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Does one have an advantage coming from a “top” hospital?

Nurses   (1,701 Views | 37 Replies)

wolfgangRN specializes in Emergency.

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wolfgangRN specializes in Emergency.

41 Posts; 1,761 Profile Views

11 hours ago, ICUman said:

Hey Las Vegas has great nursing pay with a relatively low COL. Made well over 6 figures last year. PM me if you want details. 

I worked for a huge level 1 trauma center in Utah years ago and am so over it. I’m content with my community hospitals with a nice pace and happy coworkers now. 

Nice! That was where I first started looking but there isn’t any full time offerings for the department I want to work at. I am so done with the ER. Nevada is still where me and and my husband want to live at long term, eventually.

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K+MgSO4 has 12 years experience as a BSN and specializes in Surgical, quality,management.

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I work at a "big, well known" hospital.   However it is a building full of highly specialized silos.  Yes we care for the sickest of the sick and the rarest of illnesses....however the endocrine nurse would struggle in the liver unit.  The ortho nurse would struggle in general surgery.   Someone who can do a bit of everything is really attractive on a CV.  Restructure of units, expanding scope of admission can really freak out highly competent but highly specialized people.  Someone who has worked in a regional hospital or something less glamorous is very easy to adapt to new situations. 

Like @klone I am looking for what I can't teach - soft skills, not a job hopper, good references (I live in a country where as the hiring manager I pick up the phone and talk to the previous manager and ask questions...)

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Nurse SMS has 9 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

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I am more interested in what you know than where you learned it.

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headofcurls has 4 years experience as a BSN, RN and specializes in Critical Care.

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I’ve found that hospitals with high acuity tend to stand out in the hiring process. 

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mushyrn has 6 years experience as a BSN, RN and specializes in Critical care.

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On 3/1/2020 at 12:35 PM, MunoRN said:

these nurses can find the autonomy of a non-teaching hospital to be unsettling, 

That's interesting - the teaching hospital I came from gave much more autonomy than the small town hospital I worked at previously. 

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I would be more interested in knowing about things like the patient ratios.  Sometimes the "name" hospitals are able to pay less because people will work for prestige rather than money.  Sometimes they pay less because they put the money into making sure they have the most up to date equipment and a robust staff.  I'd take better working conditions over higher pay.

My hospital pays well, but some days our staffing is terrible.  When my mother was crashing at a rehab, I was at work with 6 patients.  I told my bother to get to rehab and tell them to send her to another hospital. From there, she was transferred to a "top" hospital.  On our first day at that name brand hospital, I asked my mom's nurse how many patients she had.  The RN replied, "we usually have 4, but today I have 3."  I know full well the RNs in the equivalent department at my hospital have 5-6.  It's not that I wouldn't trust my colleagues to take care of my mom (there are great nurses on that floor), but I also know full well how little time they have to devote to each patient. If the staffing continues to worsen at my job, I'm going to be looking for employment elsewhere.  

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4 hours ago, headofcurls said:

I’ve found that hospitals with high acuity tend to stand out in the hiring process. 

Tell us about your experience as it seems to go against the general consensus.

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CritterLover has 21 years experience as a BSN, RN and specializes in ER, ICU, Infusion, peds, informatics.

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I think coming from a big name hospital *can* make you stand out, but it is just one piece of data about you. If the applicant pool is crowded, it might get you an interview but it won't get you the job. (And most places throughout the country, the applicant pool for most jobs isn't that crowded). Overall, though, it is about the experience you gained at that big name hospital.

For example, say you've been a bedside nurse at St. Jude for five years, but are moving across country. You apply at a peds oncology floor. Of course having worked at St. Jude is going to stand out and tip the scales in your favor. To a hiring manager, you have great experience in taking care of kids, giving chemo, taking care of central lines, following research protocols. But -- it is because you actually have great experience in those things. You'd probably still get the interview with that experience even if the hospital wasn't St. Jude. It just makes you stand out.

Take the job with the better benefits.

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CritterLover has 21 years experience as a BSN, RN and specializes in ER, ICU, Infusion, peds, informatics.

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On 3/1/2020 at 9:44 PM, mmc51264 said:

Really? You think having to train the residents is without autonomy?  I take it you have not worked with a bunch of 1st year residents  who know nothing about the flow of the floor. I would challenge that I have as much, if not more, autonomy than any other nurse. Even though I work at a teaching hospital .

I love working at a big teaching hospital. I see things that some nurse never see in their whole career. I strive to be a better nurse, not just one with "Big Hosp" on my resume. 

Generalizations are not accurate, or fair. 

I've worked at both small community hospitals and large teaching hospitals. While a big part of the nurse's job in a big teaching hospital is definitely keeping the resident from harming/killing the patient, you still have a bunch of residents around that can give you orders whenever you want/need them. You might have to explicitly spell out what it is that they need to order, but they are there.

In smaller hospitals, you don't always have a physician around, though that is changing a bit with the hospitalist services. Learning when to call the doctor after hours becomes a skill in itself. You have to decide if it can/should wait until morning. One hospital I worked at (many years ago) you had to call the nursing supervisor at night and run it past her before you could call the physician because they collectively complained so much about inappropriate pages.

And it isn't just about upsetting the physician/getting screamed at for calling. It's about having a good/great working relationship with them. You need those physicians to trust your judgement/assessment and react when you call about something important. If you are someone who has no problem with picking up the phone and paging the physician at all hours about every little thing, then you are going to find out that you don't get your pages returned promptly and that they don't always actually listen to you when are talking to them -- they often are half asleep afterall.

If I was a hiring manager at a small community hospital that didn't have 24hr in house physician or midlevel coverage and I was interviewing someone who came from a large teaching hospital, you better believe it is something we'd discuss in the interview as it can be a HUGE adjustment for some nurses. Some adapt well but others really struggle.

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

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On 3/1/2020 at 7:47 PM, CommunityRNBSN said:

I have no idea, and this is off-topic. But my doctor, who is an MD with 10 years experience (family medicine), told me that he interviewed for a job with Cedars-Sinai in California. They offered him 80 thousand dollars a year. An MD with a decade of experience!  When he expressed his shock at that salary, they told him “This is one of the best hospitals in the US and we have a line of doctors wanting to work here. Take it or leave it.”  (He didn’t take it.) All I have is his word for the story, so I don’t know if he was exaggerating. But when you mentioned being told it’s a privilege to work at XYZ hospital, that’s what I was reminded of. 

He may be exaggerating with that salary figure at least for SoCal standards. For physicians, well known teaching hospitals pay less than private practice in general. The advantage is the academic center provides your clinic space and all other costs associated with setting up a practice. You are basically an employee. You, however, lose control of navigating your own revenue potential.

Academic centers operate under a model similar to a pyramid scheme - the higher the position being filled (chiefs), the more they seek out big names of physicians to fill them who can command higher salaries. The lower ranks of physicians make so much less and may even work more. That could be where the "it's a privilege to work here" comes from.

In terms of nursing, I work in a US News Top 10 hospital as an NP currently but have worked in smaller settings in the past as an RN. "Top ranked hospitals" are very specialized in terms of nursing units and what nurses in those specific units are allowed to do. There is certainly a lot of learning and new experience to be had but only within that lane you're on.

Our nurse managers tend to prefer hiring nurses with experience in similar-sized academic centers so there's not much of a culture shock in terms of knowing how to deal with physicians in training and all the various clinical services that follow a specific patient. Since the OP is going from academic to community-based and smaller setting, I wouldn't think the hospital name would matter but rather what his current skill base is and how that translates to the job he's applying to.

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CeciBean has 30 years experience as a ASN, RN and specializes in MICU/CCU, SD, home health, neo, travel.

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I put in several  years in a Top 100 Heart Hospital. I loved it there. And boy, did I learn stuff! Sadly, because of financial mismanagement, that hospital no longer exists. 😫 I kind of saw that coming about the time I separated from my late ex and went on the road as a travel nurse. During my "travel period" I worked in several types of hospitals, from teaching to smallish community hospitals to large urban "name brand" ones. I found that you actually do have quite a bit of autonomy in the teaching hospitals, especially in the Summer months when the new residents arrive, because you're busy teaching them to be doctors, and sometimes that means you actually have to teach them HOW to do skills....like the time I walked in on a resident and an intern trying to put down an NG tube in a patient who was flat on his back. Really, guys? And no, they don't want to put in catheters, start IVs, or anything so mundane. What I found out mattered, in the long run, was how the unit was set up and what kind of manager it had...and whether s/he was competent. I also learned that "compact" states generally paid lower. Of course most of them are "right to work" states so  that probably has something to do with it.

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KalipsoRed21 has 12 years experience as a BSN and specializes in Currently: Home Health.

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I have worked for a nation’s top 10 facility and other magnet facilities. I currently work for the “non magnet” community hospital. I would say go for the Union, steady pay increase job.

I believe that working for magnet facilities as a new grad gave me a great nursing education. One thing I find annoying about non magnet facilities is the decreased amount of protocols and general lack of organization compared to a big magnet hospital. BUT I have found the patient interaction and care to be of a more holistic nature, which I enjoy better.

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