Why do small hospitals get a bad rap sometimes?

Nurses General Nursing


I work for an 85 bed hospital here in the MidWest. Our hospital includes a 7 bed ED, 4 bed ICU/CCU, 5 LDRP, 10 psych, 22 skilled nursing beds and 30 general med/surg beds. I think we have a nice little facility, but when I tell people where I work I always get: "Oh, I wouldn't take a dead dog to ......" I know that our hospital is not perfect, nor are we equipped to deal with every type of medical problem but we do know how to do some things. I don't know why our facility has such a bad reputation. When I talk to other nurses who work at facilities that are about our size, they say they get the same replies from the public. Why is it that most people think that unless you are a 600 bed teaching facility you are not capable of giving good care at all? The doctors who work at our hospital know quite well what the hospital can handle medically and what it cannot. They are usually pretty good about transferring a patient to a larger facility when the need arises. I always talk positive about our hospital to other people to try and improve our image. I point out the positives of our facility. We are JCAHO accrediated and always do well on our state surveys. Any thoughts from other nurses on this topic would be appreciated. I would like to hear from nurses who work in small hospitals, and nurses who work in larger hospitals. :confused:


219 Posts

Well I think it is because Americans see bigger as better. I have worked in both and small. I know the size of the facility does not influence the quality of care. Most patients don't know this. I doubt there is anything you can do to change this. Gary


992 Posts

Oh, I know there isn't any way I can probably change this. I was just curious why people see small hospitals as Band-Aid Stations instead of hospitals. I have seen some bad stuff happen at small hospitals, but I have seen some major screw-ups at larger facilities. I just wish people would know what they are talking about before they start bad mouthing our facility. With the exception of a couple of doctors, our doctors are quite good. Of course, there is always going to be a bad apple in the whole bunch. Usually if we get a trauma patient in our ER, we can have them on the chopper to Ft. Wayne with 15 minutes. The ER staff is ACLS certified, and Trauma Certified. I just don't get it. I thought good nursing care could always be given no matter what size hospital you work in. Thanks for letting me vent. :rolleyes:


28 Posts

I work in a small hospital too. We have maximum of 50 beds...plus 4 bed er and 4 bed ICU. We hear the same from some ppl but I usually just smile because it is always someone who has not been a patient of ours. Our patients tell us while we may not have the higher services of other hospitals ...we make up for it in personal style. We have a much more friendlier attitude and include the families of patients as much as possible. I lot of community ideas of your facility are probably formed from ignorance. Your hospital public relations ppl are not doing the best they can in adverstisement . It might help to speak to them about putting out more info on your hospital.


1,301 Posts

Hi. I've also worked in hospitals of various sizes. I agree with cmggriff that in the USA, bigger is seen as better. In fact, current ratings of hospitals tend to rate teaching hospitals higher than others in terms of their offerings. I can attest to the fact that teaching hospitals in my neck of the woods have the latest and greatest in technology. They tend to attract some very good experts in their respective fields. They invest heavily in the infrastructure. However, like canna, the community hospital I worked in was very personable which made our patients feel at home. There also was some very good nurses I worked with that the doctors would have to agree made them and the hospital shine.


24 Posts

I have also worked in both size facilities and I must admit I prefer to work in a larger facility. My concern with the smaller hospitals is the limited resources. I have seen patients kept at smaller facilities when they really should have been transferred. Sometimes physcians hold on to their patients when they do need a higher level of care. Of course on the other side, when a patient is transfered, the other facility needs to be respondsible to treat their colleges like equals and not assume that no one knows what they are doing. There should be follow up so the referring facility knows how a pt. has done.:D


164 Posts

its because people are stupid.

bigger is always better.

hospital xyz might be a noted butcher shop but as long as they have a good ad campaign ppl will go there thinking they are getting bigger and better care.


624 Posts

Specializes in ICU/CCU (PCCN); Heme/Onc/BMT.


Good post . . .

I live about 5 miles from a small community hospital (total bed occupancy is about 50). It has a horrible reputation. . . I've heard several people - local folk- talk very negativley about this hospital. A friend who used to work in the ER said that the day and evening staff just do not get along and that there's a lot of internal tension. Maybe the public can sense this?? (I personally think the ICU/CCU staff are wonderful at this hospital.)

I work for an even smaller rural hospital (total bed occupancy about 35 including 5 ICU/CCU beds). Interestingly, this hospital has a wonderful reputation with the community. The ER department has been described as "The Diamond of the Hospital". People actually request to come to this hospital's ER over the above mentioned hospital's ER!! (They're about 25 miles from each other!)

Bottom line, though, both hospitals are competent to provide good care to the community. They shouldn't be judged because of their small size.

Ted Fiebke

Specializes in Emergency Room.

I come from a hospital that has 4 ER beds, no ICU and


1,577 Posts

Specializes in Med-Surg Nursing.

I work at a 226 bed hospital--where they got that number is beyond me. We have a 7 bed ICU, a 14 bed Skilled Nursing Unit , a 29 bed General med/surg floor and my unit is a 30 bed telemetry/respiratory and whatever else they want to put there floor. Plus there is a unit where special procedures/One day Unit type stuff and an OB floor. I think our ER is 12 beds. Last September, when JCHAO made their visit-we scored a 95!!! Oh, I forgot also that we have a 2 bed Inpatient Hospice Unit and we used to have inpatient Psych but that closed in May as one of the Psychiatrists resigned. My hospital is affiliated with the Cleveland Clinic Foundation. I worked at a 480 bed facility in near by Erie PA and while it was a good hospital--they treated the nursing staff like crap!!!


255 Posts

I have two points of view. First, the hospital I go to if needed is a rural 100-bed facility that is excellent! The nurses and physicians are right on top of the latest treatments and keep informed with the latest research. They are never shy about sending a patient out to a more qualified facility if needed.

I normally work in a 500+ bed Level I trauma center/teaching hospital. We love getting patients from the small rural hospital for just the reasons I mentioned.

I am currently on a temporary assignment in a 100-bed suburban hospital that "I wouldn't take my dog to". And at my other facility, we hate getting transfers from here because the staff has no clue. I have spent the last three months saying "Do you realize that _______ has not been the standard of care for five years??" so many times that I want it tattooed on my head! No one (doctor or nurse) has any clue how to handle anything other than the simple vent or overdose. I have seen patients die because of poor nursing care, patients are never transfered out until it's too late ... it's frightening! :eek:

Certainly not every small hospital is dangerous, but it entirely depends on the staff and how up-to-date they keep themselves (within their limitations, of course).

I agree that this country has a larger is better mentality. But we often are told by our patients that we provide better and more personalized care in our hospital with 10 acute care and 14 NH beds, than larger hosp. These are patients who have been in other facilities with all the bells and whistles.

We are a level 5 trauma center with one ER bed and a small treatment room. We are quick to stalbize and ship those pts that are beyond our capacity to care for. Many a life would have been lost if we were not here.

This is real "fronter nursing".

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