Employer's Negative Response to Teaching Hospital Experience

[slr0610]

Hi all,

Excuse me why I vent/reach out for advice on a situation.

This may get lengthy, but again just trying to vent and give all details for some good advice. :)

Soooo.....I have worked in a major, well-known teaching hospital for my first 3 years of being a nurse. I have worked in an ICU setting for all three years and have my CCRN. Recently, during my quarterlife crisis :)......I decided that I wanted to move back to my hometown to be closer to my family.

I had my first of a couple of interviews lately at a mid-sized hospital in a large suburban area. I was contacted by HR and told my resume was impressive..woohoo...so they brought me in for an interview. I met HR at their office and she walked me over to the unit to interview with the managers....

We get to the unit and there are no managers there. After about 20 minutes, the HR person was frustrated and apologizing, saying that this interview was on both of the managers' schedules. At this point, I'm less nervous, more relaxed, very "I'm gonna go with the flow". About 10 minutes later, the managers show up saying a meeting ran late....I totally understood. Cool.

One of the managers said this was only her second week on the job, however, she did most of the questioning. I felt like some questions were just kind of "off"...which is why I don't remember a lot of the questions she asked.

Soooo....here it comes. They go over my resume. I told them one example of when I dealt with a difficult situation at work...which envolved communication between different residents and NPs. IMMEDIATELY, the rest of the 20 minute interview was focused on what support do you have at your teaching hospital? Do you understand that you won't have that personnel available here? How will you make the adjustment?

(Let me just add since they focused on this topic for the last 20 minutes...they really didn't go into any depth with my experience with patients....performance based questions, etc....which is where i hoped to shine)

Sure, I said.....I know it will be an adjustment. I am a quick learner and am a flexible, laid-back person. I will be able to learn and adjust to the different environment. I am ready for a change and a new environment. I think that seeing a number of different things at a teaching hospital can hopefully prepare me to work in new settings.

Still two of the managers continued...but, tell us a specific example of when you helped a patient/did an intervention for a patient/called an attending directly for a patient. Tell us when YOU did something?

So, sure....I gave them an example of where I had to call an attending directly since a resident wasn't responding to an urgent need. One manager was please with the answer. The newer manager continued....but, did YOU call the attending, or did your charge nurse call the attending?? Or did you have a NP that called?

Huh, what????? Am I incompetent somehow? Does working with a greater number of people mean that I have less communication skills?...I simply replied that no, I called directly for my patient. And I went on to say that I worked night-shift for over a year where....mid-level providers weren't always available. But they seemed not to care about that.

How are you going to care for patients with no-mid level providers readily available? How are you going to adjust??

(Didn't I just answer that question?) So I repeated basically my previous answer again. ONLY to be questioned once more on the same topic.

Again, this went on for 20 minutes.

Look, I COMPLETELY understand that they want me to really know that working in their unit would be a different environment and I need to realize "what I would be getting into"............But, I this point I kind of felt like the attitude was "you work at a teaching hospital where you have lots of residents and NPs to do everything, so do you really know how to take care of patients without them?" You. are. a. spoiled. nurse.

I get it. And I know that at teaching hospitals, sometimes, nurses can have less autonomy just based on all the providers involved in care. I know it would be an adjustment leaving. HOWEVER, does working at a teaching hospital somehow make me less competent/able to care for patients?? The acuity of our patients and patient needs are VERY high and critical. We see, do, and precept A LOT. And I guess I just don't understand, because I thought employers would like experience in a teaching hospital....experience with lots of students, bedside procedures, high acuity patients, seeing lots of different things, experience rounds, blah. But, I felt that I was being attacked here for working at a teaching hospital multiple times in the interview. That somehow I was less competent and had less communication skills due to all the resources I have at my current job. I also have my CCRN and have taken many continuing education courses. Guess that didn't matter.

Again, sorry for the length. And this experience is still fresh, so sorry for the venting..but I just wanted to ask...am I justified in feeling this way?.....just very disappointed they were knocking my experience at the type of hospital I work at instead of inquiring with performance-based questions. Or maybe having to wait and the "new" manager threw me into a mood? Or maybe the new manager was off?.....or Has someone experience this before and can vent on a similar situation? Advice for the future?....OR im just crazy?

Ok breathe....

Thanks...y'all are the best. :)

[HouTx, BSN, MSN, EdD]

Sorry you had such a negative experience. I know how much of downer this must have been.

Having worked in both types of environments, I think I have some insight into those hiring managers' misgivings. ICU nurses in non-teaching hospitals usually have to function at a much higher level of accountability/responsibility - we actually serve as the "residents" for the private physicians who have admitted the patient. This transition can be difficult and very uncomfortable for a nurse who is used to having a larger safety net. I have even had to deal with newly employed "ICU nurses" who had never started a peripheral IV, changed art lines, cared for central lines, etc. because these were handled by interns in the teaching hospital in which they were previously employed. Maybe these managers have had to deal with the same type of issue in the past.

But - that does not excuse negative behavior. Instead, they should have just told you what may have been worrying them & opened up a discussion about it rather than assuming. Your experience & credentials should be valued and respected. I know you'll land that next great job very soon!

[SoldierNurse22, BSN, RN]

Ditto on HouTx's post. I was recently in the same spot that you're in, and I learned to adjust. Make no mistake--it is an adjustment--but for goodness sake, you're an ICU nurse at a big teaching hospital, probably with more experience than some of the nurses at the mid-level place have in their pinkies!

They should be excited to have you, not questioning your ability to function without a physician/NP "safety net"! That's what critical thinking skills are for, and coming from a facility like the one you described, that's exactly what you'll have. :)

[dudette10, MSN, RN]

I have worked at both as a floor nurse, and it will be an adjustment. In fact, I started out as a new grad working nights at a nonteaching hospital, and the amount of autonomy can be nerve-wracking. Now, I work days at a teaching hospital, and the safety net of residents relieves some of the stress. However, I've found that first years (and sometimes second years) often do not see the "whole" patient as well as attendings do, and you have to nudge them in the right direction. I have to give my nonteaching hospital experience the kudos for being able to do that.

[mmc51264, BSN, MSN, RN]

I now work at a teaching hospital and I find that we have to "break in" new interns (residents are pretty ok so far) and we have to be better advocates for our patients at times. I used to work in a rehab unit at a LTC and I had to call MD almost every night. I had to call surgeons in the middle of the night and get cussed out (even though they may be on call once a month!!!). I would think the hospital would love to have a person from a teaching hospital b/c you have to communicate with so any different kinds of people. Sounds like someone who is threatened by you. (intimidated??).

[SubSippi]

I doubt the behavior of the nurse managers are an indication of what they think about you...they don't even know you. I understand the inclination to take questions like that a little personally (I probably would, too). It's likely that they've had a negative experience in the past with a nurse from a teaching hospital, OR maybe even that the new manager has had these problems herself. Also, it might not be a completely bad sign that they asked you so many questions, even if they weren't the right kind. If they weren't interested in you at all, they wouldn't have spent so much time talking to you!

[canigraduate]

Sounds like more of a personality issue with the managers. Honestly, I would be more worried about working for them than about them hiring you. I would sit back and review the interview objectively and make sure I wanted to work for people who aren't showing much confidence in their nursing staff.

I agree with SubSippi that it sounds more like they are focused more on their bad experiences than your qualifications.

[Esme12, ASN, BSN, RN]

As a hiring manager and supervisor and having worked in both environments......there are some nurses that come from the teaching environment thinking they want a change and find out they don't.

They have never placed an NGT, pulled a swan, called an MD. They want to know where is the lift/turn team is and don't critically think in an emergent situation. IN these larger community setting it the ICU nurses who run the codes for there are no residents/interns/fellows floating around at all hours of the day or night.

They do not like the added pressure of the increased responsibility and quickly return to the academic setting.....leaving the unit short once again.

However these managers need to get a grip, get over it and move on. My real question is....are these the type of managers you want to work under?

[monkeybug]

I'm not justifying how you were grilled by the manager, but I get where she's coming from. I've worked in both environments in L&D, an area where the gulf between teaching and non-teaching is as wide as the Atlantic. At a non-teaching facility, the nurses did a whole heckuva lot that the residents would do at a teaching hospital. And I've seen nurses with nothing but a teaching background come to a busy unit in a large, non-teaching hospital, and they floundered and failed because they just couldn't make the transition. You sound like you would be perfect in a position where you had a lot of autonomy and responsibility. She's probably been burned a few times, and so she's gun shy. I hope they give you the opportunity to show them what you're made of!

[dishes, BSN, RN]

Sounds like the managers wanted to hear answers that showed you had thought about and had insight into potential transition problems. Maybe your initial answers were weak and did not show much insight about potential adjustment problems. When interviewers seem like they are belabouring certain questions, they are reframing and expanding them, in order to give a candidate the opportunity to provide an answer that measures the behaviour they are evaluating.

[Chisca, RN]

Maybe they're afraid you will be outspoken and challenge the way they do things. Teaching hospitals emphasize evidence based practice while private hospitals will tolerate a doctor whose practice isn't current but he's been there since Moses. I have never been asked what medical school I went to when I questioned an order at a teaching institution but if you question some private practice fool you may find yourself fired.

[RNperdiem, RN]

"Spoiled nurse" made me laugh.

I am a spoiled nurse, what with the IV start team, patient transport, residents on the unit. It would be an adjustment to back to an earlier job where the pharmacist locked up the pharmacy for the night at 10pm and I had to call doctors at home.