Question for those that hire

[EDRN-2010]

Does the hospital a RN is coming from impact whether or not you will interview the person? As I begin to think about my finding my first RN job, I am wondering this. There is a really good chance that if I had trouble finding a job, through connections I could get a position in the ED at a local community hospital. A friend of mine thinks working at a small "hick town" hospital might make me less desirable when/if I applied for a job at one of the large level 1 trauma hospitals. I am thinking that having experience would be a plus? What do you think?

[llg, PhD, RN]

That's a good question. I think it really depends on the individual situation. There are a lot of factors that could influence this. In most cases, I think the small-town experience would be considered an asset rather than a liability -- particularly if you are only there for a year or two.

However, I can see it being a disadvantage if you present yourself as being "settled in" to a slower pace and less acute patient population. My clinical field is neonatal ICU, not ED ... but I have seen where some people whose experience is all at "lower level" NICU's become overwhelmed with the "big time" NICU environment. Sometimes a new grad is more able to adapt than someone who has established a comfort level with a lower level of care. For some people, it's hard to change once they have "settled in" to a slower pace or less acuity. I have seen that happen to some NICU orientees.

I think it would be important to present yourself as someone who is a real "go getter" and who was very able and willing to learn new things -- and as a somewhat "high energy" person. Get all the certifications you can, etc.

I'll be interested in reading what other managers and unit educators have to say on this topic.

Thanks for starting the thread.

[FrogKissingNurse]

I agree with you! I don't think it really matters where you come from, I think it is the experience that matters. Your exposure in a small town ED would most likely be pretty low key compared to a ED in a large city, but you would still have experience and know how the ED works. When you apply for a job it doesn't say that if you're from a small town ED we won't accept you at a large ED. However they would probably be more likely to hire someone with experience in a level 1 trauma center before you, but still. I say take the job, especially since everyone is having a hard time finding jobs. If you can get a job don't worry about how it will impact things later, be grateful that you have a job!

[MedSurgeMess]

you know, some of the stuff that you see in the "big city hospital" comes from the "hickville hospital". Who sees them first at the hickville hospital? The ER there. I think if that's where you get an offer first, then go for it. You will see all kinds of things regardless of what ER you work at. It's a variety.

[EDRN-2010]

First off, Thanks for the reply!!

Your statement below is the exactly what I was thinking.

Sometimes a new grad is more able to adapt than someone who has established a comfort level with a lower level of care.

Part of me thinks I should wait to apply at this hospital and see if I can some how get a position in one of the larger hospitals that I would like to work in. Part of me thinks it sure would take some of the pressure off to just apply at the hospital now.

[classicdame, MSN, EdD]

Anyone can have bias for any number of reasons. But I have known nurses in "hick-town" hospitals who, for a lack of available personnel, were able to perform multiple duties because there was no one else to do them. Then the nurse from a big city tertiary hospital might have so many "teams" supporting him/her that the individual nurse is less flexible. So it still comes down to the person wanting the job and how well they convince me I need to hire them.

[HouTx, BSN, MSN, EdD]

Anyone who thinks that small town ED's don't have to handle any high-level situations - - - doesn't have an accurate impression. In addition to dealing with really grisly accidents (ever seen lower limbs after they've been on the receiving end of farm equipment???), nurses frequently have to function as a medical resident until the doc can get there... in addition to dispatching ambulances and sometimes functioning as the town's 'dial a nurse' for anything remotely medical... LOL.

The true challenge???? Tiny 'critical access' facilities where the (one and only) RN not only has to be the Ed nurse, but also the OB nurse, the House Supervisor, the substitute pharmacist, etc. etc. etc.

[EDRN-2010]

This is true for sure!

My friend (an RN) who made the original comment is married to a doctor at a level 1 trauma center and probably got a biased opinion from him! She felt the managers in the level 1 centers would shy away from nurses from small hospitals and went so far as to say that they would even rather a new grad because they were easier to mold or something along those lines. It sort of made sense to me but not really. I feel like having experience is better than not and I know I could play up all the positives in an interview.

But, Knowing I do not want to retire with this hospital...if what she said is true I might be more aggressively in finding a job somewhere else. (likewise if the consensus was it wouldn't make a difference it sure would take some of the pressure off to not have to hunt and agressively persue every job posting like so many new grads right now)

I definetly have nothing against the small hospitals, my main reasons for not wanting to make this a permanent home is due to non-nursing reasons -their union, health benefit package, earned time, pay/advancement scale, employee retention and satisfaction, stuff like that. All things that wouldn't be a big deal for the short term but would be enough of an issue for me to want to move on once I have some time in.

Anyone who thinks that small town ED's don't have to handle any high-level situations - - - doesn't have an accurate impression. In addition to dealing with really grisly accidents (ever seen lower limbs after they've been on the receiving end of farm equipment???), nurses frequently have to function as a medical resident until the doc can get there... in addition to dispatching ambulances and sometimes functioning as the town's 'dial a nurse' for anything remotely medical... LOL.

The true challenge???? Tiny 'critical access' facilities where the (one and only) RN not only has to be the Ed nurse, but also the OB nurse, the House Supervisor, the substitute pharmacist, etc. etc. etc.

[DogWmn]

I worked in a small town with a 35 bed hospital, I was next door and worked as a Family Practice Clinic nurse, yet when a big accident came in we along with the docs, were called next door to the little ED. Of course first we would re-schedule patients, then trot over. So even though I was never offical but still an employee of the hospital system, I worked in the ED on occasion - a lot of times my job was to assist on casting simple fractures or looooong suture events and I also spent a lot of time picking gunk out of wounds, or helping with a Peds patient. It was a "all hands on deck" kind of thing you won't find in any big city ED. Not many LPN's ever get to work in an ED environment, so I truely enjoyed those times and according to the RN's I worked with they were greatful for an extra pair of educated hands. Also, a big plus, we were used to working with our Doc's day in and day out and knew their ummm how do I put this politely...their "quirks" better than the hospital nurses who would only see them briefly each day.

As the previous poster stated, in many of those "hick town" ED's the RN/LPN does a lot more than someone in a big city environment.

I love living in a rural environment but it's not for everyone, if you do decide to take the job, look at it as an adventure. There is a lot of history in small towns, counties and regions - so explore and enjoy, who knows you might discover a new hobby!

[llg, PhD, RN]

I never meant to imply that nurses working in small towns don't ever see "big tme" cases. I come from a small town and know that is not true. I'm sorry if I offended anyone with my earlier comments.

However, the environment in many small town community hospitals can be very different from that of an urban tertiary care center -- particularly one that sees more of such cases every day. The culture is different, and that can be a problem for some people (but not for everyone of course.)

As I said ... a lot depends on the individual person and on the individual ED's involved.

[EDRN-2010]

I didn't get the impression that you offended anyone, especially not me! I thought the reference was regarding my friends advice to me to not take a job at a small hospital.

I never meant to imply that nurses working in small towns don't ever see "big tme" cases. I come from a small town and know that is not true. I'm sorry if I offended anyone with my earlier comments.

However, the environment in many small town community hospitals can be very different from that of an urban tertiary care center -- particularly one that sees more of such cases every day. The culture is different, and that can be a problem for some people (but not for everyone of course.)

As I said ... a lot depends on the individual person and on the individual ED's involved.

[Blackheartednurse]

I think rather than the unit one previously worked on counts more than lets say the name and prestige of the hospital....If I was a manager I wouldnt give a fly f...what hospital the nurse is coming from but rather what floor she worked at..with that said I will be starting my first RN position at the largest private teaching hospital in the state on a very marketable floor (telemetry)--but I think this particular unit may open the door for me to other specialties like ER or ICU rather than the fame or excellence of the hospital.Also I didnt "go" for this hospital particularly,I applied to many different hospitals,clinic,nursing homes...but the trauma 1 hospital was actually the one that was willing to give me a chance.