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

  1. 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
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  2. 17 Comments

  3. by   emily_mom
    The hospital I used to work at was only 32 beds! We had lots of family practice docs that came in to see their patients. Also had top of the line urologist (hot too!), hand specialist, cardiac spec, ENT, optometrist, internal medicine, and I'm sure there were more that held office hours and perfomed surgeries. We only had one in house surgeon! No OB. They ship out a lot. It is kind of an in between place to stabilize before Lifeflight came in or the ambulance. We had no real ER docs...all rent-a-docs from who knows where? They closed the nursing home last year (forcing 80 people to find a new place to live), yet are trying to rationalize building a $20 million new facility. Their census is rarely above 4-10 (not including outpt surgeries). They have more nurses there than pt!! But, they will never shut it down as we are the only hospital for 35 miles one way and 55 the other!
  4. by   mattsmom81
    I have worked at 2 small hospitals..one 30 beds or so, the other 100.

    Both have since closed down, but they were not truly rural...they were located in suburbs of Fort Worth. Locals loved these little hospitals because they did not have to drive to Dallas or Fort Worth, but financially they couldn't hang on.

    I have since done agency work at other small rural sites and it seems to be feast or famine when I go there!

    Either I sit with one easy patient in ICU or I'm alone with 2 or more critical patients with zero backup and I have to transform the PCP or a medsurg LVN into an ICU staff nurse... both to get the work done and try to save a life. Now I got good at barking orders at them..."He needs Dopamine...mix it up for me...I have to suction this vent patient who'se vomiting so she won't aspirate...her ETT balloon seems to be leaking....we need to stabilize and retube...Oh look he's in VTach now...is there a pulse??...grab the crash cart....let's move"

    There is nothing scarier to me than this scenario: I'm one of 2 RN's in the house at a small rural hospital and I get a call..."Hey we're doing CPR on a baby in ER".

    I freeze for a moment because I am NOT a pedi ICU nurse...then reality sets in. The baby won't make it in the ER because 1) we're waaaay out in the country and the baby got brought in too late by family who didn't think to call 911..... and 2) we don't have the technology or medical expertise immediately available to get the baby through this anyway.....

    I had trouble dealing with these feelings so I stopped going to rural spots....prefer to work at big hospitals now with mucho resources at our immediate disposal.

    I do admire the nurses who are brave enough to work these rural hospitals though...they are troopers and have to know a little about everything.
    Last edit by mattsmom81 on Nov 22, '02
  5. by   NurseDianne
    My hubby and I both work for a small rural hosptial in South Georgia. Approx 68 beds. We have a 4 bed ER w/ a trauma room. 4-5 bed ICU (can be extended) 2 bed L & D, special procedures and one OR suite. We see alot of poor folks, indigent, etc. But that's ok, we have a purpose. WE also have a PT.OT and RT. WE do just about all of our own stuff. IF it's very serious (heart stuff) we ship it out to a larger medcial center. We have been very effective in saving lives and after stabilizing them to go on to larger facililty.
    Good things? Well, I work ER/OB. Since we are so small, some nights I don't have an OB so I work ER......thus to be pulled if one enters the facility. I work 7P. I also can work the floor, nursery, ICU, and cover in the OR if needed. Hmmmmmmmm......lots of experience. That's a definate plus. In all my years of working at this place.........12+, I have worked in UR for 2 yrs in the middle of the floor/etc. It kind of gives you a place to go when your burned out and need a break. Currently I am also the Employee Health Nurse 2 afternoons a week.
    My honey? Well he's a Med/Surg. floor nurse (although, let me insert here, we don't have seperate wings for OB,Ped, Med/Surg...etc.......) But, as of Jan 1st.......he has taken a day shift position in RT. He's burned and needed a change of pace.
    WE do have alot of specialist we can rely on and do ship our patients out when needed. WE also do alot of referrals. Plus, we have a mulitispeciality clinic where each specialists has one day a week where they come to town. I think that works fairly well. WE also have an adjoining Nursing home 100 beds and a dialysis center. For a small town, we do really great.
    I for one have loved working here. Once, during a brain cramp, I left for 6 months.......i actually moved away......and hated it......called my CNO and requested my job back. NOT a problem.
    I love the fact that we all know each other by name. WE have dinner in the homes of our docs, and they come to our BBQ's. Our Christmas party for the hospital ROCKS.....and it's just like one big family.
    NOW.......that said.......we are not w/o our problems.......we are always short of money......wanting raises.....etc.......

    Sorry this was so long.......
    Hope it answered your questions.
    Dianne
  6. by   kcrnsue
    I worked for a small hospital. If the census was 16, we were full! We only had gp's. Not doing ob anymore,or icu. Staffing was very scary. At night there was an er nurse a floor nurse (sometimes two) and maybe a cna. There was no on call respitory, so we would have to set up our own mist tents,cpap,etc. And I always prayed there wouldnt be a code.
  7. by   NurseDianne
    we don't have resp. at night, but we have such a great crew.....codes aren't scary......everyone has a job, and we depend on each other. sometimes our census is low 12 or less....and our staffing is almost nil........but we manage
  8. by   ceecel.dee
    Our place is 30 beds, 3 ICU beds, 2 birthing rooms, with 7 GP's and one general surgeon, outreach cardiology, neurology, oncology, urology, orthopedic, ophthalmology, ENT. One CRNA full time and 2 others from neighboring towns that share call with her, daytime RT, PT, OT, ST.

    We are currently concerned about our future, due to some infighting and unrest and business problems among the docs associated with their clinic. The hospital board is stepping in with some business assistance for them (they privately own the clinic as "partners") because if they go under, our patient base goes with it and we won't be able to make it.

    We run short staffed as a rule. 2 RN's per shift is typical, with most of the patient care done by our great LPN's and CNA's as the RN's are spread thin with Charge, OB, ER, etc where an RN is imperative. Typical nurseatient ratio is 1:4-5. Nursing admin/supervisors who are supposed to be on call for emergencies and questions often must work the floor just to cover adequate patient care coverage, and 2:3 do so without complaint, making less money than we do due to no OT or bonus for extra shifts picked up, etc.

    It actually, is an invigorating place to work! I believe you become accustomed to the adrenaline rush of such a place. I would not enjoy going back to a large place and have to "pick a floor" and stay there. It is exhausting, but all nurses say that. I feel really wrung out after most shifts, and hard to drag myself back if I didn't get 7 hours of sleep in between, but the energy is always back up there by the time report is half way over.

    We do use locums to cover about every 3rd weekend to give the docs a break (our ER is quite busy, and they cover all weeknights and all other weekends), but they don't like to give up the $, so locum help is received in a lukewarm fashion, and the "locals" like a familiar doc to see them in the ER. Nurses do a lot of placating and apologizing for the docs, but they are good people for the most part.

    Change is in the air....I only hope it will be good!
  9. by   deespoohbear
    Our hospital is about 75 beds, that includes 22 SNF beds, and 8 psych beds. Med-Surg is 32 beds with a 4 bed ICU. OB is 5M/5B and ER has 3 bays, one procedure room, one trauma room, and 3 exam rooms. Mostly family practice docs, but also have cardiology M-F. Also have other consulting docs such as neuro, pulmonary, nephrology, ENT, ortho at least one day a week, if not two. 24 hour emergency room coverage-4 full time docs and then some 3rd and 4th year residents covering the rest. We have are usual share of nitpicking but when it comes to a patient crashing we all pull together and do what is needed for the patient. We transfer a lot of patients out (especially cardiology and ortho) to larger facilities. I feel that sometimes we don't transfer our patients soon enough. We do have a full time internist on staff (who is smart as a whip, and just an all around NICE guy ) who is the director of our ICU. I enjoy the closeness of working in a small hospital but sometimes I get so aggravated because I believe we could do more if we had more modern equipment for some areas and a more realistic view of what we are capable of handling. But our administration pretty much has a "this is the way it has always been done and this is the way we will continue to do it attitude. Interesting thread.
    Last edit by deespoohbear on Nov 27, '02
  10. by   tattooednursie
    I work in a 56 bed LTC . . .49 occupied 7 unocupied. Most are total assist with EVERYTHING. We are never aquadatly staffed. 2 halls (when there is only 2 CNA's taking halls) suck! We cant provide the best care we can when it is like that. Typically we are devided into 4 halls, and 5 if we are EXTREEMELY lucky.
  11. by   suzannasue
    Ted,
    Presently working 30 bed facility...18 beds are Med/Surg/Pedi...the other 12 beds are considered "acute care"...6 hardwire beds and the ability to monitor 5 tele's...10 bays in the ED...the staff from our units are frequently pulled to staff the ED which causes me a lot of "slow burn" because we are left short staffed on the floor and because only a couple of us are floated...I am all into fairness and this aint cuttin it...but I do it although it chaps my hide....
    The hardwire area handles all sorts of things...of course...vents, drips etc but it cannot be properly staffed when there are several very serious cases present...the equipment is frequently out of order (b/p cuffs for monitoring q 15 vital signs) and if we do manage to find a portable vitals machine, it is not unusual to find it has disappeared for someone who has to take their pts vitals...
    had a pt on a NIpride drip one night, b/p cuff for monitor was malfunctioning...borrowed a portable monitor from ED (the ED was not busy and no one needed the monitor!!!)...the next morning the ED manager had a hissy fit and told us that her equipment was to NEVER leave the ED...needless to say...our manager upheld the ED manager and we had to do manual b/p's on this pt q 15 minutes because only one of our vital sign machines was in working order...luckily for the pt (and dayshift staff!!!) , she was transferred that morning by 0900 to our "mother facility"...
    We staff (on good days) day shift 3 or 4:1, night shift ususally 4:1 although on my weekends, it is usually 6:1...
    A lot of our pts are from LTC...once they are stablized on the acute care side.. they are transferred to the Med/Surg/ Pedi side...if they lose their beds in LTC, they are put into "swing bed" status...there is more reimbursement for a "swing bed" by Medicare than if they are kept in "acute care" status...
    I wish I worked with NurseDiane and her husband in South Georgia,...there is no camaraderie amongst the staff...lots of resentment between the "sides"...and management promotes the resentment...they have no clue about staffing according to acuity...they just look at numbers...I often wonder why I have "landed" here, but the other "local" facilities are even MORE political and poorly staffed than we are...I could drive an hour to another larger facility, but, dang...the benefits and money are pathetic everywhere around here...big sign on bonuses mean nothing to me...went that route before...found out exactly why the sign on bonus was so large...stayed there for 3 years, finally just walked away...it was either that or I was gonna die...
    We have no specialists on staff...consulting surgeons whom I would not allow to operate on road kill...everything else gets "sent up the road"...we have stablized many a pt in this facility...and I am extremely grateful that they have somewhere else they can go to have better medical care given by docs who are more "skilled"...
    There you have it... a personal glimpse into my special corner of HELL...
  12. by   stressedlpn
    I loved working for a smaller hospital, I got so much expierance, I learned alot for alot of different areas since I was the float.
  13. by   Ted
    Appreciate the input! Will respond in depth at a later time. Don't have much time now, unfortunately.

    Cheers!

    Ted
  14. by   sbic56
    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.

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