Working in a Teaching Hospital?

mmc51264, BSN, MSN, RN · Feb 15, 2015

I work in a teaching hospital and I love it. Pros: really interesting cases, great attending physicians, nurses are crucial to helping the interns/residents learn. We have a resident on call 24/7 so we can have a doctor when we need one. Cons: residents who don't value the role of the nurse, when I was orienting, I had to fight the interns to get checked off on procedures, residents turn over quick so when you finally get a working relationship with them, they are gone.

I like to learn new things. So I listen in on as many conversations that I can whether it is between docs and residents of with the patients. I get to learn, too.

Cohiba · Feb 15, 2015

Cons: Dealing w/1st year Residents

Pros: Getting to teach those same 1st years--they have a far-more-advanced academic preparation but that doesn't mean their learning has stopped...

elkpark · Feb 15, 2015

Every time someone asks what is working in a teaching hospital like, or do you like working in teaching hospitals, I always think of a short humor article I saw years ago in a nursing journal -- it was a chart of the common terms used in nursing job postings and what they really mean. You know; like, "conveniently located midway between beach and mountains" is code for "it's in the middle of nowhere," "ability to multitask a plus" is code for "you're going to be expected to clean floors and pass meal trays in your spare time," that sort of thing. According to the chart, "teaching hospital" is code for "part of your job will be to make sure the residents don't kill anybody," and thinking of that always makes me smile when people ask about teaching hospitals (because it's so true :)).

Having said that, though, ditto to what mmc said, and I really like working in big, busy teaching hospitals. :)

Editorial Team / Admin · Feb 15, 2015

Honestly, as far as learning for nurses, I don't think there's that great of a difference between teaching and non-teaching facilities, at least in my experience. Instead, it depends on what each facility offers nurses.

The facility where I completed my clinicals was a teaching facility; the facility where I work is a non-teaching facility. Both offer monthly trauma inservices, both offer certification exam prep courses, both have unit based committees, both offer many more learning experiences. The key differences? Medical students and residents. Working in the OR, I am very happy not to have residents. Appendectomy? 15-20 minutes from skin incision to skin closure at my facility. At the teaching hospital where residents were involved, the average skin incision to skin closure was 2 hours. I'd go crazy if an appy lasted for 2 hours each and every time I did one- my record in a shift is 5.

Instead of looking at teaching vs. non-teaching, look into the educational opportunities offered specifically to nurses. I think you'd find that a more valuable measure since teaching tends to refer primarily to medical students and residents.

klone, MSN, RN · Feb 15, 2015

I've worked at both. Pros: When the s**t hits the fan, there are always plenty of docs there. You never have to have a pissing match at 2am to get the freakin' anesthesiologist to get out of bed and come in to give the poor lady an epidural. They tend to place more value on education and EBP. The residents knew all the latest evidence and techniques, and the hospitals seem a lot more cutting edge, as a result.

Cons: a lot less autonomy. At the non-teaching hospital, especially at night, the nurses ran the show. In L&D, we did EVERYTHING, and called the doc at home when the baby was about to start crowning. As a result, the nurses were adept at things like applying FSEs, lady partsl exams, sterile spec exams, ferning tests, collecting GBS, and yes, even catching babies. I had caught a dozen babies on my own in the 5 years I worked at the small community hospital. When I moved to the teaching hospital, the nurses were in awe of that. They had no idea how to apply an FSE, and their vag exams were not honed at all.

The other con is that the interns show you no respect. They walk in, not realizing that they're BELOW the nurses on the hierarchy, and the nurses know WAY more than they do. Usually, the R3s and above tend to know the score, and there's a lot more mutual respect (but then the little birdies fly the nest and it's a sad day).

NurseSpeedy, ADN, LPN, RN · Feb 15, 2015

I worked in a teaching hospital when I first graduated and stayed for 8 years. I preferred the teaching hospital over nonteaching. There was always a doc at my fingertips in house for orders on patients. They were just out of med school so most were open to suggestions. The down side was that they were just out of med school, so you had to call them to correct them a lot...I always had at least one new doctor write for potassium chloride IVP with each new set of interns we got.

KelRN215, BSN, RN · Feb 15, 2015

As a nurse, I only ever worked in a teaching hospital but I worked in a community hospital as an aide.

In a large teaching hospital, you might have dozens of Attendings that rotate through the service, each covering the inpatient unit for 2 weeks/year. Therefore it may be more difficult to develop a working relationship with them. Whereas, in a smaller hospital, you may have only a handful and may get to know all of them very well. In community hospitals you're also in touch with the Attendings much more often as there aren't always interns, residents or fellows to go through first. There can be pros and cons to this. The Attendings know you and you them but you also have to call them at all hours of the day and night when something happens with the patient, and they may not be too happy to be paged at 3am for tylenol.

There are pros and cons to working with residents as well. It's nice that there is an MD available in house at all hours but it's not always helpful when it's a resident who's just rotating through to check off the pediatric portion of his surgical resident and he has NO concept of normal pediatric VS or what to do for the child. I seriously once had a hydrocephalic 2 month old who was about to herniate and was showing signs of Cushing's response with a HR of 80- the Neurosurgery Resident tried to tell me "it's ok because she's sleeping." I said, "she's 2 months old, it's not OK." Less than an hour later we were pushing her crib directly into the OR, bypassing pre-OP as she started seizing and needed immediate surgical intervention.

License2Heal · Feb 15, 2015

Thank you, all, for taking time to answer my question. Your responses were awesome and gave me many things to consider. Really appreciate your expertise with this topic! :)

License2Heal · Feb 15, 2015

Loved your statement about "part of your job will be to make sure the residents don't kill anybody". That sounds frightening, especially for a new grad!

klone, MSN, RN · Feb 15, 2015

Loved your statement about "part of your job will be to make sure the residents don't kill anybody". That sounds frightening, especially for a new grad!

Don't worry - as a new grad, you won't be expected to save the patients from the interns. That's what your charge nurse is for. :)

NurseSpeedy, ADN, LPN, RN · Feb 16, 2015

Don't worry - as a new grad, you won't be expected to save the patients from the interns. That's what your charge nurse is for. :)

Yikes. My hospital made some new grads act as charge when the original charge nurse had a day off. Also, I had to tell my charge nurse how to set up a patient's PCA when I had just graduated because I wasn't IV certified yet...and it was a teaching hospital.