May I vent about rural hospitals? LONG rant!

  1. I agreed to work ICU at a local rural facility. When I arrived for the first time, as usual 'nobody had time' to orient me properly (the norm) so I poked around and got my bearings.

    It was a 5 bed ICU, 2 vents, 2 unstable DKA's and a screaming old lady in CHF. They don't say a word to me til shift change then they announce proudly (like I should thank them) 'Well you were going to be alone but we found another nurse to work with you." I was amazed and my jaw hit the floor I'm sure.

    The 2nd nurse arrives and airily announces "I want Bed 5...I had her last night"...I thought, OK fine...she is on her way to CT and the nurse needs to go with.... and I wanted to stay in the unit and get organized anyway.

    Well, day shift leaves (they had 3 nurses all ICU qualified) THEN this 2nd nurse starts whining. "Never had a vent before" (so why is she in ICU and why did she ask for bed 5, I ask?)" This is just too hard for her and she is a NEW GRAD and I need to help her." She can only handle the 1 vent patient... so I need to take the other 4 patients and 'help' her with her one.

    At this point steam is coming from my ears and I am truly feeling dumped on. I call the supervisor who says "I'm no ICU nurse...this is your problem". I say, nobody told me I would be in charge and be given a new grad to precept as my coworker in ICU...my first time out here. She shrugs. The DON doesn't care, isn't ICU qualified either, the unit director is out of pocket.

    I figure...XX#OO%....just get through it...and don't look back. Well this new grad drives me nuts all night...basically I should have taken all 5 patients myself and delegated tech stuff to her because she had no clue, was a total drain on me, majoring in minors, has to walk out of the unit numerous times to 'get some air' while I never even got a sitdown break (didn't DARE leave her alone with the patients) Calls her floor friends to tell her how 'hard she is working' (with her one vent patient...whom I am supervising closely so she won't hurt her)

    Shift end: the new crew comes in and tries to RECRUIT me...please come back, etc. I have to stifle guffaws and various other expletives...LOL! Trying to think exactly what I will tell my agency....but calming down first...!

    Anywho, thanks for letting me vent ya'll...I LOVE the freedom and flexibility of agency work but I'm learning to stay clear of these small rural hospitals...I seem to get the same kinda crazy trip every time...guess I'll learn someday, eh? :roll
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  2. 28 Comments

  3. by   Brownms46
    Matttsmom...you're a better woman than me...for sure! I would have called my agency...told them what the deal was, and told the DoN...supervisor...and anyone..else I would be leaving, if they didn't get a qualified ICU nurse...and or at least a couple of techs in that unit! That God that was a one nite deal!

    God Bless you for keeping your ! Wait a min! What was a new grad doing on nites????
  4. by   2ndCareerRN
    I feel for you mattsmom.

    I was recently offered a travel assignment to a rural hospital. Seemed like a good deal, until I asked about other staffing. I would have been the only RN in the facility from 5p-5a. granted there would have been a few LPN's and aids, but I did not feel like being the House sup, pharmacy, L&D (we just send them out), ER, and pushing all the IV meds for the facility.

    I really don't know how they plan on filling that position, unless it is with someone that has a lot of rural experience, or someone with no experience at all.


    At least you made it through the night, and it sounds like it will be your one and only night at that facility.

    bob
  5. by   nightingale
    [i]She can only handle the 1 vent patient... so I need to take the other 4 patients and 'help' her with her one.


    Anywho, thanks for letting me vent ya'll...I LOVE the freedom and flexibility of agency work but I'm learning to stay clear of these small rural hospitals...I seem to get the same kinda crazy trip every time...guess I'll learn someday, eh? :roll [/B]
    Holy Moly! Kinda makes ya glad your an agency nurse.. I hear ya loud and clear!

    I guess the minimal criteria has been met by staff, no one was hurt so they want want to "Hire ya"....

    YOU are wise to stay clear of that facility.

    Thanks ofr sharing your story...:angel2:
  6. by   mattsmom81
    Thanks for listening guys...It's been awhile since I went 'way out in the county' and I forgot that THE most important question to ask is what are the credentials of my coworkers...thanks for the reminder!

    This new grad was all puffed up they were letting her in the ICU...I gave her the CYA talk with plenty of warnings...reminded her she would likely be alone at night in this ICU very soon...her eyes got real big and hope she's thinking about what I told her.
  7. by   mattsmom81
    Originally posted by 2ndCareerRN
    I feel for you mattsmom.

    I was recently offered a travel assignment to a rural hospital. Seemed like a good deal, until I asked about other staffing. I would have been the only RN in the facility from 5p-5a. granted there would have been a few LPN's and aids, but I did not feel like being the House sup, pharmacy, L&D (we just send them out), ER, and pushing all the IV meds for the facility.

    I really don't know how they plan on filling that position, unless it is with someone that has a lot of rural experience, or someone with no experience at all.


    At least you made it through the night, and it sounds like it will be your one and only night at that facility.

    bob
    I hear ya, Bob. Glad you asked the right questions before you got stuck in that place. They LUV to snag new nurses and get them in that job...someone they can blame them when the shyt hits the fan.
  8. by   nightingale
    This really makes all the traveling I do to and from Denver less painfull. Even the "big" hospital in town sends out the "really sick ones"... yeah but who takes care of em in the meantime?
  9. by   mattsmom81
    Ever get the feeling some of the less experienced country docs just kinda 'experiment' with patients? They were anxious for my input...but I also am aware I REALLY shouldn't practice medicine without a license...LOL!

    Had a 19 yr old with acute abd pain and WBC of 30K...the docs paniced, rushed her to surgery...found nada...then left her paralyzed on a vent for a day trying to figure what to do next...I do my asessment...it's like...guys...she has acute abd signs...foul vag discharge...sexually active...abd explore was negative...why have we not done a colp and cultured her up for PID?? And please let's extubate her b4 she has complications of mechanical ventilation!! The doc says uhhh...I can't extubate her...her CO2 is 4...I reply "Yah but it's respiratory not metabolic...did you know you have her on a rate of 36? ( altho I don't know WHY)

    I suggest she is BLOWING OFF the CO2...and ask permission to wake her up, begin a wean schedule,observe, and extubate her if/when ready....He says "Do you know how to do that?"...I say sure I do.

    The docs were like...uhhh...OK...good idea...thanks for your help...nice to have a 'real ICU nurse' here....hmm.

    While it feels good to be appreciated.... Yup it's a little scarey at these country hospitals.

    Makes me appreciate even the jerkiest of docs at my big facilities who DO know what they are doing and why despite their arrogance. (Can't believe I'm saying THAT) LOL!!

    Maybe I'm being a little hard on them...they are young docs...probably trained in a big teaching hospital with lots of experienced docs and nurses around to help them...then relocated to the boonies (maybe on a rural med school scholarship program) and got a culture shock. Can't help but feel bad for patients way out there though...

    Thanks for this forum...nice to be able to vent to other agency/travelers. We really have to hone our CYA skills don't we?! LOL! :roll

    Gotta kid in college in this part of the county and know where I'll be if he ever ends up in THIS place...Mama won't leave his side til he's transfered OUT. :stone
    Last edit by mattsmom81 on Feb 11, '03
  10. by   KaroSnowQueen
    mattsmom, i live three blocks from a small rural hospital where they couldn't find their butt with both hands if you gave them a "you are here" map. I drive 45 miles one way to the nearest large city(both for work and for medical care) just because I have been a pt in this hospital and they scare me to death!!!!!!!!!!!!!!!!!!!!
    Had an old old old doc who kept them in the dark ages for years and years. He finally semi retired and now there are young docs, but no offense, both the foreign docs and the home grown ones, are so insecure, it seems, in their knowledge that it is frightening.
    We refer to our local small rural hospital as the bandaid station and I have told my hubby and kids to lie and say our insurance doesn't cover coming three, and to ask to be transferred out ASAP if they ever end up there.
    I know many many docs in the bigger hospitals may not be on the ball either, but there are plenty more to choose from and find second opinions from if you happen to want one. I agree with you, the level of knowledge in these country hospitals is frightening at times.
  11. by   mattsmom81
    Hi Karo...I do like the friendliness of a small rural facility, but I agree...it is worrisome when a loved one becomes a patient in them. I don't blame you for choosing the bigger facility...I would too.

    Even if your doc is fairly good, the staff comes into question too.....who would ever put a new grad into ICU as staff without requiring some clinical orientation/precepting? Quite dangerous.

    I would make the drive to Denver too Nightngale!
  12. by   eddy
    Originally posted by mattsmom81
    who would ever put a new grad into ICU as staff without requiring some clinical orientation/precepting? Quite dangerous.
    Sadly, it was probably either that or you were going it alone. They probably figured 2 is better than 1. Unfortunately, this is not really the case.

    On the flip side. I have had some pretty good experiences in the rural hospitals out my way (some bad too... but...). The ones here have nurses that more or less float to every unit. They seem to know their stuff, but there are just so few of them. I feel for these communities. I fear many of them will lose their local facilities in the near future as it is becoming near impossible to recruit young nurses out in BFE. Ultimately the health and safety of the communities they serve will suffer as a result. It's a shame.
  13. by   scherzo
    This post is over a year old...but I am a new member of this board...and upon reading the replies, I am not seeing the words "SAFE HARBOUR" anywhere.

    I have been an RN in a rural hospital. Yes, they can put you in some really compromising positions. Safe Harbour is a regulation that says, "this situation is unsafe and I am making you aware of this." You are making them formally aware of the problem when you fill out the paperwork and submit it. If anything happens, it protects you from liability. The DON and the supervisor and everyone have formally stated that they know that it is unsafe but they have no other options. Most hospitals will do whatever it takes to avoid safe harbour because it increases their liability.
  14. by   mattsmom81
    Good point Scherzo...and I may have to resort to Safe Harbor in my current job...I have gone on staff at a relatively rural LTAC hospital with a small ICU and they are wanting us to take some fairly sick patients without appropriate resources. I have pulled Safe Harbor forms up from my BON and placed them in my locker.

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