Large hospital and specialize or small hospital and cross train?

JennRN65 · Sep 8, 2008

I am a nursing student graduating in December. I am trying to decide whether to work at a larger hospital and specialize (L&D, ER, ICU, Med, Surg, etc.), or work at one of the smaller rural hospitals in our area and cross train. I like the variety of patients and experiences that I am having precepting in the small hospital, but many of the more critical patients get shipped out. Any suggestions or advice would be greatly appreciated.

Do you have a specific long term goal?? Which of the populations have you enjoyed working with the most?

applelady · Sep 8, 2008

So far I've enjoyed the smaller hospital atmosphere more than the larger hospital, for many reasons. I enjoy having a variety of patients with varying needs. I've also noticed that at the two smaller hospitals that I have done clinicals at, the nurses work more as a team instead of individually in caring for their patients.

Long term, I hope to work towards maternal/neonate healthcare, ICU or ER, but I'm not closing any doors as of yet. There's really not any part of the hospital that I haven't enjoyed.

snowfreeze, BSN, RN · Sep 8, 2008

There are two routes, take the small hospital and semi specialize in everything for a rewarding career at the low level or work really hard for a while (teaching facility environments can be stressful) and work in some specialty units and get some awesome experience then as you slow down toward retirement, work in a small town facility and have enough experience to be comfortable with just about anything that arrives.

Also be aware that there is a new direction for improving work environments. Doctors won't be allowed to belittle you and co-workers wont be allowed to do that either.

What do you expect to achieve as a nurse? Do you want to teach new nurses, or be the most awesome nurse manager of all time. You sound like you would like some experence in many aspects. I wanted to be a flight nurse so I got a job in one of the toughest facilities with a low nurse patient ratio just so I could get my time in for a position in the future because that facility had just been purchased by a facility that had an awesome critical care flight team. My plan worked, I loved it and learned a lot. I am now a travel nurse.

Good luck with what ever you choose.

Do some research about your local facilities.

accessqueen · Sep 8, 2008

You have to follow your heart on this one. When I was younger, I needed to be where the action was. I worked ICU in a 1300 bed teaching hospital. I really really loved it and learned a heck of a lot. 27 years later, you couldn't pay me enough to work in that kind of environment. But I know that I 've been there done that. So now I work in a small 130 bed community hospital running the PICC team, and I love it. But if I'd never worked in a larger, action filled hospital I'd probably feel like I don't measure up somehow. So, ask yourself, what's going to make you happy? do you need to be where the action is with lots of blood and gore? or do you like a slower pace where you can really bond with your patients? The good thing about nursing is you can always change. You can always go somewhere else and learn something new. So follow your heart.

tiggerforhim · Sep 8, 2008

You've got great opportunities either way. However, and this is my opinion based on my personal experience, cross-training is a great way to get a wide variety of experience that will allow you to truly discover your niche. Some nurses go all to pieces if they are put in an area that's not their specialty. My first job was a float pool nurse in a major Magnet teaching hospital. I was assigned to a large variety of units, and had I stayed there I'd have gotten the training to be an ICU float nurse. However, I gained an amazing variety of experiences and discovered where I truly loved working, which was Peds, and when we moved, then I took my next job as a Peds nurse. My current job has me working with chronic illnesses of a variety of rare diseases, but a large component is still kids, and I work with them as often as I can. So, I guess, my point is, getting the basics down in a large variety of settings can only help you if you decide to go on and specialize in one area of nursing. As long as you're not afraid to ask lots of questions in all different areas, you'll do very well. In any case, you'll learn so much in your first year of nursing I don't think it will matter much if it's small hospital/wide variety, or large hospital/specialty. When I took my Peds job we would get sent to other Peds floors for staffing issues, but because I'd had a great experience in my first job, I loved the floating, and looked upon it as an opportunity to learn something. Just my 2 cents.