad; if it's a bad trauma, we may stabilize, but then they get sent out PDQ.

One thing I've thought about being in my little hospital is that I probably get to do more than I would at a larger hospital with more staff and more striation in care. I mean, I've assisted with TLC insertions at the bedside, placed tubes in every opening the body has, started IV's in hands, legs, feet, and arms, bagged pt's, done CPR on pts, put in a oral airway until the code team got up from the code they were working downstairs, dressed surgical, diabetic and decubes, had acute MI and CVA pts that really, really should have been in ICU, but ICU was full and they weren't stable enough for transport. If I was working at a huge inner city hospital, I would probably be on a floor that was "just" CVA, or just cardiac, or just kids, or whatever.

In one shift, no kidding, I started the shift with a 7 year old in one room (asthma) who got DC'd home, got the room cleaned, and got an ER admit of a 104 year old woman with syncopy, R/O CVA/TIA. I mean, I don't think you'd get that in a bigger hospital. Of course, in a bigger one, you'd be able to specialize in one system or process (cardiac, renal, surgery, etc.), so I guess they've both got their pluses.

FireStarterRN, BSN, RN

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

There are positives and negatives to both. In a small hospital you often have to be more self reliant. I've worked in a critical access hospital for 8 years, I recently quit to do agency fulltime. I got burnt out on the intense politics that were going on there which seemed to supply an endless supply of melodrama and angst. Plus, a small hospital has similar dynamics as a small town; You know everything about everyone and the social hierarchy can get rather hardwired.

I'm working at a medium sized hospital now. The atmosphere is less inter-departmentally intimate. The units mostly have more people where the commraderie is lively and warm within the units themselves. I'm seeing and learning a lot that I never saw in the tiny hospital. Today I worked and was able to do some things that I never did at my smaller hospital. One example is that I had a pt with an epidural pump. At my former hospital, the CRNAs were the only ones to touch the epidural pumps. Today, I got to give a fentanyl breakthrough epidural push through the epidural line, following the hospital protocol. I had the the anestheseologist walk me through changing the settings, I got to change the bag in the pump, something which I never had the opportunity to do at the small hospital, mostly because of long held traditions there. Also, I got to take care of a pt recovering an aortic coartication repair surgery and two post open hearts. I never saw anything interesting like that in the small hospital. It's really fun to participate in all that a larger hospital has to offer.

On the other hand, I really learned to be self reliant in the small hospital. I got to float throughout the hospital and get a good taste for whatgoes on in OB and ER, plus SOP once in awile. So, a small hospital can also provide a broad spectrum of experience if you are flexible and take advantage of the opportunities that present themselves.


Specializes in General, Vascular. Has 6 years experience.

I work in a large hospital where we have specialty floors. You get to be very experienced in that field (ie.. Cardiac), but when you float to other floors, you feel like a fish out of water. For example, a Rehab Nurse floating to a Cardiac Surgical Floor. The specialty knowledge increases, but your general knowledge decreases. That's one thing nice about smaller hospitals is that you can see everything. The downfall, is that you may not see the more critical patients since they are most likely sent off to a larger hospital.

Pat_Pat RN

Specializes in ER, Med/Surg. Has 8 years experience.

I work in a rural hospital. We have 22 Med/Surg beds, 5 OB beds and about 7 in our ER. We staff (at night, when I work) 1 House Supervisor, 1-2 OB, 2-3 Med/Surg, 2-3 ER. During the day we have a "day surgery" department and a visiting specialists clinic. I'm not sure of the staffing for them.

I know all the nurses, Unit Clerks, Lab and Xray techs by first (and last) name. We call our docs by their first names usually. [Dr. John, Dr. Matt, Dr. Dan, etc...]

While I was working my way through nursing school I worked in the ER as a Tech and Unit Clerk. I worked in the lab as a phlebotomist and peon. Now I work on the Med/Surg "floor" [which is the floor that everything else is on too. The OB "hall" is just seperated from Med/Surg by a row of 12' wide rooms down the middle (dirty utility, bathroom, shower, med room...) Basically a "U" shaped unit, OB on the left, M/S on the right, nurses station in the bottom of the "U" and med room etc. in the middle.

At night we don't have any housekeeping, dietary, pharmacy or Mechanical.

We just got a couple of RT's in the last few months. Before that the nurses did all the RT functions, even in the ER. We had one RT tech that trained me, so I did breathing treatments and put people on Bi-Pap and was trained the most on our tiny little vent.

I like the small setting. Plus it is much closer to home.

The nearest "big" hospital that has 200+ beds has the same starting salary for RN's as our facility.

That's the view from here....

RNperdiem, RN

Has 14 years experience.

I now work in a large university teaching hospital. I started out in a small community hospital.

At the community hospital, the pharmacist locked up the pharmacy and went home at 10pm. There was one housekeeper and 2 security guards. On the weekend night shift I knew most of the employees in the building by sight. I liked the teamwork and atmosphere.

Best of all parking was free and close by.

mpccrn, BSN, RN

Specializes in ICU. Has 30 years experience.

i've worked ICU in both. bigger hospitals have much better toys to play with, usually see sicker more unstable patients. the skills you gain are immeasurable in this type of situation. now that i'm in a smaller hospital, i bring those skills with me and am able to adapt to changing situations a bit better than my coworkers that have only worked at smaller institutions. docs know my past, i worked with many of them at the larger institutions. they've told me several times that they are glad i'm taking care of their patients....or worse yet, "why can't you be taking care of my patient? i'd feel better if you were" i've been personally asked to care for a certain patient by docs because they were very unstable or difficult for whatever reason. if given a choice as i new grad....i'd bite the bullet and go to the bigger hospital, gain the skills and intuition that i could then take to a smaller hospital. i wouldn't change the choices i've made. :nurse:

I've worked both, big and small......... and have to say that I got the most experience at the small hospital. We don't have ICU, surgery, or OB, but we are rural and see a lot of traumas, etc. Remember, big things happen in small towns - we've seen gunshot wounds, stabbings, major mva's, etc. And emergency precip deliveries in an Er that doesn't even have a warmer......talk about experience. You get it when you don't have respiratory there to help you, you and two other nureses are the only nurses in the house, you are the code team, respiratory, housekeeping when needed, the IV start crew, etc. We occasionally get nurses from larger facilities that are exceptional - truely excellent in their focus area, ie cardiac, icu, etc. However, ask them to do an EKG, give a neb treatment, etc. and they don't have a clue. So, I would summarize by saying that yes, experience in a large hospital is great, however, I would say that the experience of a small, rural hospital is priceless! I feel comfortable with the unstable pt that was just stabbed multiple times, the kid with status asthmaticus, and the elderly person in CHF. I think that every nurse should have to work in a rural hospital and get a feel for what rural nurses go through on their shift.......

Heh. Our ED, nights, has an RN, LPN, and PA. You get a doctor for an MI or CVA - sometimes. Usually we stabilize and ship.

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