Which is better for new grad? Big Medical Center or small hospital?

medicrnohio, RN · Jan 31, 2005

I am a new grad myself but I will share my opinion. I tried the big medical center and didn't like it at all. It's kinda like you get lost in the midst of utter chaos and confusion. Although I'm sure not all big medical centers are like that. I myself have opted for a smaller hospital which I will start working at soon. Everyone I have talked to loves working there, they love the family like environment and smaller size. Good luck in your choices. I'm sure you'll make the right one for YOU.

mitchsmom · Jan 31, 2005

I am wondering the same type of thing for my preceptorship: I will probably have the choice of a small hospital & unit similar to my town where I would be employed, or a big hospital where I'd get more of a variety of experience.

I'll be looking to see what people post here in response to your question. Is it better to have experience similar to what you'll use or a wide experience that may not be as applicable? (in my situation I mean high risk, etc... my L&D ships all hi risk out...oh and the small place is an hour away instead of big hospital 2 hours away)

11:11 · Jan 31, 2005

Both have their positives.

I began work at a small 45 bed hospital. What made it different than other small hospitals in my area is that it had a busy ER and a true dedicated 5 bed ICU as opposed to "High observation/ICU/Tele" beds.

I was hired as an ICU nurse but probably spent half of my time in the ER and Med Surg. I worked there for a year, got a good foundation with variety and had no trouble stepping up into a large 28 bed ICU smack dab in the middle of Southern California that was overrun with insanity.

That small 45 bed hospital had one of the best OB depts in the area with all of the nurses being PALS and NRP cert, and some of them instructor cert.

On the otherhand, starting work in a large medical center has its benifits too. Obviously you are going to see things there that you will not see in a small hospital, and you will see twice as much.

Working at a small hospital can be "kinder gentler" in some ways but its easier to blend into the bigger hospital.

I would tour the small hospitals in your area, see what their OB units have to offer, see what their ER's are like, if they have ICU ability etc. The management at that first hospital truly had their act together. The small hospital I casual at today does not. I would not work their full time.

For me starting at a small hospital was perfect. It was the perfect environment for my personality at that time. Now I prefer the bigger facilities though I would consider a smaller one in the future.

Its all up to the facility. You just have to go see them for yourself.

Do your internship at the large hospital.

HTH

11

schroeders_piano, RN · Jan 31, 2005

It wasn't that long ago (it has been awhile, it just doesn't feel that way to me) that I faced this same decision. I chose a small hospital and I still love it. I started out working Med/Surg and then transferred into the ICU. I have had tremendous learning experiences. I have had the opportunity to cross-train to any area of the hospital that I wanted to. I have some friends that went straight from nursing school into the large medical centers and the one thing they tell me is that it just doesn't seem like a family were they work. My friends told me that they may work with different people every shift and never work two shifts with the same person. The nurses in a small hospital become a "second family".

There is a huge advantage to working in a small hospital, even though you won't be working with very high acuity patients, many times you are the first medical perosnnel these patients see before being shipped to the larger hospitals. My hospital has run into the situation of having a very high acuity ICU patient that needed to be in a larger facility, but it was too dangerous for an ambulance to be on the roads and it was too dangerous for lifeflight helicopters to fly. We ended up taking care of that patient until it was safe to transfer. I don't work with the most advanced equipment and I perform nursing skills that fellow collegues no longer perform, but I ABSOLUTELY LOVE my small hospital.

Sorry for the long post,

Schroeder

Nesher, BSN, RN · Jan 31, 2005

I work at a large urban teaching hospital and the problem for me is now that I have my MN and am looking for a change - I can't imagine going to a smaller less cutting edge type environment. SO I recommend the large hospital - more opportunites ...you might just love it...I did.

careerdejour · Feb 1, 2005

Both have their positives.
I began work at a small 45 bed hospital. What made it different than other small hospitals in my area is that it had a busy ER and a true dedicated 5 bed ICU as opposed to "High observation/ICU/Tele" beds.
I was hired as an ICU nurse but probably spent half of my time in the ER and Med Surg. I worked there for a year, got a good foundation with variety and had no trouble stepping up into a large 28 bed ICU smack dab in the middle of Southern California that was overrun with insanity.
That small 45 bed hospital had one of the best OB depts in the area with all of the nurses being PALS and NRP cert, and some of them instructor cert.
On the otherhand, starting work in a large medical center has its benifits too. Obviously you are going to see things there that you will not see in a small hospital, and you will see twice as much.
Working at a small hospital can be "kinder gentler" in some ways but its easier to blend into the bigger hospital.
I would tour the small hospitals in your area, see what their OB units have to offer, see what their ER's are like, if they have ICU ability etc. The management at that first hospital truly had their act together. The small hospital I casual at today does not. I would not work their full time.
For me starting at a small hospital was perfect. It was the perfect environment for my personality at that time. Now I prefer the bigger facilities though I would consider a smaller one in the future.
Its all up to the facility. You just have to go see them for yourself.
Do your internship at the large hospital.
HTH
11

I had been wondering the same thing. Do you think it will be perceived as a bad reflection on me if I move to a small hospital after internship?

LilRedRN1973 · Feb 26, 2005

I was struggling with this same issue. I graduate in May of this year and have a choice between 3 hospitals. One is 5 min. from my house, 145 beds, pays $28/hour, and is privately owned. They don't handle traumas and their patients generally aren't high acuity. Most of their ICU patients are cardiac in nature. The other hospital is 30 min. from my house, 350 beds, pays $25/hour, and is not for profit. They have a Level II trauma center (the only one in northern Nevada) and their patients are of a higher acuity level.

I chose the one farther from my home because it's a teaching hospital that I feel offers me more variety and experiences than the smaller hospital. I've done clinicals at both places and hated almost every minute in the smaller hospital. The only floor I enjoyed my clinicals at the smaller facility was OB/L&D and I have NO interest in pursuing that avenue of nursing when I'm done with school. I love the ICU, especially the trauma patients we get.

I will be getting paid less and driving farther, but it's worth it to me. Money isn't everything and experience is far more important to me right now than a bigger paycheck.

I'm curious....I grew up in Houston, although I moved here in 1994. I lived in Humble and remember taking my grandmother to MD Anderson for her treatments. I really loved that facility and thought the nursing there was terrific!! I also have a relative who was a surgeon at Hermann Hospital and back then, it seemed like a terrific place as well. Not sure where you live at, but I would probably consider one of those two hospitals, if they have not changed. Lots of experience to be had there!! I couldn't imagine working the facility they had in Humble, although I'm sure it's MUCH bigger that it was when I lived there.

Melanie

abundantjoy07, RN · Feb 26, 2005

In Houston there are so many different choices. If you want to work in a hospital, but not in a big one...then you should look outside the Medical Center and try for Hospitals like Memorial Hermann Northwest or the one downtown right next to 45...St. Lukes or St. Josephs? There are so many hospitals outside the Medical Center. If you live in the Woodlands they have their own hospital.

When I graduate I'm planning on coming back home to Houston (yay!). We're a big city and there's tons of choices.

*PICURN* · Feb 26, 2005

I would recommend the larger medical center

I did all my clinical rotations in smaller, community hospitals but worked as a CNA in a larger teaching hospital.

I think for a new grad, you are going to want to have a really supportive environment. That's really all that matters.

If you can find it in a smaller hospital and you think that would work better for you, then do that. I just think teaching hospitals are WONDERFUL for new grads. I have seen so many things that I never would have experienced in a smaller hospital. I also think if you are trained and have experience at a larger teaching hosiptal, you really can go anywhere and do well. On the other hand, if you start off at a smaller hospital and then try and move to a larger one, you might struggle.

*just my take on it*

BETSRN · Feb 26, 2005

I graduatewith a BSN in May. Needless to say, the job fairs are beginning to come. I am sort of torn regarding which hospital to choose. There are many hospitals in the Houston Medical Center. However, there are a few hospitals that are closer to my home. I've been told that it's better to be trained in the big "state of the art" hospitals and the to transfer to a smaller hospital nearer home. The Medical Center is 45 minutes away from my home. There are hospitals that are about 20 minutes away. I have 2 school age children and the traffic from the area hospitals is easier to navigate.
I am planning to do either OB or Med/Surg. Does it really matter that much where I start off working?
Thanks.

Do what is BEST for your lifestyle. You can get training either way. Pick the hospital based on how you FEEL about the facility and the people. You'll get the skills as you work. You need to have a job you LIKE in a setting where you feel comfortable. Shadow nurses in the hospitals you choose to consider BEFORE making your final decision.

Proximity to your home can make a big difference (especially with the family responsibilities you describe). The same technology is everywhere, some just use it more than others. It doesn't mean more is better (expecially in OB where I am). I vote for low risk, family-like and small any day!

mattsmom81 · Feb 26, 2005

My suggestion is go with the most dedicated new grad education department.