Small rural nurse intimidated by large hospital

[Nataayy]

I have only worked in small rural hospitals and I believe because of this I am a great nurse. I have obtained a wide range of experience compared to my counterparts at larger hospitals. I can draw blood and ABGs, obtain and somewhat interpret EKGs, perform RT, PT and at one hospital I ran Lab test. (mono, strep, cardiacs) I have the amazing ability to work with minimal supplies and resources. Like other RNs at small hospitals I wear many hats simultaneously. Currently I work in the ER and the house supervisor. As night house supervisor I am over the ER, M/S, and ICU. We don't have an OB department. After 7pm I am the pharmacist, housekeeping, dietary, and lead nurse in all codes. At times, I am very close to wearing the doctors hat when the one incompetent doctor is giving me that "what do I do" look.

I am a military wife and we will be moving at the end of the year. I determined that this is the perfect time to start making strides toward my dream job of nurse anesthetist. This means becoming an ICU nurse. I began to look for jobs at our new duty station. Many are large hospitals, the one I am most interested in working at is a level 1 trauma hospital.

These large hospitals are starting to intimidate me. I believe that when I apply for an ICU position in a large hospital they are going to look at my small hospital experience and say that I am unqualified to work in their ICU. They will state that I lack exposure to many medical disorders. I have extensive experience in common ER disorders and trauma situations but due to the rural location, pts with uncommon conditions are rare. For example, last week was my first pt with sick sinus syndrome. I know how to take care of a pt like this by using my knowledge of cardiac pathophysiology. I believe that a large hospital HR will not care that I have the knowledge; they want me to have the experience. When sending in my resume I don't think they will care that I have phlebotomy or RT skills, because nurses don't perform these jobs in large hospitals. They have more than enough employees in these department to complete the job.

Lastly my husband made a statement that made me unsure of my ability to easily obtain ICU position. He pointed out that large hospitals are more modern in technology. My experience working in rural hospital has set me back in working with the most up-to-date equipment thus putting me behind the other job applicants.

Do I have standing for being intimidated by larger hospitals or am I making a mountain out of a mole hill? What are your views on the ability to transition from small ER to large ICU? If you are HR personnel would you care I have experience in outside areas (RT, pharmacy, PT) or lack experience using modern/high-tech equipment?

P.S. I know that some CRNA school will take ER experience but these schools are few and being a military wife it not guaranteed that we will be based by any of these schools. I want to get the ICU experience to increase my choice of schools & military bases.

[eatmysoxRN, ASN, RN]

I'll tell you initially that I am merely a fairly new nurse.

But anyways. I think you'd have a shot. It sounds like you had a lot of responsibilities. If the ICU is your dream, go for it! I'd say even if your resume doesn't get past HR, try contacting nurse managers directly. Let your interest be know (although I've heard it's best to leave out that you just want your exp for CRNA school).

I'm sure it would still be a big transition, but I know if they hire new grads into some ICUs, you would be a great candidate.

Good luck!

[sauconyrunner]

You can do it! Do not be intimidated! I worked my first years in Nursing at Level one Trauma centers. Then I became a traveler, and they sent me ALL over, including a hospital with literally only 6 inpatient beds. It was one of the hardest assignments I had because as you know, at night, staffing was very limited. It's a lot harder to run a code with only a PA and 2 nurses.

There are so many unusual medical conditions that no one expects you to know how to treat them. In a large trauma center ICU you will have so many more resources to learn and guide you in strange syndromes and their care than you do now. You can EASILY learn to use new monitors and equipment, you are a Nurse- smart and adaptable.

One thing you can do to make yourself more attractive is to be sure to have all certifications you can have, possibly including a Monitor tech type certificate. In our ICU our the MD expects the nurses to read 12 leads and look at the CXR and interpret it- and we are a small rural hospital (150 beds, 16 ICU).

Don't sell yourself short. :) You have real Nursing experience-with VERY strong assessment skills. You can totally do this and I think if you point out the positives you'll soon find yourself with lots of offers. GOOD LUCK! and let us know how it goes.

[anotherone, BSN, RN]

I have only worked in small rural hospitals and I believe because of this I am a great nurse. I have obtained a wide range of experience compared to my counterparts at larger hospitals. I can draw blood and ABGs, obtain and somewhat interpret EKGs, perform RT, PT and at one hospital I ran Lab test. (mono, strep, cardiacs) I have the amazing ability to work with minimal supplies and resources. Like other RNs at small hospitals I wear many hats simultaneously. Currently I work in the ER and the house supervisor. As night house supervisor I am over the ER, M/S, and ICU. .

DO NOT DOWNPLAY THESE. I work at one of those huge trauma 1 hospitals, not in icu, the icu nurses are expected to be able to do everything, even though the rest of the nurses aside from icu/er are not. Give yourself some credit! New grads get hired into these Trauma 1 icus and ERs. you have more to offer than they do!

[Shay1482]

Trust your assessment skills, and your ability to prioritize. We all learn as we go, and transfer that knowledge to others. The ultimate decision will be made by the unit manager and I think your goals to further your career would impress rather than hurt. Good luck!

[threebrats46]

I work at a large city hospital and the nurses are required to perform RT,phlebotomy,EKG and on a regular med surg unit.

[Goobstress]

Don't let anyone intimidate you. I came from a very small rural hospital and started traveling to L.A where I started working for the best hospitals in here. I found that my small rural hospital prepared me for everything that would come my way and found myself to be knowledgeable in my specialty more so than their nurses because as you said we have to wear different hats in a small hospital. You will find that these larger hospitals might have equipment that are older than you are and that is why they have money. Trust your instinct and just go for it. You can do it and good luck.