Larger Teaching State Funded or Small Community Private Hospital?

[KarmaComesAround]

If you had to make a choice, which one and why? Pros and Cons. Have you worked at both, and which one did you like better as far as how they treated staff, supplies available, atmosphere, nurse to patient ratios, benefits? Thanks for your time in advance.

[wooh, BSN, RN]

Large teaching state funded. No contest.

Small community private hospital? Nurses will ALWAYS be sacrificed to the whims of the physicians. Docs bring in the money, nurses cost money. Worked in one, my little sister is currently working in one, and if it comes down to staff vs physician? Doc will win EVERY SINGLE TIME.

And the "nurses cost money" attitude is in everything. You will never get a bit of respect, you're just a red line on the budget sheet.

[NickiLaughs, ADN, BSN, RN]

It kinda depends on where you are in your career.

As a newer nurse, I would recommend the big teaching hospital. You are going to get your bootie kicked around, BUT the experience is invaluable, and you will appreciate the good things that are present at other hospitals. Usually a big teaching hospital you are going to work hard, learn a lot, the supplies can be good or bad, depends. Staff can be brutal (at least in my experience), ratios can be rough. Benefits usually better. A big unit you can meet staff when you've been there 6 months and they think you are starting your first week.

Community hospital will probably allow you quicker ride up the ladder depending on the turn over. There will be a feeling of more of a family environment typically. Lower acuity on average which can make you ill prepared for the rough days, although it would depend on the facility.

[Corey Narry, MSN, RN, NP]

Based on my experience, as I've worked in both as an RN (I'm an NP now)...

Large teaching state funded hospital

PROS: great learning environment in terms of interesting cases, rounds with attendings and team of residents with nurse input always sought after, lots of support from highly-experienced nursing educators and CNS, well laid out and clear-cut policies and procedures, strong collective bargaining for nursing staff, state pension, nursing staff in general has a voice in plan of care, care is evidence-based driven and follows national guidelines, access to online educational resources from the university, discount with hospital sponsored CEU's, and even for graduate school (if affiliated with a nursing school).

CONS: large system -- you only meet nurses in your unit and some per-diem floats, location typically in large congested cities so parking spot is limited -- you either park off site if new and get shuttled, parking usually not free. New residents each July or August and orders are never right.

Small private community hospital

PROS: closely-knit setting, you know everyone, parking is easy and free, better gifts for nurses during the holidays and annual nurses week.

CONS: physicians rule and get treated like king...they bring revenue! private practice physicians too old to be practicing or not following evidence-based medicine and deviating from national guidelines to suit profit for self, little support from nursing administration in terms of education (very few experts such as educators and CNS), downsizing common making workload heavy (you have to do everything cause ancillary staff were dissolved to save money), union weak, few interesting cases, no residents to call during the off shifts so you have to "bother" and attending who isn't too happy with your page or phonecall.

Isn't it obvious, I prefer the academic hospitals better!