pro's vs. con's of working in a teaching hospital

Hey there!

I work in the ER (Trauma) @ a vey big teaching hospital. I love it 'cuz you work with new residents every other month. Sometimes its a little frustrating due to the lack of experience of the resi's but they are very smart and catch on quite fast.......

I liked it, since the whole facility was accustomed to people asking questions and learning stuff. I found the interns and residents, and attendings to be very helpful and supportive to each other and to the nurses. And vice versa. Hard-working and very smart people for the most part. (This was in a VA hospital.)

The main problem, as seems often to be the case, was the way the nurses treated each other--particularly those in management.

Technology is great in teaching hosp. Sometimes in the OR the residents are a pain, you already have so much work, but find yourself always cleaning up something for them. You have to track them down to get permits signed and for verification of procedures at the beginning of the day only to find they have changed the whole OR schedule and they would not have contacted you about this, had you not called them first, but who do you think gets blamed by the attending?

Teaching hospitals are a great place to learn! You see all sorts of esoteric illnesses you wouldn't see in you basic community hospital, plus you get the chance to participate in new treatments. You can participate in research, often whether you want to or not, when patients on studies are admitted to your unit. Staff education is usually emphasized, at least in the 4 teaching hospitals I've worked in.

On the minus side, there are the residents. On the first day of my present job, one of the old-timers took me aside and told me "Part of your job is to prevent the residents from killing the patients." I've found that to be true! On the other hand, you have a real opportunity to contribute to the education of the residents -- if you're an experienced nurse, they can learn a lot from you and the good ones know it.

Staff tends to be younger and more mobile in a teaching hospital, which means turnover is tremendous. That, too, can be a plus or a minus.

There's always a physician around when you need one to "bless and order," which cuts down on late night phone calls to cranky attendings. (The residents get to call the cranky attending!)

There are usually student PTs, RTs, nurses, pharmacists, dieticians, etc. around in addition to the medical students, residents and fellows (who seem to travel in packs anyway) so travvic is a real concern during day shift and during the week. On the other hand, you can learn a lot from those folks, too. I have.

The last time I worked in a private hospital was 14 years ago. I worked with a surgeon who had a propensity for taking dead people to the OR (was he really willing to use any last-ditch effort to save a life, or was he collecting fees?) and a pulmonologist who bronched every one of his patients every day whenever he was planning to buy another chunk of real estate or take a fancy vacation. You don't see that in a teaching hospital!

I worked in a teaching hospital for 13 years. Overall, it was a really good experience. You tend to see a little bit of everything, unusual stuff you might not see anywhere else, and to work with a great variety of people. You can learn a lot, too, because they are accustomed to teaching and some of the docs really love to teach. Sometimes dealing with the students/residents is a pain, but you also become part of their educational process. Teaching hospitals also tend to be big places, with a variety of specialty areas, so that you can move around and get a lot of varying experience without actually changing jobs. It was an experience I wouldn't have missed.

I love working in a teaching hospital. The residents are much friendlier and more respectful of nurses (so far). There is always someone there to give orders anytime of the day. I also love that they are learning just like everyone else.

First of all, I'd like to respectfully disagree with the person who said that teaching hospitals have the best technology- this is NOT the case (no offense intended; I'm sure you were lucky!) in all hospitals. Many medical schools in large urban areas have more than one hospital that they utilize, to provide the greatest variety of experiences for their students/interns/residents, and this can very much include those hellhole facilities that you wouldn't take your neighbor's biting dog too, trust me on that one! :)

Downers:

-They don't know squat. You will be teaching them almost as much as their instructors are. This can be dangerous if you aren't on your toes, because they will write the wrong medications, the wrong doses, go up on the rate when they should be going down, give 02 to a heart patient that can't have it and vice versa, etc. They will ask you lots of questions, some of which you won't know the answers to, which is frightening, because if you don't know them, SOMEONE has to make sure that that person gets the correct information, and this has to happen quickly.

-They're worse than a bachelorette party crammed into a bathroom after a long night of boozing. They do indeed travel in packs, and you'll have to fight your way through a throng of them sometimes to get what you need or get to your patient. They have a habit of, when in groups, standing around your decompensating patient who's suddenly crumping out on you and offering no help at all because they're either frozen stiff in fear or literally don't know what to do first because of their lack of experience.

-They get cranky at night just like the docs do. Don't think that just because they're students that they don't mind being woken up- doesn't matter WHAT you're doing or how important it is. Some of them will tell you not to call them until morning. Some of them will yell at you if they feel you've woken them up unreasonably. Some of them will huff their way all the way to the unit and then be an a**hole to you all night long. They like to sleep, too, so you're not getting off THAT hook.

-They will rotate through every 30 days or so. You will finally learn someone's name and they will be gone. Some of them don't care about that rotation because it's not their primary choice (ie, a pedi MD who couldn't give a crap about truly learning anything on your geriatric floor). Some of them, because of this, will give poor care because they're heart isn't in it. This is not good for the patients. There is little consistency to be had with so many people rotating through.

That said, I LOVE working in teaching hospitals, and now I'll tell you why.

Pluses:

-They don't know squat. You have a wonderful opportunity to teach them what you know. You can share little things that mean a lot to the patients, things that aren't taught in medical school. You can teach them how to show compassion, you can teach them how to be gentle, you can show them how to maneuver a patient to inspect a wound without hurting them in the process. You can teach them that all nurses are not horrible and that the job we do is ESSENTIAL to them succeeding as a doctor. You can teach them all you know about healthcare, because they are there to learn, and for the most part, if you approach it in a tactful way, they are all ears and will utilize you as a resource. They will also ask you what YOU think about the course of treatment, and you will have a fabulous opportunity to suggest things that they might not have thought of (for instance, maybe the reason that baby is having bradycardia and desatting is not because she needs more 02, but because she is experiencing reflux and it's painful for her). You can literally have an effect on the care your patient receives, and for me this is priceless. Also, if you're learning a new job, or a new condition, or you're a new grad who doesn't know anything about real-life nursing, they become your friends. You're all learning together, and this is wonderful IMO. You can ask each other questions, even if they seem stupid or common-sense (you KNOW you should know this, but for some reason you don't...) because you're ALL learning together.

-They travel in packs. There is ALWAYS someone present during the day, usually multiple someones, who might be able to help you with SOMETHING. They have knowledge that we don't, just like we know things that they don't. This can be very valuable if you just tap into it! Usually when they're on the unit, so is the doctor who's in charge of them. If something goes wrong, there are people to assist you, etc. Plus, if you have an audience of med students, every little thing you do looks amazing. I work in the NICU, and you'd be surprised: Wow! How do you turn that baby over like that without tangling anything up? Can you show that to me? Or more often, it's me going to them and saying, Hey, you know, if you do this this way, it won't get tangled like that...and then they look at you like you're Jehovah and you feel infinitely better about yourself. Always a plus.

-Cranky interns? Guess what? They're not ALLOWED to treat you like crap, and if they do, they have a supervising doc that has your back in more ways than one. After hearing my cardiac-nursing mom complain about the primadonna doctors kicking the trashcan clear across the room because she brought him the wrong kind of occlusive dressing (He preferred a certain brand), I'm thankful that if that DOES happen to me, I can have a one-on-one with the person who is responsible for passing them. Enough said.

-Rotating every thirty days is sometimes a BLESSING. If you don't get along with someone, personality clash, dangerous practices, whatever, they'll be gone in a month.

And I could go on. I have so far loved working in teaching hospitals and will probably, if I am ever to move, investigate the teaching hospitals in the new area FIRST before I even look at the privately owned facilities. Currently, my teaching facility is progressive and a real environment of learning for all people who work there. We have specialties that, because of our affiliation with leading research teams, are known all over the country and are nationally recognized for being the best. That makes me proud to work there. But that's not the only reason. I've had experiences in a number of other hospitals, and they're not all the same. Generally, though, I like 'em.

RubyVee...your last statement.."you don't see that in a teaching hospital..."

In mine I saw it. I worked neuro.......and we got lots of overflow..medical , surgical, everything ...

The neuro docs had only had experience on cadavers.

Where are they going to get experience doing Lumbar Punctures?

EVERY pt who came onto our unit- - the medicare/medicaid patients.... I'd guess 80 % of them got an LP. The doc explained to them that they had an elevated temp and he was "checking for an infection."

I saw LOTS of different invasive procedures done....

after all, that IS where they learn....

they don't learn it all on cadavers.

They have to have a warm body with blood circulating thru it....pressures to measure, specimens to obtain, etc.

And saw a few "complications" as a result of these

needless interventions.

Passing Thru, VERY good point!

I had completely forgotten about that. In the NICU, what that translates to is babies who probably SHOULDN'T be resuscitated ARE, and with physical issues because of it that the family will now have to deal with, just because the resi's need to practice intubation on SOMEONE.

I have a friend who works in an ER and she says that at her hospital (which is also teaching-affiliated), the most recent example of this was a gunshot victim who came in, was coded, and died. The family brought him in, all forty of them, and they were a mess because this guy was only 18 and apparantly was not the intended victim; he was just riding his bike down the street. The students and their supervisor kept his naked body in the ER for TWO HOURS after he died to practice intubation on him, the whole time the family outside grieving and wanting to come in and say their goodbyes.

So that's definitely a negative, but thank goodness it doesn't happen all the time!

One of my best jobs and most pleasant experiences/memories came from my time in a large teaching hospital. I loved it!! Much more collaboration with the medical staff on dealing with patient care issues, of course it was mainly because of the residents. When the faculty came to round with the residents they would nearly every time ask me (and other nursing staff) to join them on rounds and allow us to participate in answering and asking questions. It was so much fun and very rewarding. Most of the residents relied heavily on the nursing staff to help them to not make fatal errors. We also saw lots of stuff I haven't seen anywhere else.