Move from small hospital to large hospital


I have been a labor nurse since 2005, and have worked in two hospitals that both averaged between 150-180 deliveries per month with level II NICUs. My husband and I are relocating to the Tampa Bay area, which has several large hospitals.(6000-7000/year) I want to work PRN, but the thought at working at one of these hospitals makes me nervous, just because they treat much sicker women than I am used to seeing. The hospitals I have worked for have always had to transfer extremely sick women. However, I do think that the experience would be good for me. Has anyone gone from a small hospital to a large one? What was your experience?


7 Posts

Specializes in Labor & Delivery.

I am thinking about doing the same thing. I currently work for a small, level II community hospital where we do 150 deliveries per month. I am thinking about moving to a larger, level III hospital in the area where they do 300+ deliveries per month. A little nervous of the transition to the bigger hospital with the sicker patients. But also afraid if I don't make the switch now, I never will want to.


309 Posts

Specializes in Dialysis, Nephrology & Cosmetic Surgery. Has 21 years experience.

I haven't got any experience of either L&D or working in the US but I have worked in a large hospital and also one of it's satellite units. I think sometimes working in a smaller unit may give you some advantages, obviously I can only speak from the point of view of a dialysis nurse but when I worked at the smaller unit - no Dr, emergency help - we didn't even have an oxygen cylinder - we needed to be able to make decisions ourselves and I realised when I rotated back to the main hospital that I had more confidence than most of the other nurses. Were I would except a situation when it arose and deal with it, other nurses wouldn't feel comfortable relying on their own skills and judgement. I know you say that your higher acutity pts are transfered out, but I'm sure you will also have the unexpected emergency you deal with? Also at the larger hospitals they must have HDUs etc that would absorb these pts, so I feel you may be underestimating the skills and experience you have, so I wouldn't be seeing it as a disadvantage.

Hope all goes well with your adventure - Jane

Specializes in OB GYN NB. Has 16 years experience.

I say do it! My first job as an RN was at a small community Hosp. that did 450 births per year. I certainly felt I had some good experience under my belt when 5 years later I went to work for a large city hosp that did about 8000 births per year. Honestly, when I started, I felt like I was back in orientation. It was a whole other world. It was tough for the first few months, but my confidence and experience soon began flourish. I couldn't believe the variety of patients I cared for and their specialized needs. I doubt you are going to be thrown to the wolves and be given a critical care OB patient, there are nurses in that size hospital that have gotten specialized certification to handle those pt's. But, don't be shy about asking questions and learning whenever you can. I spent 3 years there, before moving to the area I am in now. Those 3 years would have probably equaled 10 years in the smaller hospital. That being said, the experiences you gained at the smaller hospital are so valuable. Nothing like being the "CODE TEAM" yourself while you wait 30 min for help to arrive. I would say that the area I felt like I lost touch with in the larger hospital is neonatal resuscitation. I would of course initiate steps, but an entire team would arrive within 15 seconds at the larger hospital.

Good luck to you which ever choice you make, but I say make the leap and enjoy your growth!


14 Posts

Thanks for the replys. Makes me feel a little better about making the transition. I figure, if I don't do it now, I won't, and I know the experience would be great.


17 Posts

Specializes in OB. Has 7 years experience.

I went from a very small community hospital, about 30 - 50, deliveries a month, to a hospital that does about 140 - 160 deliveries a month. It's a much smaller number than what you are talking about but I've seemed to finally after 3 months adjust to the swap. It's been a little challenging learning the different ways that the new hospital does things but I've made it through. I'm feel pretty more and more confident each day.


6 Posts

I was in the same situation as you a few years ago moving from a small town in Kansas to southern California. I was so scared but knew the change had to be made. I was suprised to find that women have babies in California the same way they do in Kansas!:lol2: What I realized about myself is I knew more than I realized. You're going to learn and grow so much and will be feel so proud of yourself in the end. Do not be afraid to ask questions!!

By the way.....I NEVER in a million years would've thought I'd be a charge nurse in this busy unit by now, but here I am!!

Specializes in L&D. Has 54 years experience.

I agree with LiverpoolJane about knowing more than you think. I spent most of my career working in very large Level III teaching units. Then I moved to a small, rural town. From 600 deliveries a month to 60. Much less physically demanding, but boy!! In the Big Cty Medical Center (BCMC) I couldn't get close to a bad baby for tripping over all the NNPs, residents, Neonatologists, etc. Here, it's me and the OB doc, assuming he got there for the delivery (they usually do). I've seen us get a baby delivered within 5 min of the helicopter landing on the roof of the BCMC. Here in the country, we're really good at intrauterine rescusitation because we don't have in house anesthesia, OR crew, or docs. You will be apalled at how long the docs will watch a pattern that you'd cut now for in your smaller unit. But if you can get a baby out in a flash, you can watch something yucky for longer and mayble it'll resolve or mom will deliver vaginally. I'd never done a speculum exam until I got to the little rural hospital, all those interns and medical students to train at the BCMC. Although you'll have things to learn about dealing with high risk situations on a long term basis, I'll bet you have skills and confidence in handling some things that the high risk nurses don't have. Go for it. You'll learn a lot and have a lot to teach the other nurses.

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