So, what's it like?

Sour Lemon · Oct 1, 2016

Our docs are old, tired, and maybe a little cranky. They want a quick update and to get home to their families ....not to pot-luck and hang out talking about what they did over the weekend.

A previous employer of mine was reluctant to hire nurses who had only worked at teaching hospitals. They were perceived as less independent and used to having a doctor available on premises at all times. Whether or not that's a fair assumption, I couldn't say. I have only worked at the type of hospitals that did not want anyone to learn anything. "Friendships" between doctors and nurses were actually discouraged, although good working relationships were not.

CardiacDork, MSN, RN · Oct 1, 2016

Our docs are old, tired, and maybe a little cranky. They want a quick update and to get home to their families ....not to pot-luck and hang out talking about what they did over the weekend.
A previous employer of mine was reluctant to hire nurses who had only worked at teaching hospitals. They were perceived as less independent and used to having a doctor available on premises at all times. Whether or not that's a fair assumption, I couldn't say. I have only worked at the type of hospitals that did not want anyone to learn anything. "Friendships" between doctors and nurses were actually discouraged, although good working relationships were not.

Definitely a poor assumption. Our doctors that rotate in the MICU are not all ICU experts. They are IM residents that rotate through the entire mix of services. That being said, a lot of the ICU education is left up to nursing to pass on to our residents.

A lot of patients are rescued by either RN it RT and early intubation initiated. Residents are so hesitant to intubate, but early intubatation is better than latent. Anyway that's another tangent but a very good example.

Morning rounds, what can I say? I hear and absorb everything the residents hear. Maybe not on all 20 some patients but hey, day after day the knowledge adds up. Keep in mind that I am witness to rounds from MULTIPLE teams such as

Pulmonary, nephrology, infectious disease, and cardiovascular being the top ones.

Also, being in such an open environment where I can freely walk into the doctor room sit down with my docs and ask questions and pick their brains and visa versa, has brought me to the point where I find myself suggesting and being an active member of the patients team.

Your former employer is really missing out on some good nurses. :)

Also, what kind of facility doesn't want their employees to learn and grow?

Sour Lemon · Oct 1, 2016

Also, what kind of facility doesn't want their employees to learn and grow?

I'm not always entirely serious.

...but I am serious about my employer's comments. It was a physician-owned hospital and the doctors had been complaining about "teaching hospital nurses" and their perceived dependence. They made it a big point to find out exactly what type of hospital I had come from and whether or not MDs were frequently around or on the premises.

CardiacDork, MSN, RN · Oct 1, 2016

I'm not always entirely serious.
...but I am serious about my employer's comments. It was a physician-owned hospital and the doctors had been complaining about "teaching hospital nurses" and their perceived dependence. They made it a big point to find out exactly what type of hospital I had come from and whether or not MDs were frequently around or on the premises.

As if having a room of interns means much when they turn and ask you "what would you do in this situation?" or my favorite "What would you do? If I call my fellow or attending I wanna have an idea of what to suggest". :whistling:

missmollie, ADN, BSN, RN · Oct 1, 2016

I feel that working at a teaching hospital gives nurses more independence. If any patient is admitted in the month of July, I assure you it's the nurse who is making sure that all orders are correct.

I think your physicians have an issue with a nurse who knows what needs to be done, not that they are less independent. I feel we have to be independent because the first year residents need teaching not just from the attending, but from the nurses as well.

nutella, MSN, RN · Oct 1, 2016

There are important differences.

The teaching hospitals I worked at are all on the forefront of innovation, discovery, teaching, best practice... there is a high expectation around the standard of care. You have the learning structure in place for the residents and they are usually young, motivated, latest knowledge, work patient oriented nowadays, collaborate with nurses nicely. There is much more "talk" going on and people are just used to contribute. Usually you have more resources and supporting services like iv teams, phlebotomy, float pools, clear leadership structure and contingency plans. There is always something new and exciting going on.

The cons is that depending on the culture of that teaching facility, the work environment can be more punitive as well as a lot of them focus on excellent numbers all around and do not leave much room for mistakes. Almost all of the teaching hospitals I worked at (and I have worked at plenty) have very elaborate policies and practice guidelines - nurses are expected to adhere 100%. Work volume and acuity is high, which is ok in critical care because the staffing ratio is better but it is a problem on med/surg tele floors. Patients that would be in an ICU in a community hospital are on med/surg tele floors in those major hospitals. A patient has to be very sick to be in the ICU in those large teaching facilities.

IMO teaching hospitals are great places to learn if you want that environment and also to work. You know that residents usually do a good job because they are learning as well and go by the book.

Non teaching hospitals are different because you do not have residents and med students. Instead you rely on hospitalists or attendings. If it is a small facility with not high acuity, the providers may be not in the hospital for most of the time and you have to call them for everything. Also, there is less control. If the admitting attending is old school close to retirement and has not caught up on progress or has the "I am the allmighty physician - complex" it can become a problem. You often have to wait some time for them to get back to you. You encounter more the "garden variety" of problems and the population appears older and more chronically sick IMO.

The ICUs are often "tray ICUs", which means that most of their patients are not intubated and get food trays. It is what I think of myself as "ICU light". Despite the fact that nurses in the tray ICU insist on having a "very demanding and difficult job" I have to say that it does not compare to a teaching hospital ICU/CC (I have worked critical care as well in the past and see a huge difference). I am generally speaking a collaborative person but that is one of my pet peeves - when the tray ICU nurses complain and try to create the illusion that their job is harder than med/surg or tele med/surg. It is actually the other way around (I have worked both) because med/surg has a crazy level of multitasking, require flawless time management and you have less resources.

I never thought I would leave teaching hospitals but I did. The long commute, constant high acuity and unrealistic expectation were not what I wanted at this stage in my life. I enjoy working in the non teaching hospital though at times it bothers me that it takes longer to see some new knowledge being implemented. Those sheep skin underlays and heel thingies are back - I had a moment when I saw that - didn't nursing decide like 20 years ago that those things do not work to prevent pressure ulcers and does not replace repositioning regularly ???

Sour Lemon · Oct 1, 2016

I feel that working at a teaching hospital gives nurses more independence. If any patient is admitted in the month of July, I assure you it's the nurse who is making sure that all orders are correct.
I think your physicians have an issue with a nurse who knows what needs to be done, not that they are less independent. I feel we have to be independent because the first year residents need teaching not just from the attending, but from the nurses as well.

I don't think that's it, because I occasionally got admission orders as bad as, "Do whatever you want. I'm going to sleep." They fired a lot of nurses there, too ..nurses who weren't precise or quick to come to a conclusion. I swear they had a trap door, or something.

guest769224 · Oct 1, 2016

We have one doc at my level 2 center, that says to me almost every time I call, " I don't know, do what's good for him. You can order what he needs." So vague. I always consult the charge nurses in that situation. I suppose one could argue it promotes critical thinking.

CardiacDork, MSN, RN · Oct 1, 2016

I don't think that's it, because I occasionally got admission orders as bad as, "Do whatever you want. I'm going to sleep." They fired a lot of nurses there, too ..nurses who weren't precise or quick to come to a conclusion. I swear they had a trap door, or something.

I think in conclusion both have their strengths. Both RNs gain independence in their own ways. In the case of non teaching hospitals, it seems that the more experienced and tired physicians don't want to be bothered and expect nurses to know what to do.

In the case of teaching facilities, I see residents depending on nurses. Residents much rather ask the nursing staff before asking their attendings. Later taking the advise provided by nursing and making suggestions accordingly.

As of right now I enjoy my role at teaching facilities. I've heard stories of the burned out physicians and the old school physicians and I frankly don't care for that in my career at the moment, maybe later.

CardiacDork, MSN, RN · Oct 1, 2016

There are important differences.
The teaching hospitals I worked at are all on the forefront of innovation, discovery, teaching, best practice... there is a high expectation around the standard of care. You have the learning structure in place for the residents and they are usually young, motivated, latest knowledge, work patient oriented nowadays, collaborate with nurses nicely. There is much more "talk" going on and people are just used to contribute. Usually you have more resources and supporting services like iv teams, phlebotomy, float pools, clear leadership structure and contingency plans. There is always something new and exciting going on.
The cons is that depending on the culture of that teaching facility, the work environment can be more punitive as well as a lot of them focus on excellent numbers all around and do not leave much room for mistakes. Almost all of the teaching hospitals I worked at (and I have worked at plenty) have very elaborate policies and practice guidelines - nurses are expected to adhere 100%. Work volume and acuity is high, which is ok in critical care because the staffing ratio is better but it is a problem on med/surg tele floors. Patients that would be in an ICU in a community hospital are on med/surg tele floors in those major hospitals. A patient has to be very sick to be in the ICU in those large teaching facilities.
IMO teaching hospitals are great places to learn if you want that environment and also to work. You know that residents usually do a good job because they are learning as well and go by the book.
Non teaching hospitals are different because you do not have residents and med students. Instead you rely on hospitalists or attendings. If it is a small facility with not high acuity, the providers may be not in the hospital for most of the time and you have to call them for everything. Also, there is less control. If the admitting attending is old school close to retirement and has not caught up on progress or has the "I am the allmighty physician - complex" it can become a problem. You often have to wait some time for them to get back to you. You encounter more the "garden variety" of problems and the population appears older and more chronically sick IMO.
The ICUs are often "tray ICUs", which means that most of their patients are not intubated and get food trays. It is what I think of myself as "ICU light". Despite the fact that nurses in the tray ICU insist on having a "very demanding and difficult job" I have to say that it does not compare to a teaching hospital ICU/CC (I have worked critical care as well in the past and see a huge difference). I am generally speaking a collaborative person but that is one of my pet peeves - when the tray ICU nurses complain and try to create the illusion that their job is harder than med/surg or tele med/surg. It is actually the other way around (I have worked both) because med/surg has a crazy level of multitasking, require flawless time management and you have less resources.
I never thought I would leave teaching hospitals but I did. The long commute, constant high acuity and unrealistic expectation were not what I wanted at this stage in my life. I enjoy working in the non teaching hospital though at times it bothers me that it takes longer to see some new knowledge being implemented. Those sheep skin underlays and heel thingies are back - I had a moment when I saw that - didn't nursing decide like 20 years ago that those things do not work to prevent pressure ulcers and does not replace repositioning regularly ???

We have had an influx of these ICU nurses from the community hospitals around the area and levels 2 centers show up to our level 1 ICU and be completely surprised and overwhelmed. They've told me the patient population they cater to, lots of patients that should really be on the medsurg floor or step down unit. I'm blessed to be at a level one. I was looking back at the patients I've taken care of. I try to keep a list of times I've taken care of patients on a device and in the last 6 months I've taken care of 7 ECMO patients, 10 balloon pumps, 10 VADs, and 27 CRRT patients. That means that out of 72 shifts, about 54 were days with device patients.

CardiacDork, MSN, RN · Oct 1, 2016

There are important differences.
The teaching hospitals I worked at are all on the forefront of innovation, discovery, teaching, best practice... there is a high expectation around the standard of care. You have the learning structure in place for the residents and they are usually young, motivated, latest knowledge, work patient oriented nowadays, collaborate with nurses nicely. There is much more "talk" going on and people are just used to contribute. Usually you have more resources and supporting services like iv teams, phlebotomy, float pools, clear leadership structure and contingency plans. There is always something new and exciting going on.
The cons is that depending on the culture of that teaching facility, the work environment can be more punitive as well as a lot of them focus on excellent numbers all around and do not leave much room for mistakes. Almost all of the teaching hospitals I worked at (and I have worked at plenty) have very elaborate policies and practice guidelines - nurses are expected to adhere 100%. Work volume and acuity is high, which is ok in critical care because the staffing ratio is better but it is a problem on med/surg tele floors. Patients that would be in an ICU in a community hospital are on med/surg tele floors in those major hospitals. A patient has to be very sick to be in the ICU in those large teaching facilities.
IMO teaching hospitals are great places to learn if you want that environment and also to work. You know that residents usually do a good job because they are learning as well and go by the book.
Non teaching hospitals are different because you do not have residents and med students. Instead you rely on hospitalists or attendings. If it is a small facility with not high acuity, the providers may be not in the hospital for most of the time and you have to call them for everything. Also, there is less control. If the admitting attending is old school close to retirement and has not caught up on progress or has the "I am the allmighty physician - complex" it can become a problem. You often have to wait some time for them to get back to you. You encounter more the "garden variety" of problems and the population appears older and more chronically sick IMO.
The ICUs are often "tray ICUs", which means that most of their patients are not intubated and get food trays. It is what I think of myself as "ICU light". Despite the fact that nurses in the tray ICU insist on having a "very demanding and difficult job" I have to say that it does not compare to a teaching hospital ICU/CC (I have worked critical care as well in the past and see a huge difference). I am generally speaking a collaborative person but that is one of my pet peeves - when the tray ICU nurses complain and try to create the illusion that their job is harder than med/surg or tele med/surg. It is actually the other way around (I have worked both) because med/surg has a crazy level of multitasking, require flawless time management and you have less resources.
I never thought I would leave teaching hospitals but I did. The long commute, constant high acuity and unrealistic expectation were not what I wanted at this stage in my life. I enjoy working in the non teaching hospital though at times it bothers me that it takes longer to see some new knowledge being implemented. Those sheep skin underlays and heel thingies are back - I had a moment when I saw that - didn't nursing decide like 20 years ago that those things do not work to prevent pressure ulcers and does not replace repositioning regularly ???

We have had an influx of these ICU nurses from the community hospitals around the area and levels 2 centers show up to our level 1 ICU and be completely surprised and overwhelmed. They've told me the patient population they cater to, lots of patients that should really be on the medsurg floor or step down unit. I'm blessed to be at a level one. I was looking back at the patients I've taken care of. I try to keep a list of times I've taken care of patients on a device and in the last 6 months I've taken care of 7 ECMO patients, 10 balloon pumps, 10 VADs, and 27 CRRT patients. That means that out of 72 shifts, about 54 were days with device patients.

I have a vented or two vented patients everyday so I do not even count the vent really.