Interesting subject. I am always amazed at the number of people who do not understand how it is in small hospitals.
Our pharmacy is out of the building by 4:30, along with purchacing, medical records, and anyone else who does not have to be there. We NEVER have a doc in house to cover the people on the floor, just the ER doc, and they tend to not be there either, if nothing is going on, which is not often, but it does happen.
What do the ER nurses do when a critical patient comes in and the ER Doc is not there. we treat the patient, getting orders by phone if the patient needs meds STAT, if not, we get the labs and xrays done that are needed. In our ER we have One RN, one Doc and a tech from 7am to 11pm, after that it is the RN and Doctor. The charge nurse is responsible for everything, there is one charge for the whole hospital. I work weekends and got the luck of being charge, so now, I am in the ER, the nurses call me for any meds they need from pharmacy, help if a patient is going bad, and get the fun job of supervising the CNA's, which is a chore in itself.
Wildtime pretty much summed it up when he decribed how it is in very small hospitals.
As a nurse you either become very independant fast or can't handle it and quit fast. It is a tough situation for new grads. You do have to be very confident in your assessment skills.
If someone codes on my shift and the doc is not there, I run the code until the doctor gets there. Never had to do that yet, but it will happen. The only time I ever ran a code is when the doc went to talk to the family in the middle of the code.