Working in a Teaching Hospital?

elkpark · Feb 17, 2015

(keep in mind that "teaching" refers to teaching physicians, not nurses). There's much less autonomy for nurses at least in the teaching hospitals I've worked at, which sort of stunts the learning progression of the nursing staff.

Not necessarily. The "teaching hospital" at which I trained a kazillion years ago had a few residents and its own hospital-based diploma school. Much of the hospital was organized around the education of the nursing students. Lots of academic medical centers are also teaching centers for nurses (as well as other disciplines). The ones in which I've worked over the years have had student nurses, pharmacy students, PT and OT students, etc., etc., and everyone's education was taken seriously. The nursing departments were strong and active within the organization, and taken seriously and treated with respect by the medical leadership. But, as with everything else in life, I'm sure there are other models out there.

danielle2000, MSN, RN · Feb 17, 2015

I prefer community hospitals because there are more of these hospitals than teaching ones. When you work in a teaching hospital you receive great training no doubt, physicians around the clock. Learning the current evidence based practice in your unit. Resources galore. But it is not always a reality in the community hospital there is no admit team, or team leader more likely other staff members share different roles and responsibilities. The physician will not come in unless the patient's condition has turned for the worse and there is still no guarantee. Nurses, however develop critical thinking skills more readily, you learn how to adapt and improvise. You must be a self motivator though. I have worked in community hospitals where they have hired nurses coming from a teaching facility and assume they do not have to admit or be charge. Their knowledge is on point along with their skills but sometimes they remain task oriented not expanding on critical thinking which appears to lie dormant. I agree it is a great place for any new grad nurse to work for to get a solid foundation but keep in mind when you step in the community hospital setting it may be a real culture shock.

dudette10, MSN, RN · Feb 17, 2015

PMFB's statement about getting residents to intervene is a much more accurate description of what we as nurses bring to the table in terms of "saving" patients in a teaching facility. I have worked in one non teaching and one teaching hospital. While you have much more autonomy in non teaching hospitals, you have less power to advocate for patients.

If you work in a teaching facility, don't get sucked into the "interns are morons" statements. I have seen nurses treating interns and some residents with derision, which does nothing for interdisciplinary collaboration. I have also seen dumb residents lording their authority over nurses due to their own insecurities. We have one intern and one resident who do that now. The intern upset a family over her disagreement with a night nurse's method on a nursing skill in front of the patient and family..so much so that they told me about it when I was the day nurse.

That said, I will never go back to a non teaching facility if I can help it. Having had a few patients who didn't have residents assigned to them solidifies my opinion. One such patient was being discharged post op by his surgeon. The surgeon didn't wait for the results of the blood draw before putting in the discharge. A triad of symptoms that were innocuous by themselves, coupled with the results of his CBC prompted my call to the attending who was annoyed with me when describing symptoms, but who stopped in his tracks and cancelled discharge when I got to the CBC results.

Jules A, MSN · Feb 17, 2015

I have worked at community hospitals and teaching hospitals and both have their pros and cons. As a new nurse I learned an amazing amount of information quickly at a large inner city teaching hospital. The baby docs rarely gave us a problem and most were kind of cute in a wide-eyed Bambi type way. Like others mentioned I loved the vast access to doctors, medications and the latest, greatest supplies and interventions. When the magnet stuff started rearing its ugly head and they were encouraging us to do free work in the interest of advancing nursing power I started rolling my eyes. Maybe I missed it in other responses but the money can be lousy for RNs and I personally take issue to that but again some places are worse than others. As a NP I love it because although the jobs aren't as plentiful since I'm now medical staff I'm out of the nursing fray and get the best of the above without the negative.

NicuGal, MSN, RN · Feb 17, 2015

I have to disagree with some people who said it is a teaching hospital for docs, not nurses. You will learn a lot of info and such just by listening to rounds. And most of the docs at teaching hospitals will teach you and answer questions when asked, they want you to have good information. When I was a student way back when, at the hospital my school was at, those docs swooped in, did rounds, left the orders for us to transcribe and have pity on the one that had to call them for clarification. Hopefully, that has improved lol

But I do love the residents who say to us, I have no idea what to do, where to start, and I love guiding them thru the maze if NICU. í ½í¸€

MunoRN, RN · Feb 17, 2015

Not necessarily. The "teaching hospital" at which I trained a kazillion years ago had a few residents and its own hospital-based diploma school. Much of the hospital was organized around the education of the nursing students. Lots of academic medical centers are also teaching centers for nurses (as well as other disciplines). The ones in which I've worked over the years have had student nurses, pharmacy students, PT and OT students, etc., etc., and everyone's education was taken seriously. The nursing departments were strong and active within the organization, and taken seriously and treated with respect by the medical leadership. But, as with everything else in life, I'm sure there are other models out there.

That's a good point, I should have clarified; teaching hospitals are not the only places where nurses can have an above average learning experience as a new grad. "Teaching" hospital refers to teaching physicians, not nurses. In my state the hospital that is known as by far the best place for a new grad to learn is not affiliated with a med school, so it's not a teaching hospital, so I wouldn't limit the hospitals I consider as a new grad to only teaching hospitals in order to get the best learning experience.

wanderlust99 · Feb 18, 2015

It really is dependent on the particular hospital IMO. I've worked at both. And there are large hospitals that are "teaching" but I certainly wouldn't call them academic. It's a big difference IMO. Just because there are residents doesn't mean anything.

The place I learned the most about ICU care was a 250 bed community hospital. It was such a difference for me after coming from an academic facility that was full of residents. You work with one attending and you the nurse present the patient to the team, not a resident. The attendings at this hospital would ask us questions, similar to what you see with residents, and it was a great experience! But of course not all places are like this.

I am back at a large "teaching" hospital but I really do prefer the smaller ones.