Small or large hospital as starting point?

TNRNMAN · Oct 1, 2005

I am interested getting some input on your experiences with chosing a hospital for your first nursing job....primarily relating to the size of the facility.
I have narrowed down my options to two hospitals, both that SEEM to have a very positive work environment. One is a large hospital with a very structured new grad program, one is a small community hospital with informal mentoring/orientation for new grads.
My question is: What, in your personal experiences, were the
positive/negative aspects of starting at one or the other, large or small? While I have always envisioned myself working in a small community hospital close to home, I am concerned that I may be limiting myself a bit in regard to learning opportunities/potential areas of practice within the hospital by starting out there.
Thanks for your input :) .

Well here I go, keep in mind I need sleep if this sounds weird, I have already messed up one reply,

I started at a small community hospital and grew from an LPN to RN in that time and learned alot and sometimes thought I had learned all there was to learn to a degree and thought I was the stuff in Cardiac care and ER care, well then I went to the Big City and boy did I find out real quick I did not know JACK, if my opinion your young and new now is the time to learn and grow all you can I wish a thousand times that I had gone to the BIG hospital many years before I did. But again I say, DO WHAT FEELS RIGHT FOR YOU> :)

LeesieBug · Oct 1, 2005

Thanks for the response.

What you experienced is exactly what I am a bit concerned over....however, as I have been mulling this over today, I think I MIGHT have come up with a posible solution to this. I am starting to lean toward going with the smaller hopital, then as I gain basic experience looking into doing per diem work at a larger facility to gain broader, more diverse experiences that I can apply to my practice at the community hospital. Hmmm...maybe.

I do know one nurse who did something similar to this. She worked in a small SCN for years, felt the need to broaden her horizons and took a per diem job at a major medical center in a NICU. Seemed to work out for her pretty well.

Anyway... thanks again for the response..if anyone else has something to share, I'd sure appreciate it.

10ACGIRL · Oct 1, 2005

My answer is try an ALF first but make sur that it is not a skilled nursing facility. They expect toooo much work whether it be an 8,12,16 hour shift. I begged for the ALF upstairs because the SNF expected me to put 16 hour like work on 30 residents in an 8 hour shift. Thats just too much for me. :cool:

I am interested getting some input on your experiences with chosing a hospital for your first nursing job....primarily relating to the size of the facility.
I have narrowed down my options to two hospitals, both that SEEM to have a very positive work environment. One is a large hospital with a very structured new grad program, one is a small community hospital with informal mentoring/orientation for new grads.
My question is: What, in your personal experiences, were the
positive/negative aspects of starting at one or the other, large or small? While I have always envisioned myself working in a small community hospital close to home, I am concerned that I may be limiting myself a bit in regard to learning opportunities/potential areas of practice within the hospital by starting out there.
Thanks for your input :) .

NurseyBaby'05, BSN, RN · Oct 1, 2005

I am starting out in a 900 bed Level I trauma center. The acuity of the patients is great. Most of them are from outlying community hospitals coming to the city for answers. The experience is great, but can be very overwhelming at times. I see a lot of everything. That, in itself, is a double edged sword. There are days I am cursing myself for biting off more than I can chew. On the other hand I know I will probably have another patient with the same issues next week for reenforcement. That way, when I finally do catch on, the skill won't be lost. Let me try to clarify that. If there is some procedure, disease, diagnosis that's a little uncommon, it won't be the only one I will see for a year like you would at a smaller hospital.

Altra, BSN, RN · Oct 3, 2005

I am starting out in a 900 bed Level I trauma center. The acuity of the patients is great. Most of them are from outlying community hospitals coming to the city for answers. The experience is great, but can be very overwhelming at times. I see a lot of everything. That, in itself, is a double edged sword. There are days I am cursing myself for biting off more than I can chew. On the other hand I know I will probably have another patient with the same issues next week for reenforcement. That way, when I finally do catch on, the skill won't be lost. Let me try to clarify that. If there is some procedure, disease, diagnosis that's a little uncommon, it won't be the only one I will see for a year like you would at a smaller hospital.

LeesieBug, the choice you described between the 2 hospitals is EXACTLY what I mulled over. I had most of my school clinicals at a small hospital in my own community. I also worked there as a tech. But ultimately I chose the larger, urban Level I ER.

As NurseyBaby described, there have been many times in the last 3 months that I've muttered to myself "WTH was I thinking??" It can be overwheming. There have been and probably will continue to be some jarring bumps in the road, but I'm glad I made the choice that I did. The variety and intensity of my experiences at the larger hospital are way beyond what I would have had at the smaller hospital. I'm also glad to be in a teaching hospital. There is generally a different working relationship with the physicians, and a much stronger commitment to continuing education, than I had seen in the 'burbs.

I also had the same structured orientation vs. individualized, less formal mentoring alternatives to consider. I felt that a structured orientation would be better for me, and I think that, at the very least, a formal new grad orientation program indicates at least some level of commitment on the part of the facility.

Nothing is written in stone - if I find that I want to come back to the smaller hospital, then I will pursue that.

Only you can decide what's best for you. Let us know how things turn out. :)

AlexCCRN · Oct 3, 2005

Large hospitals typically see high acuity patients. New grads are often attracted to the challenge and prestige. However, there is the 'churn & burn' factor. New grads are ill-equiped to meet the challenge and the experience can demorolize if your not precepted properly. Community hospitals might be a better starting point; a place to grow and solidify core talent, build confidence, establish a reputation. Particularly, a hospital that hosts a SON is optimal: very nurse friendly mostly. Move up to a large facility when your ready to acquire high level experience. As an anology, Med/Surg before Critical Care. Many think otherwise but they're wrong. Just a few months Med/Surg experience will stand by you; makes you more flexible and self-sufficient. In the final analysis, how you are precepted makes all the difference. Spend some time shadowing in each facility, meet the preceptor(s). It's time well spent.

LeesieBug · Oct 3, 2005

Interesting...your posts look at the issue in a way that is a little different than how I have been thinking about this, as far as the issue of diving in to a more hectic setting with complex patients versus getting my feet wet in a calmer, slower paced atmosphere.

MLOS, my clinical experience has been opposite of yours. I've done my clinicals up until now in a large teaching hospital, that I was positive was the place for me to start.....until I started my senior preceptorship at a community hospital. I am in love with the atmosphere there, and the way everyone is so eager to share their knowledge with me. One thing you brought up that I need to look into is commitment to continuing education. That's an important issue for me. Thanks for sharing your experience! I am happy that your decision is working out well for you :) .

Alex...THANK YOU for making that point! I haven't run into anyone that has put it quite that way...It makes a great deal of sense to me. Your point addresses one of my major concerns in choosing my first job. I don't want to start work so stressed out that I hate my job and want to quit. I have heard of many new grads that are so overwhelmed that they either job-hop or quit nursing all together. I want to set myself up for success.

OK...this is helping....I'm starting to feel a LITTLE less torn between the two .

LeesieBug · Oct 3, 2005

I am starting out in a 900 bed Level I trauma center. The acuity of the patients is great. Most of them are from outlying community hospitals coming to the city for answers. The experience is great, but can be very overwhelming at times. I see a lot of everything. That, in itself, is a double edged sword. There are days I am cursing myself for biting off more than I can chew. On the other hand I know I will probably have another patient with the same issues next week for reenforcement. That way, when I finally do catch on, the skill won't be lost. Let me try to clarify that. If there is some procedure, disease, diagnosis that's a little uncommon, it won't be the only one I will see for a year like you would at a smaller hospital.

I understand what you are saying...the diversity and repetition will be beneficial to your learning. :)