Pros/Cons of working in a Teaching Hospital

PamRNC · Apr 6, 2005

Pros: med students, interns, residents (1st yr, 2nd yr, 3rd yr), fellows, PAs, NPs. All this and more are available nearly around the clock, so that you don't have to chase down the attending between office hours, surgeries, and wake him/her up at all hours when your pt suddenly decides that now is the most important time to get an order for a laxative because he/she hasn't had a decent BM for the last 4 days.

Also, with all these new docs can come more approachable attitudes, they are learning, willing to share info, and in some cases willing to learn from you. :)

Since all these people are generally on the floor, or available throughout the shift, you get to know them, they get to know you, and it can make for a more cooperative work environment. You learn which docs, you have to give every last scrap of info to, and which ones you can tell to just write an order for such and such.

Cons: med students, interns, residents (1st yr, 2nd yr, 3rd yr), fellows, PAs, NPs. Sometimes, too many cooks does spoil the stew! :chuckle

If you have a particular service (ortho, onco, vasc) that works your floor, but have a boarder patient from another service (med, gyn, ob) getting ahold of the right team member might be tricky depending on whether there is a single, team beeper number that an intern carries on days and then passess on to the night intern, or if it is a guessing game between which individual team member is covering on a particular shift/day/night.

July 1st every year - that's when all the newbies roll in, and nobody knows the patients, the unit routine, or how to do the little things like order magnesium sulfate for an IV supplement vs magnesium citrate which won't supplement much of anything except the number of "code browns." :rotfl: (This is a true story - and through a physician order entry computer system - so it wasn't a handwriting problem.)

Remember the docs are doing clinical rotations too. So, depending on how their rotations are set up you may only have amonth to break one group in before they switch services and you have to start all over again with the next group. (of course, if they were not good to begin with this could go into the pros section. :rolleyes: )

Other Pros to working in a large teaching hospital:

Usually they will be doing more progressive techniques, surgeries, and looking to use some of the more techie tools to promote clinical excellence.

Often, there will be opportunities for regular staff nurses to join any number of committees to improve service, care, recruitment, retention, specialty interests like CAM - Complementary and Alternative Modalities, interdisciplinary committees (RNs, MDs, SWs, RDs, etc) for the different service lines.

Larger hospitals often look to go for recognition through Magnet.

Teaching hospitals also do research (nursing, medical, etc)

Nursing students!!! had to save the best for last :chuckle

newgrad2005 · Apr 6, 2005

Are you looking at UCI??? Just curious :-)

SmilingBluEyes · Apr 6, 2005

I MUCH prefer working in a community hospital on the small side versus a large teaching hospital. The care I render is much more personal and I am allowed a much more autonomous practice as an RN at the smaller hospital. I appreciate residents and large classes of nurses have to learn someplace; I just would rather not deal with tons of them underfoot where I work. JMO.

BETSRN · Apr 7, 2005

I MUCH prefer working in a community hospital on the small side versus a large teaching hospital. The care I render is much more personal and I am allowed a much more autonomous practice as an RN at the smaller hospital. I appreciate residents and large classes of nurses have to learn someplace; I just would rather not deal with tons of them underfoot where I work. JMO.

I,too, have always liked the autonomy I have. I have always functioned like those interns and residents.

I always wonder what I would do if I didn't have that autonomy?

It might be nice to NOT have it sometimes.

JaneyW · Apr 7, 2005

I,too, have always liked the autonomy I have. I have always functioned like those interns and residents.
I always wonder what I would do if I didn't have that autonomy?
It might be nice to NOT have it sometimes.

EXACTLY!! We don't even have 24 hour anaesthesia even though we do about 160-180 births a month. Boy it would be nice to pass the buck or call in a NICU nurse for a birth (we have no NICU!!!).

However, last night we had one of those panic-type brady episodes x3 in a row. If we hadn't had to wait for the doc to come from home, it would have been a stat c/s. But we held it together--prepared for the worst as best we could--and the doc was able to deliver an 8/9 apgar baby by vacuum without cutting.

SmilingBluEyes · Apr 7, 2005

you do that many births and no 24/7 anesthesia coverage? WOW bad deal. I would not like that at all.

JaneyW · Apr 8, 2005

you do that many births and no 24/7 anesthesia coverage? WOW bad deal. I would not like that at all.

That is really one of the only reasons I feel I might need to leave. I told my manager that I think the main reason we have trouble finding good staff that will stay is because of the anesthesia issue. The hospital just won't do it. Our anesthesia will also go home--sometimes 30 minutes+ away shortly after starting epidurals at 2am. Or when we have a full board of 8 active patients. It is very frustrating and would only take one bad case.

I would also like to have a NICU. We have to call a perinatal transport team that can take 30+ minutes to arrive. It's just that stress in the back of your mind all night. The nurses I work with are soooo awesome and that's what really keeps the unit going as smoothly as it does. I have learned so very much from these ladies and enjoy being there and feel very confident in our team work.

SmilingBluEyes · Apr 8, 2005

I assume you don't allow VBAC right? What concerns me about lack of 24/7 anesthesia, is you have no idea what is coming in the doors, and what emergent case you may face. What do you do in these cases, lacking anesthesia coverage?