[MOOSEMAN]

Well think I've got you all beat. Until I started traveling 2 years ago, I worked full time in a rural hospital in Maine. 4 ER and 9 Acute/Critical beds. Think it is the smallest hospital east of the Mississippi. Left because of politics in hospital, with it being that small you couldn't escape the problems. What I'd give to go back to an ER that sees 12-15 pts on a real busy day.

[CraigB-RN]

Hmm Yup that's smaller than mine. I've got 16 acute/SSB and 2 ER. What a change from doing critical care agency work in baltimore. I actually travel 4 hours to moonlight in critical care so I don't loose those skills. I worked in Northern Maine in the late 80 & early 90's. I used to love that 3 hour ambulance drive in the snow with a high risk preg 13 yo.

If anyone told me that I'd be discusing medicare reimbursment for the hours spent providing nursing care, when I started this I would have told them they were crazy.

[adrienurse]

My mother is an RN at a 25 bed rural hospital. I'm always like GAAAK, why do you stay there Mom? But she loves it. She does everything, trauma, surgery, ER, L&D, Hospice, medsurge, psych, waiting for LTC placement.......

They're always threatening to close the place b/c they can never atract experienced nurses and are always shortstaffed.

It's not my cup of tea, but hey, she loves it.

[NurseKimberley]

My hospital is a CAH also, but we only have 8 beds in our hospital and 32 in the attached LTC. An LPN manages the LTC, an RN manages the ER/Hosp, and 2-4 CNA's work (mostly the LTC). It's quite different from the great big hospitals I'm doing my RN clinicals at! Swing beds are great, they're just LTC admits that need more skilled care (our LTC is intermediate care); at our facility it's just the same paperwork as an LTC admit.

[ruraluprn]

This is so neat! A forum for rural nurses. I too work at a CAH we have a total of 24 beds 9 of which are designated Swing Beds. We do not do OB except for emergency deliveries in the ER. We have a 2 bed ER. We do not have an ICU...we call it a monitored bed unit. Our average daily census is 7-8 patients but we occ. get down to one or two (that includes the swing beds)
Swing beds do make money...the paperwork is a pain though.

I love working at our hospital, I have been able to do a little of everything from working in the ER to riding on the ambulance with an unstable transfer and also the less exciting things like taking care of the patients awaiting the nursing home beds.

It is true one or two people on medical leave cause a staffing crisis. I am currently the acting director of nursing since our DON retired and we are unable to recruit a DON. We have had to use some agency staff this summer to meet our staffing needs, our census would go up when everyone wanted vacation.


Becky

[NurseKimberley]

Well I'm the SDC here, which at least in rural places is a catch-all for a little of everything. I do staffing (we use agency a lot, can't find anyone out here), teach CNA classes, and generally do administrative junk under the DON. You really have to have an appreciation for this type of thing to be able to handle the rural setting.

[ruraluprn]

So true,
Nice to meet you...I never thought of using our SDC to do scheduling :-) Our supervisors and DON have always done it!

Becky

[NurseKimberley]

Sounds like a great place to work
Tell your SDC to count his/her lucky stars!!!

[Dave ARNP]

I worked as a NP at a Rural Hospital right after I graduated.
16 beds, 1 OR, 2 beds in ER.

Facility never keeps more than 1 MD's at a time. 1 for general, and 1 who does surgery. Current surgeon is 77yrs old. Let us pray!

No OB/ICU. All rooms are cardiac, as they all are monitored up! Any chest pain gets you admitted, if you have so much as 1 risk factor, you board a chopper. (risks... HTN, CHF, HLD...)

1 RN, 2 LPNs, 2 CNA's. Thats their staff.

Did I mention, they use a whole lot of MS04?

-David Adams, ARNP
-ACNP, FNP

[mazz]

I am amazed to know that there are hospitals smaller than this one (15 acute and 3 ER beds). We have alot of swing bed pt's also. Honestly speaking, in actual time and resources I swear the swingers use more than acute patients ever do. We currently are having a problem with beds being taken up by LTC patients- a very frustrating thing! I didn't go to nursing school to work in a nursing home and that is alot of what we do, unfortunately. But we do rehab, and it is great to see the old folks getting stronger and more independent. But when they start to bring their own recliners in, it means they have been here too long!!!!!

Some things you see or learn in rural nursing that you will never learn in a big city (I worked in big cities before coming here)
1. You CAN transport a patient to the ER in a wheelchair in the back of a pickup truck when your 2 ambulances are out on calls.
2. Cattle and sheep drives are still done on roads and highways- and they will move out of the way! So don't stop and wait for them to move because they won't- drive through them (slowly).
3. Cowboy poker is not as mundane as it sounds. It involves a table, chairs, four really stupid or drunken volunteers, and one very large bull in an arena. Have I said enough?
4. In a fight, the horse is going to win, every time.
5. There are some towns in the U.S. where you can't buy underwear.
6. There is still such a thing as a social admit; and pipes being frozen is a good enough excuse to extend your hospital stay by a day or two.

Whoops! gotta run! Time to go burn my ditches.....