Teaching hospital? Or not.

[netglow, ASN, RN]

Wondering if I can get the opinions of some RNs who've worked teaching hospitals and regular hospitals.

As a soon to be new RN, is it tougher to do that first year or two when you not only have to wrangle seasoned MDs, but have to deal with newbie MDs too (teaching hospital)? Or is the environment more open for constant teaching, meaning it would be good for me too? I've heard an opinion that there is more autonomy for an RN when MDs are not crowding things. And, also I've heard that it can be easier when you must have intervention, to get it when they are all over the place... I've heard that teaching hospitals can be a major drain, when you have attendings at a constant level of irritation, and newbie residents at a constant level of paranoia interrupting your day. This I would think would add another layer to the stuff a new RN already has to deal with?!

What has been your experience? Examples please!

[Tait, MSN, RN]

After dealing with a fresh GI surgeon this year who treats his patients more like engineering problems than people, I am glad I don't work at a teaching hospital.

Don't get me wrong, we still have students from the area colleges, and plenty of new grads, however we are not considered a "teaching" hospital.

Best of luck!

Tait

[elkpark]

There are pros and cons, just as with any other type of facility. I've always liked big teaching hospitals -- seems like there is more of a general atmostphere of teaching & learning all the time, and you tend to see the more complicated, "exotic" cases that community facilities refer on. You have more opportunities to take part in formal, structured educational opportunities (attending grand rounds, ethics rounds, nursing inservices, etc.) In my experience, it seems that standards are higher in general in teaching hospitals, and there's less emphasis on cutting corners and doing just enough to get by. Because of the teaching emphasis/orientation, they often have better, longer orientation programs for new nurses than non-teaching hospitals.

None of the above is meant to suggest that the opposite is true of all non-teaching hospitals! :)

[Daytonite, BSN, RN]

i worked in a number of both large teaching and medium sized community hospitals. i found that the large teaching hospitals, surprisingly, were the most friendly. the mds (student docs, interns, residents) rotate through the different services all the time so they never stay for very long. because they are low on the chain of command, if student docs, interns, or residents are difficult to deal with you merely report them to the person that is their chief or supervisor and they usually get a talking to by them. the last thing they are expected to have is a nasty attitude toward the nurses. the resident staff are all on salaries and need the recommendation from the chiefs of their service once they finish their residencies, so they are usually going to respond to a talking to from their chief. the only time they might be a problem is if the chief of a service is an sob, but i never saw that happen. attendings were usually nice and if they went after anyone they went after the student docs and interns or a nurse who made a really stupid mistake and disserved their wrath. attendings depended on the residents to do a great deal of the work for them. residents passed work on down to the interns. i found that most of the student docs and interns to be very nice. they would ask questions of us. in some cases we wondered if they were smart enough to be docs. sadly, we had some nurses who treated these young medical students like they were dirt. people talk about nurses eating their young. . .you haven't see what a nasty nurse can do to a young doc. it was very sad to watch a nurse humiliate a young doctor. we had many resident doctors that were very pleasant to work with and found that we could ask them just about anything. you get to feel very close with them. they work very long hours for a pittance of a salary, are often the only doc on call that respond to you and very sleep deprived. we learned a lot along with them. yes, there is more autonomy for the nurses, a higher level of work and stress because these learning facilities are often tertiary care centers that are getting patients with problems that other hospitals are not equipped to handle. they are often engaged in research of certain types of diseases so those patients are going to be admitted there. when research is being done special care protocols may need to be followed to the letter. we had all kinds of advanced practice nurses around constantly reminding us or inservicing us on this protocol or that procedure. i got used to it. you learn a lot when you work in these facilities. nursing is a career of constant change. you need to burn that thought into your mind. i would get 6 days off work and come back to find something new had been changed or added to our protocols. new procedures and new equipment are introduced there all the time. that's the way the job is. however, there is always someone around to help or support you--staff everywhere. the teamwork was like i've never experienced it.

community hospitals are not as exciting. i found the doctors were more like tyrants and it is at these facilities where i saw a great more intimidation of the nurses by the doctors. doctors there were the obvious stars of the show. there is little to no research going on there. in many of them i recall going to inservices on customer relations. this is because they were in competition with the hospital down the way to attract the patient to come there. smile and treat the customer--er, patients--nicely. that was a big focus. you will hear that talked about on the general nursing discussion forum. of course, treating patients kindly should be done, but when nurse need to be told that over and over you have to wonder why the anxiety about it.

if i had my choice, i'd go to a large tertiary teaching hospital every time.

[Jules A, MSN]

I have to admit that although I'm helpful and patient I really hate having nursing students on the unit but as for the 'baby docs' I kind of like them. Most are very open to our opinions because they wisely realize that we are the ones interacting with the patients round the clock. It makes me sad when a good batch is ready to move on but thats how it goes. It has been a great learning experience for me also.

[elkpark]

i worked in a number of both large teaching and medium sized community hospitals. i found that the large teaching hospitals, surprisingly, were the most friendly. the mds (student docs, interns, residents) rotate through the different services all the time so they never stay for very long. because they are low on the chain of command, if student docs, interns, or residents are difficult to deal with you merely report them to the person that is their chief or supervisor and they usually get a talking to by them. the last thing they are expected to have is a nasty attitude toward the nurses. the resident staff are all on salaries and need the recommendation from the chiefs of their service once they finish their residencies, so they are usually going to respond to a talking to from their chief. the only time they might be a problem is if the chief of a service is an sob, but i never saw that happen. attendings were usually nice and if they went after anyone they went after the student docs and interns or a nurse who made a really stupid mistake and disserved their wrath. attendings depended on the residents to do a great deal of the work for them. residents passed work on down to the interns. i found that most of the student docs and interns to be very nice. they would ask questions of us. in some cases we wondered if they were smart enough to be docs. sadly, we had some nurses who treated these young medical students like they were dirt. people talk about nurses eating their young. . .you haven't see what a nasty nurse can do to a young doc. it was very sad to watch a nurse humiliate a young doctor. we had many resident doctors that were very pleasant to work with and found that we could ask them just about anything. you get to feel very close with them. they work very long hours for a pittance of a salary, are often the only doc on call that respond to you and very sleep deprived. we learned a lot along with them. yes, there is more autonomy for the nurses, a higher level of work and stress because these learning facilities are often tertiary care centers that are getting patients with problems that other hospitals are not equipped to handle. they are often engaged in research of certain types of diseases so those patients are going to be admitted there. when research is being done special care protocols may need to be followed to the letter. we had all kinds of advanced practice nurses around constantly reminding us or inservicing us on this protocol or that procedure. i got used to it. you learn a lot when you work in these facilities. nursing is a career of constant change. you need to burn that thought into your mind. i would get 6 days off work and come back to find something new had been changed or added to our protocols. new procedures and new equipment are introduced there all the time. that's the way the job is. however, there is always someone around to help or support you--staff everywhere. the teamwork was like i've never experienced it.

community hospitals are not as exciting. i found the doctors were more like tyrants and it is at these facilities where i saw a great more intimidation of the nurses by the doctors. doctors there were the obvious stars of the show. there is little to no research going on there. in many of them i recall going to inservices on customer relations. this is because they were in competition with the hospital down the way to attract the patient to come there. smile and treat the customer--er, patients--nicely. that was a big focus. you will hear that talked about on the general nursing discussion forum. of course, treating patients kindly should be done, but when nurse need to be told that over and over you have to wonder why the anxiety about it.

if i had my choice, i'd go to a large tertiary teaching hospital every time.

this has been my experience, also.

[Be_Moore]

I work in a teaching hospital and love it. In our ICU, we work with a "team" of a 1st year Intern and a 3rd year Resident. The MD's are very approachable and humble. They are always open to suggestions and are more than willing to flex their book knowledge if you have a question. Many of them actually love to teach because it reminds them that they are smart (because they spend a lot of time being overwhelmed by actual patient care vs. book patient care!). Having worked in a non-teaching facility before (where all the MD's first names are 'Doctor') and now working in a facility where MD's are on a first name basis...I don't think I'll ever go back.

Downside to teaching facilities is that you don't get to utilize your nursing skills as much. For example, a patient codes...there is a line of students and interns who are volunteering to do chest compressions or run the code with their fresh ACLS knowledge...so we a lot of times stand back and watch and make sure they aren't messing it up (Hah!). Other downsides are that sometimes the baby docs are a little timid/stingy. You need something to chill a patient out and they order 0.25mg of Ativan. >.

Upside is approachability and learning experiences. When the MD's round daily (Attending and all the interns/residents, a social worker, the charge nurse, a pharmacist, and a respiratory therapist), you can learn a TON just by listening to them discuss the patients. Other pros about teaching facilities are cutting edge research goes on there a lot of times...many of the attendings supplement their time by doing tons of studies...so you may very well get to give cutting edge experimental drugs and do experimental procedures that may one day become standard treatment modalities.

[interleukin]

Teaching, hands down

[DolceVita, ADN, BSN, RN]

Nice question. Thanks.

[wonderbee, BSN, RN]

At a large teaching hospital, we have a chance to teach the docs to value nursing staff. It's a chance to grow them up right. Most of them appreciate it. I kind of like having them around. They foster a continuing diaglogue of teaching and learning. Sometimes we're the student, sometimes they're the student. Teaching hospital all the way.

[beachbutterfly]

Teaching hospitals are not my style,I hated my rotation there!!!! Seriously everytime I had my rotation there I developed a headache, the constant rounds of medical students were tiresome...I like smaller or just regular hospitals but I'm sure you will learn a lot of there because overall those are very good hospitals:)))

[carolina4]

TEACHING HOSPITAL..no further questions. You get to see 10x cooler cases than a boring private hospital. All i did on my rotation at the private hospital was sit & hide and read about more interesting diseases or the meds the boring patients were on.