[wizap]

Hi,
I also work at a critical access hospital. We have 4 ER beds, 2 ICU beds, 2 OB beds, and 13 med/surg beds and 1 negative pressure room. We have 2-RN's, 1-CNA and 1ward secretary on at night. Lab and X-ray are in house 24/7, and surgery is on call at night. Strokes and AMI's are sent to the 200 bed hospital 80 miles away by lifeflight. ...when the weather is OK.

[ruralnurs]

What is Rural Nursing? We have about 12 RNs that work in our facility, we are Critical Access, about 80 miles away from a larger facility. We are rural, (actually acording to the US census we are Frontier) our county is in the mountains and butts up against a reservation, we have many people in our county that have no running water or electricity.
We have some very wealthy people that have moved here to "live in the mountains" and many that live way below the poverty level, many migrant fame workers and many that just want to "live off the grid".

We are in a big hunting and recreation area so we get ATV wrecks, horse injuries, snowmobiles, motorcycles (ever seen what happens to someone that hits a deer with a Harley?), farm injuries, hypothermia, MVAs (ofcourse), and anything else you can think of.

We take care of all kinds of people, to include our family, friends, old high school teachers, the woman that our husband had an affair with, the person we know was convicted of child molestation, we deliver babies of women we know are drug abusers, we care for our collegues, neighbors (including giving them a ride home from the ER) and many people we don't know.

We are what are known as "Rural nurses" kind of a "Jack of all trades but a master of none." We have great relationships with our docs, RTs and other personell, including the EMTs that bring pts in....we have to.

We have 10 rooms (16 beds), 2 are ICU, 2 are OB, one is a negative pressure, and then we have a 4 bed ER. We have 2 RNs on all the time, and have a "call nurse" to be called in when needed (up to an hour away). We sometimes have the luxury of having another nurse to make 4, at the most, when we have a big trauma. We don't have a pharmacy per say, we get drugs from the pyxis and mix pretty much everything our selves, RT on call, x-ray in house, docs in house or 10 minutes away (we have lots of standing orders for things like chest pain, anaphalaxis, trauma).

In the last year (that I can think of) we had 2 rattlesnake bites, one that went into anaphalactic shock, (if giving Pitocin scares you look up all the possible complications with anti-venom!); a psychotic man that had a methadone overdose then proceded to have an MI (had to ride on the ambulance with him 75 miles to a higher level facility...fun!); 2 teenagers from an MVA that just walked into the ER, bleeding, glass everywhere, one ended up having an IC bleed; a family of 6 in a van that hit 3 horses at night; a 4 month old with respiratory distress that couldn't be shipped out for awhile and ended up having botulism (from honey); 2 teenagers that were hit by a drunk driver, 16 and 18, one came in CPR in progress, never left alive, the 16 year old shipped out, brain had herniated and his mom had to decide on organ donation, and the drunk driver was the son of one of our nurses; plus "boring" old med/surg pts.

I (and all the nurses here) do ER, M/S, ICU, peds, help in surgery, and 4 (we are training some of the others) do all aspects of OB (no high risk). We delivered a VBAC (no we don't do those on purpose) in our ER as she came in by ambulance, crowning, we had to stabilize and ship a woman with twins that was having ctx at 28 weeks and membranes ruptured at our ER entrance (we had no history on either of these women as they were not our pts), we had a beautiful baby boy born to a first time mom with no complications and our nurse realized he was a bit dusky at 12 hours, alerted the doc, did and ultrasound and discovered transposition of the great vessels (average time to diagnosis is 3 days, us...12 hours), but we don't do high risk???

I LOVE my job, I love the nights I work in ER and get that rush when we have an ambulance come in, and I love the team work when we have an MI or a cardiac arrest and we all work together and get the job done. I loved the night I was the only OB nurse on and I helped deliver 2 babies 3 hours apart, had to clean the room in between the 2, I also love the high I get when I am a 1:1 with an ICU pt on a nitro drip, insulin drip, and ART/CVP lines, and I enjoy taking care of the 86 year old lady in with weakness when I have time (not real often) to sit and listen to her how nursing was 60 years ago when she was one.

I have coworkers I KNOW I can count on. I also teach the childbirth classes. It is so nice to see a woman as a CB instructor, be her L&D nurse and then teach her to breastfeed as her MB nurse!

That is what is so great about rural nursing, its like a fortune cookie, you never know what you will get!

[santhony44]

Critical access, technically 25 beds, probably 10 beds realistically. Currently no OB nor OR due to only one physician (actively recruiting two more) plus 2 NPs.

ER is a room, with one treatment room for overflow. Lab and x-ray go home and are on call. We are about 30 miles from a city of 250,000 people and a couple of big hospitals.

You know you're doing rural when your elderly patient arrives in ER following her MVA and when her son-in-law shows up, he says "I'd have been here sooner but I couldn't get off the phone." "Who were you talking to?" "Everybody who saw the accident!" He'd had like three different people call and tell him his MIL had been in an accident and was in the ER!

[snowfreeze]

I have found rural nursing by accident, and I think I like it so far. I am a travel nurse and was hired as ICU/telemetry. My second week here in a small town in Maine I took care of a 20 hour old baby and c-section mom and one of my two admissions was a 5 yo with abd pain, the other was a 96yo with seizures. I asked the supervisor if they were comfortable giving me the OB/GYN newborn assignment and they said that the two OB nurses were sick so I was the next best thing. Well until last evening I had not checked a fundus since nursing school nor had I changed a diaper on a newborn for 17 1/2 years for my youngest child. I see where rural nursing is a jack of all trades type thing. This is a small town, pop around 5,000 I think and I work in a 25 bed facility. Having OB, ICU, tele, med/surg and rehab all on one small unit is interesting.

[wizap]

Rural Nurses stretch and grow!!! Never know what you will be doing next!!!! LOL

[snowfreeze]

Thanks for the support wizap!!!! I sure was scared going into report that night..didnt seem so bad by morning report time though.

[mtndew]

I am the nurse manager for a fedrally qualified health center. The nearest hospital is 37 miles north or 42 miles south of here. We frequently have emergency patients who walk into our center with lacerations, mva, chest pain. We stabilize and call the ambulance. We do have a lab, for send outs only. We don't have any xray.

[loriangel14]

I work in a 26 bed hospital about 15 miles from a full service hospital. We have no ER or OR and one doc that does rounds once a week and if we call her specifically to come to sign orders or death certificates. We handle physical rehab, palliative, elderly waiting for nursing home placement and oddball pts that don't fit anywhere else( usually mental health).

[awsmom8]

I guess my community is not big enough to be called even rural! We have about 35,000 people (including a large state prison) and our community hospital is a 35 bed SNF with 1 (yes you read it right!) overnite bed. It has 6 ER beds that see almost 1000 pts a mth. There are no specialists, not even an ortho on staff. No ICU, no CCU. Located 10 miles away is a Extreme Sports Camp specializing in BMX, Skateboarding and Inline skating and Olympic level gymnastics that will have up to 4 fractures a day on a busy day, not to mention head injuries. Children/adults are flown by helicopter that takes on average an hr to get them to a Level 1 facilty. The hospital here is the only one in a 45 mile radius.

And to top it off, the fire dept only has EMT's, no paramedic for the first 20min, and if the ambulance is on another call it will take up to an hr to get an ACLS ambulance. Alot of pts. chose to drive themselves to the hospital, even with chest pain as it takes a minumin of 50 min to arrive by ambulance. So some of them are not in the best of shape when they arrive.

[heartlover07]

Originally Posted by awsmom8

I guess my community is not big enough to be called even rural! We have about 35,000 people (including a large state prison) and our community hospital is a 35 bed SNF with 1 (yes you read it right!) overnite bed. It has 6 ER beds that see almost 1000 pts a mth. There are no specialists, not even an ortho on staff. No ICU, no CCU. Located 10 miles away is a Extreme Sports Camp specializing in BMX, Skateboarding and Inline skating and Olympic level gymnastics that will have up to 4 fractures a day on a busy day, not to mention head injuries. Children/adults are flown by helicopter that takes on average an hr to get them to a Level 1 facilty. The hospital here is the only one in a 45 mile radius.

And to top it off, the fire dept only has EMT's, no paramedic for the first 20min, and if the ambulance is on another call it will take up to an hr to get an ACLS ambulance. Alot of pts. chose to drive themselves to the hospital, even with chest pain as it takes a minumin of 50 min to arrive by ambulance. So some of them are not in the best of shape when they arrive.

I know the camp that you speak of, I worked there for a summer doing the overnight horseback trial rides for the campers! Wow, I didnt realize there were that many injuries there on a daily basis! I know I was one of them, I ended up in the ER after one of the horses threw me on the ground and then proceeded to stand on my femur with all of her weight until someone pushed her off of me!
Luckily it was not broken, but i had a huge bruise in the shape of a horseshoe for quite some time