newly hired at a rural hospital

  1. Hi All,
    I have just been hired at a rural hospital with total beds 39. There is also a three bed ICU uh should I say room? Anyways, I previously worked in a 200 + bed facility and the floor that I was charge nurse on was a 36 bed step down/tele unit. What types of things are different between the rural hospitals and the larger ones. The only thing I do know is that census stays pretty much the same with an occ low census day because of this being Arizona, we get the snow birds in winter and in the summer the vacationers as well as the employees wanting vacation.
    If anyone has worked both, tell me which one you prefer.
  2. 16 Comments

  3. by   ernurse2244
    Hi, I work in a 40 bed hospital. I have worked in 400 bed ones as well. Main differences: you will very soon learn to know most of your patients and their families...there will be alot of repeaters. You will run into them in the grocery store, etc. where they will stop you for free advise or just to talk. Your equipment may or may not be as up-to-date as the bigger hospitals. Don't know what your hospital's financial situation is. Ours isn't so good but they do eek out some new machines from time to time. You will seldom see major illnesses or they will be shipped from the ER straight to a bigger medical center. You will have to be alot smarter, though, because there is such a variety of patients. No more working ortho, or peds, or icu. Our hospital has one nursing station...all patients are cared for from there, so you may have a surgical patient, trauma patient, diabetic, psych patient, cardiac get the drift. I work ER now, but have worked all areas of the hospital. When I first came, all nurses had to be able to go to L&D, ER, ICU and help out in OR. Now ER and ICU nurses are required to have ACLS (minimum).

    I really like this hospital. I like knowing all the people that work in the hospital. Everyone is on a first name basis, even the "bosses". Frequently when I call and say I need help, the DON is the one who comes to help. The administrator stops by almost every day and really has an open door policy.

    Confidentiality is a major problem because you are treating friends and neighbors of folks you know or family members of people who work in the hospital. Folks will call you to find out what was wrong with so-in-so who was in the ER last night, or people from another department will drop by to see who the ambulance brought in.

    Hope you love it!
  4. by   mittels
    Thank you for the input, I think I will really enjoy the work. I dont live in the town I will be working in, but 25 miles from it. Im sure though that I will eventually run in to many people that I will be caring for.
  5. by   obliviousRN
    I came from a major trauma center to a small rural hospital completely across the state. What a change! But I love it!

    The biggest differences I notice are how all coworkers get along. There are no "cliques" and every department interacts very well (meaning nursing, lab, xray, etc.) We have to if we want to get through the day.

    I have a lot more nursing freedom as a rural nurse. I can make many more decisions about pt care than I could in a huge hosp. and there are many challenges w/ equipment and such that you learn how to work around. (every make montgomery straps w/ silk tape and foley catheters sliced down the center?) Every day is an adventure.

    A coworker of mine put it best I think. At a rural hospital you are a jack of all trades and a master of none. Very fitting.
  6. by   Ted
    I do everything:

    1) provide total patient care
    2) answer all phone calls (which I actually hate doing)
    3) input all orders
    4) mix my own drugs
    5) do my own blood draws
    6) do my own ekg's
    7) call the MD when I see fit
    8) arrange my for all transfers/discharges, etc
    9) float to most areas of the hospital (when the unit is closed)
    10) because of #9, I provide great continuity of care from the ER to the ICU!!!

    Of course I also work for the state's smallest hospital and probably the smallest ICU. Because of this I usually have one, maybe two and rarely three patients. I also work nights! So. . . doing all of the above really is not big deal. And I like it!

    I know I'll never experience this anywhere else. So I'm going to enjoy it while it lasts.

    Yep! I like my job. The quesion always remain, though: Where will this hopsital be in the next year or two???

  7. by   Evie

    i will be graduating at the end of this year.. i want to do rural nursing - i love the idea of being multi-skilled, the exposure to such a huge range of everything, and living in a smaller community, not being just a number. i have always wanted to work in a rural setting.

    what i am trying to work out is, is it ok to accept a position in a graduate program in a rural health service district? (not remote though.)

    i have done reasonably well so far in my studies and have worked in aged care throughout this time, so i am gaining confidence every day. obviously working as a carer/nurses aide is different to an rn but it has allowed me to work hard at mastering basic nursing skills. so i will not be graduating as an rn with no experience if you know what i mean.

    what do rural nurses think about new grads coming to their hospital? do you recommend i spend my first year in a bigger hospital? our rural hospitals seem to actively promote the recruitment of grads and there is a rural scholarship scheme in place. will i be disadvantaged by going "out west" straight away?

    i will be going on a rural placement soon for 4 weeks and i am sure that during this time i will get a feel for what it would be like and put some things into perspective. but if anyone has some thoughts on this i'd love to read about them!!

  8. by   Evie
    i might add that the area i am looking into is a "major" centre in our outback.. the town has 5 local docs, hospital, ambulance, dental and chiropractic care, flying doctors base, and the centre of the health service district that covers a substantial area.

    it is about 700km from the capital city.
  9. by   gwenith
    Evie I would work at a "regional hospital" before going on to a rural or remote area hospital to start with.

    The smaller the hospital the greater your scope of practice but also the greater your responsibilities with fewer resources to cope with them.
  10. by   obliviousRN
    I have to politely disagree w/ the above post. I think a rural hospital is a great place to start out. I have worked at large metro trauma centers and small rural hospitals both. I see our new grads at our rural hospital (where I currently am employed) exposed to so much more of a variety of patients. They come out of their 4month orientation very able to cope w/ the challenges a rural hospital throws their way, because they've seen and dealt w/ it every day. In a larger metro center, you are secluded to one area when obtaining a position as a new grad and unless that area is ICU or ER (rare for a new grad usually), then you are working w/ the same type of patients repeatedly and not much changes (unless there's a code).

    I know everyone has a different opinion, I think it just takes whatever works for you and your style of learning. No offense meant to anyone!


    edited to add: we are the only hospital in our county 10,000square miles in the middle of nowhere. We see codes, MVA's, GSW's, falls, stabbings, cowboy injuries (a whole complex series of injuries all it's own ), etc on a frequent basis.
  11. by   Evie
    thank you both for sharing your thoughts.. i'd love to hear what more people think! it is interesting to hear differing opinions..
  12. by   gwenith
    Things are more than a little different here - the rural hospitals do not have much of an orientation - actually last time I worked in one the orientation consisted of showing you how to get a hold of the LMO and warning you not to feed the possums.

    Our rural hospitals the new grad is often left alone or just with one EN on a shift. There may only BE 8 or 9 staff for the entire hospital.

    Our remote area hospitals are often only manned by one nurse - that is it no more. The doctor is the flying doctor and may be at least one to two hours away by plane on a good day. They do have phone lines though so you can call and speak to someone.
  13. by   obliviousRN
    Wow! What a huge difference! I didn't realize that.

    Our hospital always has an MD present and is staffed by 2-3 RN's and one LPN w/ 2 CNA's. Unless we have less than 3 patients, then we drop off one CNA and the LPN. One RN covers the ER and the other usually covers the floor and OB. If there is an ICU pt present, then we call in an additional RN to staff 1:1 in ICU

    I've only felt short staffed once here. It was one of those crazy full-moon sort of days where the admits never stopped and the ER was constantly full and 2 OB's came in. Made for an interesting day that's for sure! I felt like I was back at the trauma center!

    Thanks for letting me know what a difference it is for you.
  14. by   gwenith
    Not a problem - not a lot of people living in the cities here don't realise just how sparse the population is in some of these areas. Still remember meeting the Director of Nursing (and only nurse) for one of our gem mining towns - maitained that his patients only swung down out of the trees every third week:roll