To nurses who work(ed) for small, rural/community hospitals.

[Ted]

Please share your stories or describe what it's like to work for your small, rural/community hospital (50 beds or less, I guess. . . I mean really small!!!) What type of specialist(s) are available for consult? What's your patient/nurse ratios? Describe your staffing. Are your adequately staffed or are there lots of holes?

What are your likes and dislikes in working for a small rural/community hospital? What do you feel are your hospital's strengths and weeknesses?

This is an extremely open-ended inquiry. I'm looking to see just how similar or dissimilar my hospital may be to others. I work for a 32 bed acute care hospital with a 5 bed ICU/CCU. Within a year's time, we're getting smaller! To 15 beds between med/surg and the ICU/CCU with several of the 15 "beds" available for telemetry.

As written in other threads, I've expressed concern with the viability of our hospital. Yet I'm told that it won't close because it services such a wide geographical area (which include areas of three different states!) How is your hospital handling all of the cuts to reimbursements, and nuring shortages, and other problems found within healthcare?

Thank you ahead of time. And. . . cheers! :)

Ted

[sbic56, BSN, RN]

I work in a 42 bed rural hospital. We are affiliated with a much larger hospital and consult with specialists there. I work in OB; we have a level 2 nursery and send the sicker neonates to the larger hospital via their transport team.

As far as staffing, we have good days and horrible days. I have seen a few days where we sit around with one mom and babe or are even "closed" with one RN on duty in case we get someone in. Then, there are days with 5 deliveries, several gyn and mom/babe couplets, as well as outpatients in for NST's or whatever for 3 or 4 nurses. Doesn't sound too bad until you realize that we are responsible for just about everything on a small unit as ancillary staff is minimal. We are also and LDRP; so we all are experienced in every aspect of care. Each of us are labor, postpartum, surgical and neonatal nurses.

All in all, we are set up safely to deliver the care our patients need. It would be nice to be a little more state of the art, though. We are partly computerized, but still do alot of writing which makes for more work in the end.

It's interesting to see the difference between larger and smaller hospitals and how they operate. We had a nurse who previously worked at a hospital that had 20+ deliveries a day where her function was purely L&D. It was quite a transition for her to come to a small place like ours where we are responsible for everything. Not saying one is harder or easier than the other ...just different.

[cactus wren]

I work at a 54 ( maybe, currently undergoing remodeling..don`t know what the numbers will be when..if ever..they are done) bed hospital. We are the only hospital for many miles, and have lots of traffic going to and fro from mountains and lakes to Phoenix metro area. Have a 4 bed Icu that has the room to expand to 7 if we ever get busy enough...only licensed for 4, use 2 of the other rooms for M/S overflow, and the 7th is storage. Have a big Er, something like 3,000 square feet, like 10 bays, and usually have folks waiting.

Also have new surgical suite, like 4 rooms with an outpatient dept. All of the above were new construction as of 4 years ago.

Have family practice, internalists, 2 gen surg, 2 ortho docs on staff. Have many specialists who come up from Phoenix about once a week.. If I ever have an MI, I plan to have it when my fav. cardiologist is in town

We are down to only 2 docs delivering babies..` is ob/gyn, and the other is family doc, all the other family docs have stopped OB due to the horrid cost of Malpractice ins. We have 3 birthing rooms, and 4 post partum.

Most of our really ill patients are shipped to Phoenix ASAP, We have a chopper based at our facility( not ours..privately owned service), which is a great help. Have noticed that we are now keeping patients much longer as it is harder to find bed in Phoenix, had one snakebite this summer for 5 days( as ER extend:D ) waiting for bed...

Best thing about us is that I

know everyone from the maintenence men to the CEO by their first names, and they know miine...Worst thing is....see above.......

I work days in ICU, and we are usually well...sorta...staffed. 2 nurses, but no US or other help, but we all work well together, and usually have a busy but ok time. On nights there is only 1 nurse staffed, so we either pull from M/S or call agency...............have spent major buck

s on agency this past month...The bean counters refuse to staff 2 nurses at night................so all is not wonderful

I have worked large places and small, I like small better.................even if I haven`t seen a SG in 2 years.................When I get to feeling bored here, I just pick up a few shifts in Phoenix with agency, and that cures it...

But isn`t that true every where? :D

[canoehead, BSN, RN]

I work in a small hospital and my pet peeve is having to be housekeeper after hours. Esp when pt care takes priority, and if you are moving people around on night shift chances are you don't have time to do the mopping and dusting in addition.

Just my 2 cents.

[sbic56, BSN, RN]

OH, I do feel your pain on that one, canoehead! It has gotten better for us, but before we had LDRP rooms we had to completely strip and disinfect each labor room after a delivery after we moved the patient to a semi-private room. That totally stunk!

[ceecel.dee, MSN, RN]

Yes, Canoehead, I agree totally! Housekeeping and dietary duties, medical records, office work duties after hours...even physical therapy on weekends and holidays...all done by nursing! None of this is appreciated by the nurses at all!

[deespoohbear]

Originally posted by cactus wren

Best thing about us is that I

know everyone from the maintenence men to the CEO by their first names, and they know miine...Worst thing is....see above....... :D

So true! At our small hospital we are on a first name basis with some of the docs. (usually the younger, more progressive ones). When you work in a small facility you do know everyone by name from the person who mops the floors to the members of the board. When my MIL died at our small facility last spring, the support was incredible. From the staff who cared for her to my co-workers on my unit everyone was just super. But the down side of being in a small hospital is that sometimes everyone knows a little too much about you.