My 1st job as a Peds RN; need advice

**canoehead, BSN, RN** · Aug 28, 2004

Hmmm, it's a tough decision.

If you didn't have to move I'd go with the big hospital as they will be used to nurturing new grads. Once you got your feet under you it would be easy to subspecialize to teh field you like.

If the smaller hospital has a good orientation program and a supportive staff you could do a year there to get experience and confidence, then decide if you want to make the big move or try something else. Keep in mind that at a smaller place you may learn things that will have to be unlearned at a larger facility.

I started as a new grad at a large facility and found it intimidating, but supportive. As I moved through my career- far from peds now- the most common fear for more general nurses is sick kids, and it's a worry I don't think I'll ever have to deal with. Good luck no matter what you decide.

GottaBeanRN · Aug 28, 2004

Hi Canoehead,

Thank you for getting back to me. I was just wondering what types of things do you think I would learn at a smaller facility? I thought I would learn more at a huge children's hospital as opposed to a smaller one.

I am nervous about being intimidated. But I suppose everyone is. I am just so tossed b/n the 2.

Pediatric Critical Care Columnist · Aug 28, 2004

Just weighing in with my $.02... I think what Canoehead was saying was that you may learn the ropes at the smaller hospital, then make a move to something with a more dedicated pediatric focus, to find that what you've learned is very old-school and not at all current practice. You would certainly get a much broader pediatric knowledge base at the larger centre. Community hospitals are great for their smaller census, lower acuity levels and time to provide all the finer touches. But in terms of seeing and doing I think you'd learn more and develop better assessment skills at the bigger centre. That is where your community hospital will be sending their sicker kids, and those who need specialized treatment.

I will admit to a bias here, since I have only worked at tertiary and quaternary care facilities. I've admitted kids from community hospitals whose outcomes would have been much better (like they'd be alive...) if we'd gotten them much sooner. And my own son was a patient on a pediatric ward of a community hospital where he was allowed, at the age of three, to roam around his room unsupervised, with an IV in his little hand. Mommy comes in to find the tubing wrapped 600 times around the pole and the cathlon nearly out and kinked over near the tip. Thank God it was the pole and not his neck! I guess they thought he'd be safe because the door was closed!!!

mgc239 · Aug 28, 2004

Hi there

I was in a similar situation 5 years ago, and I went with the big city hospital. I am glad I did because I have learned so much, and they ended up paying for my graduate degree at NYU as a PNP. I have taken courses at other community hospitals and after only 5 years RN experience, I already feel that my knowledge base and assessment skills are far beyond what their experiences have been. Ultimately, it is up to you with what you are comfortable with, but trust me, after a year, you will most likely feel comfortable with the position. Being in a large hospital also gives you added benefits, and experiences with those that are top in their field.

Hope that helps!

Maria, RN, PNP:balloons:

eb_rn · Aug 29, 2004

its been my experience that a small hospital may offer more support and help develope a basic knowledge of general peds prob....rsv/ pneumonia/ bug bites/tummy aches, etc.. but a larger hospital will give u more experience on syndromes, anomialies, etc. while also giving u the knowledge in the gen. stuff as well.......I work in a mod. size childrens hospital and have seen tons of syndromes. We also get most of the abused kids in the state. And we have a vent ward, long term trach/vent kids. It has been interesting, and my environment has always been one of support...I have not ever felt that I was left alone to sink or swim...... however, my experience in a small hospital (it was an adult hospital, but in a small town, total bed # was 60, including ALL ICU/LDRP beds as well as reg. hospital admissions) I was given mediocre support for my 2 weeks orientation, but was left to handle it on my own...charge nurse over all patients, except LDRP/ICU/ER...and there was only 3...yes 3...RNs in the entire hospital. This was pm shift and there were also 2 paramedics in ER, unless they were out on a run...oh, and the on call md was in ER, unless there werent any pts, then he went home...yes home...and that was at least 15 minutes away. So, my long winded explanation really just says, that small hospitals offer a different learning experience that larger hospitals, it just depends on u and what u need on whether or not u should choose a small or large facility to work in.

GottaBeanRN · Aug 29, 2004

Thanks to all of you for your informative responses. I really appreciate it. I still have not made a decision but believe me I can not stop thinking about it and doing my research. There are other factors, important factors, that come into play with my decision. But I thought I should begin with the pros/cons of both hospitals. To me, I know I would learn a lot more at the large teaching hospital and become a great nurse. However, the other hospital seems to offer great things as well. I guess I just have a lot of thinking to do.

But thanks again and I am still open for suggestions!

jeepgirl, LPN, NP · Oct 8, 2004

i would go for the place where you can get a better orientation. i had a hard time transitioning to peds when i got out of school... i too had NO clinicals in pediatrics and very little classroom instruction. it was really a hinderance to me.