Every accredited nursing program includes a hands-on learning component known as clinicals. Usually included in the second half of your education, clinicals are a series of shifts you spend at the hospital, learning various types of nursing and working with patients under the direction of a clinical supervisor.

Different nursing schools are affiliated with different hospitals, which means that where you get your education will define where you do your clinical. Larger nursing schools, for example, are often associated with teaching hospitals, which tend to be big, well-funded, and full of complex cases that can’t be treated elsewhere. City hospitals (especially the ones in urban centers) don’t have the same level of sophistication, but you’ll see a faster pace, a lot more emergency cases, and even be involved in more decision-making.

Another option is the community hospital. If you live in a rural area, or within an easy drive of a small town with its own facilities, you may be asked to spend some time doing rounds there. For some people, the tight-knit staff can feel stifling. For others, it’s the chance to be part of something worthwhile.

Benefits of a Community Hospital

• Not as many critical patients: When community hospitals get complex cases, they almost always send them on to larger hospitals, which are equipped to handle the high-intensity illnesses and injuries. If you want something less stressful and more low-key, this is a good fit.
• Smaller staff: In a teaching hospital, chances are you’ll see dozens of doctors and nurses every day—not all of whom you know by name. There tends to be a lot of coming and going in a teaching hospital, so if you’re hoping to make connections with the staff, look for a smaller place to learn.
• More autonomy: In a larger hospital, there are plenty of people on hand to help you learn. Although you’ll always have support during your clinical rotations, you can expect more autonomy on the job, since there aren’t as many staff members around to lend a hand.
• Better reports and letters of recommendation: One of the reasons nursing students do clinicals is to learn and grow—which is why this portion of your education is graded just as much as lecture-based classes. Because you forge a tighter bond with your supervisor in a clinical hospital setting over a larger facility, you might be able to get better grades or even a letter of recommendation (or referral for employment) out of the deal.

Working in a community hospital—whether for nursing school or for your career—is very much a matter of preference. Some people thrive in a big-city setting, while others find the anonymity stifling. Before you make any decisions about what’s right for you, you may want to try both settings. Researching nursing schools ahead of time is a good way to learn where your clinicals will take place and what kind of reception student nurses get there.

If you have goals beyond nursing school and a typical four-year degree, you may want to visit the possibility of a career as a nursing director. Although it can take quite a bit of extra education and experience to become qualified for this position, the pay and benefits can be well worth it.

What Does a Nursing Director Do?

A nursing director is the supervisor in charge of the nursing staff in a large hospital setting. This can mean anything from overseeing staffing and patient care issues in a city hospital or coordinating clinicals and staffing issues in a teaching hospital. Because the focus is more on being in charge of other nurses (as opposed to working the floor), you can expect a lot more paperwork, administration, and bureaucracy than you would find in a lower-level nursing job.

Although every position and employer is a little different, you can expect to:

• Supervise practical nurses, registered nurses, and nursing staff
• Oversee patient care
• Act as administrator for nursing services programs (in an educational capacity)
• Supervise clinical instruction
• Participate in hospital committees
• Perform/oversee research related to nursing and the provision of care
• Monitor compliance to laws, ethics, and regulations
• Operations management
• Maintain patient records
• Develop and oversee nursing budgets and maintaining expenditures
• Create policies and procedures
• Conflict resolution

Because so many of these duties have to do with management and hospital administration, most nursing director positions require a minimum of a Bachelor’s degree, with larger hospitals requiring as much as a Ph.D. in either nursing or a related field (such as public health administration).

It’s also important that directors of nursing maintain their nursing ties. This means that you must be licensed to work as a nurse by the state board and keep up the proper licenses and certificates. Several years of experience on the floor is also a prerequisite for the job, since you’ll need an insider’s view on what kinds of challenges nurses face every day.

Nursing Director Compensation

Of course, all this education and hard work comes with its perks. Nursing directors tend to be the highest paid nursing professionals, with salaries that pass the $100,000 per year mark for larger institutions. Some hospitals also offer performance bonuses.

Emergency and crisis situations might require some weekend or evening hours, but for the most part, this position sticks to normal business hours and a Monday through Friday workweek.

Watch and listen as Angie Ballenger, B.S.N. discusses her own personal experiences as a heart transplant ICU nurse and why her working environment is so critical at UAB Hospital.