What You Need to Know Before Going to Work at a Small Hospital

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For many RTs, nothing can beat the 24/7 hustle and bustle of the big hospital. But if you crave a more intimate setting, there are literally hundreds of small hospitals across the country that need RTs too. We talked to five AARC members who manage these facilities to get their take on what therapists need to know before going to work in one.

All hands on deck

First and foremost, smaller facilities often mean smaller staff sizes and more hats to wear.

“We do everything,” said Lorie Christy, RRT, respiratory care manager at 25-bed Compass Memorial Healthcare in Marengo, IA.

That means PFTs, the ER, transport, codes, pulmonary rehab, sleep studies — formal and HST— Holter monitors, the occasional newborn delivery, and general floor work.

“In most large hospitals you are specialized to a certain area,” she said. “We work very closely with all departments and help out wherever is needed.”

Marlyce Campell, CRT, says RTs in her facility must know it all — from preemie care to the patient in hospice.

“You may be the only RT for the shift or weekend,” said Campbell, director of respiratory care and sleep lab at the 25-bed Trego County Lemke Memorial Hospital in Wakeeney, KS. “You have to know how to be very organized and be able to handle several things at once.”

According to Jennifer Hemann, CRT, director of cardiopulmonary services, the sleep center, and the laboratory at the 47-bed Crossroads Community Hospital in Mt. Vernon, IL, small hospital respiratory care means performing more than just the respiratory care hat role.

“Typically, if you are in a smaller hospital, RT is cardiopulmonary services, which includes some basic cardiology along with RT,” she said. “Staffing is very limited due to the hospital size, yet RT can be needed in multiple areas of the hospital, often at the same time . . . these RTs are true superheroes, constantly running all over the hospital to care for patients in a variety of care settings.”

Jim Valentine, CRT, says being able to prioritize the needs of patients and emergencies is paramount for the small hospital RT because sometimes you are the only RT in the building.

“I also think you must be able to work as part of the team which includes nurses, physicians, social workers, and PT,” said Valentine, the respiratory care manager at the 55-bed Pomerene Hospital in Millersburg, OH. “You do not always have a second therapist to help validate your decisions and thought processes.

For Brenda Wilkerson, CRT, the cardiopulmonary supervisor at the 94-bed Johnson Memorial Hospital in Franklin, IN, being a small hospital RT definitely means being a “jack of all trades.”

“From neonatal resuscitation to adult ICU to hospice care to EKGs, EEGs, and things large hospital therapists never get exposed to — they are part of our routines,” she said.

It’s like family

Therapists who do take a closer look at small hospitals generally want a more personal environment, and these managers say they will definitely get it — in fact, it’s one of the biggest advantages to this setting.

“We get to know our patients and their families,” Christy said. “When one of our patients comes into the ER we generally know what may be going on and what we can do for them. We also will follow that patient to the floor if they are admitted.”

“You really get to know your patients and their family,” echoes Campbell. “They trust you.” Therapists are also part of the whole hospital team — not just nursing, but PT, LTC, staff on the ER floor, and more.

“It’s very rewarding to work in a small hospital,” Campbell said.

Hemann says everyone—from the unit nurses to the ancillary departments and even administration—works side by side to care for patients in her facility.

“When you have teamwork with your counterparts, co-workers begin to feel like family,” she said. Staff members are genuinely interested in each other, not just inside the hospital but outside as well, and patients take notice.

Valentine believes a small facility fosters a family feel.

“Both staff and patients get to know each other and develop a relationship that often goes beyond the hospital stay,” he said.

That family atmosphere means RTs have access not just to their fellow caregivers, but to the highest levels in the facility too, says Wilkerson. “The organizational team — from CEO through housekeepers — all know each other, and we all talk to one another,” she said. “The access we have to the C-Suite folks is second to none.”

Things to consider

Working in a small facility may result in:

  • Increased on-call time due to the smaller staff size.
  • Working with a limited quantity of high-tech equipment.
  • Taking on multiple tasks that go beyond patient care, such as discharge planning and restocking.
  • Having to transfer patients to more specialized facilities.
  • Being the only RT in-house at any given time.
  • Running into patients outside work with questions about care, due to small-town living.
  • Less competitive salaries.

So, should you pursue a job in a small hospital, or shouldn’t you?

In making this decision, Valentine suggests you: “Ask yourself, are you comfortable with your skills and are you able to critically think? Are you open to the idea of working by yourself as the only therapist on a shift? Are you open to being part of a team of health care providers who share decision-making in the care of our patients?”


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