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Pros & cons: working at a small vs large hospital?



I recently moved to a new state and I currently have one year of telemetry experience at a big, busy level 1 trauma hospital. I have had opportunities arise from two different hospitals for somewhat similar positions:

  • Neuro PCU at a similar hospital to where I worked (Level 1 trauma) It's also a brand new unit.
  • Intermediate care floor (not super sure the difference between PCU and intermediate care?) at a small hospital which is a campus of a very closeby somewhat bigger hospital. This is more general medical patients. I already had my interview here (haven't yet for the other position), and while it seemed like a great team with good management, I am a little apprehensive. There is no ICU and no OR at this hospital. So that floor would technically be the highest level of care there? If a patient crashes or needs surgery, they have to be transferred to the main hospital.

So, I'm basically just looking for the biggest differences in working at a small vs large hospital, and if anyone has any advice on which I should lean toward. :happy: Thanks!

DextersDisciple, BSN, RN

Has 8 years experience.

Well do you want to work with higher acuity pts? The sicker pts will be at the larger hospital. I work For a large hospital and one of the small hospitals it owns. I like the change of pace and the community hospital feel. I usually know most people I see In the halls by name and always say good morning To those I don’t.

Neuro PCU sounds awful. Very Confused/agitated but not sick enough to be intubated and sedated? Chances are you’ll have 3-4 pts all trying to climb out of bed at the same time. I worked in a med surg/neuro ICU and that was tough enough with just 2 semi-conscious confused pts to take care of.

And since it a brand new unit I’m sure there will be manyyy kinks that will need to be worked out from the get-go.

I would worry more about a unit being brand new than the type of patients you'll have. As DextersDisciple said there will be many kinks to work out, to put it nicely.