The pitfalls of a small rural hospital - page 2

by loveishope 11,781 Views | 19 Comments

I am working at a small rural hospital as a charge nurse on a med surg floor. In fact, the hospital only has med surg and an ER. It is very different. There is no 24 hour pharmacy, no RT, and no doctor (Nurse Practitioner or PA... Read More


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    I too work in a rural hospital and our big sister medical center is an hour away. To quote a nurse from Canada "You've got to be an hour smarter" with assessing a patient, ? need to transfer and predicting what their condition might be 60min later. We have access to an e-pharmacy via telephone for mixing, rates, compatabilities etc. We recently insistuted hospitalists 24/7 in house. Before that we had only docs on call at home for gen surg, ob, peds, ortho, Internal med and family practice. About 15yrs ago there was no MD in the Ed, just those docs on call that would come in after a medsurg nurse triaged the pt in ED!

    I am thinking that you know how fast a pt could crump..and then what? Who's gonna help? Most likely, the pt's at the rural hospital are less acute. But when you are used to having monitors in front of you, CVP's and all those ancillary staff you may feel lost. You will find that the floor staff will all pitch in and the ED is always available in a "code" or "rapid response" type scenario. Comfort levels will increase when you really get to know who your working with.

    Also, think about what you have to offer! Perhaps you could host a staff in-service on some ICU type topic that could enhance pt care/outcomes, or, help develope protocols, or assist in instituting a rapid resonse team. Hopeully your unit manager would be open to hearing new ideas you may have to increase patient safety or acheiving PI goals.
    Every experience is a learning experience! You learn from new job, new job learns from you! It's a win-win!
    SuesquatchRN likes this.
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    Bad things about small, rural hospitals is when you have an emergency things don't always go too well. I don't like that feeling of helplessness.
    AKav8trix likes this.
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    I work at a small community hospital in a 6 bed ICU/CCU on night shift. The RT goes home at 11pm...housekeeping leaves at 10pm, pharmacy goes home at 8pm, dietary leaves at 7pm. So, on night shift I do it all! I draw(and sometimes run) my own ABG's. I'm pretty good at it too so if another unit needs an abg, I'm sent to do it by the nursing supervisor. I also have to do my own vent checks, administer my own neb treatments, start my own IV's(another thing that the nursing supervisor asks me to do). If we are full and getting another ICU pt, I gotta move the pt out as we have no house orderly at ALL(even on day shift), then clean the room myself. Gotta mix my own IVPB's, et al.......
    xtxrn likes this.
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    Quote from loveishope
    I was thinking the same thing. I even go to the pharmacy at mix meds like antibiotics, etc.. I also get to play respiratory tech. The only thing that concerns me is that I will not be able to work in ICU again because I am afraid I won't be hired because I am not working in ICU anymore. And I really love ICU.
    I worked in a 125 bed hospital (small from where I started). We had an ICU, ED, OB-Gyn, med-surg/ortho (where I was), and a tele/medical floor. The house supervisor did pharmacy runs at night and mixed the meds (had as many of the twist-on piggy backs as possible). There was a pharmacist on call for anything really nuts- but in the time I worked there (about 3 1/2 years total) I only saw him once.

    I LOVED that place (I'm still in contact with a LOT of people from there, even close to 9 years after relocating back to my home state- they are my friends- and have been even during the time I've been gone- don't get that here with the bigger hospitals with a 'colder' general temperament of the folks who live here. (I grew up here- I can be annoyed )

    While really sick kids were sent out, we kept other pediatric patients (as long as we were able to handle them up to 2 steps "worse" than admitted- to give the helicopter time to rev up ). Had a lot of interesting stuff there, and as another poster said, things weren't all divided up- we got whatever we got

    AND, the docs were great- the ortho guys were among the first to do minimally invasive hips- 2 of the 3 were doing them before mid-2002. We did have RT, and lab at night.... and full PT/OT/ST during the day. Cardiac that needed more than medications were sent out (but since then, they have a full-time cardiologist in town).

    It's a different pace from a bigger city hospital, but one I really enjoyed
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    Quote from kool-aide
    Bad things about small, rural hospitals is when you have an emergency things don't always go too well. I don't like that feeling of helplessness.
    Awww. That's one of the prices people pay when choosing to live in a smaller town. But, FWIW, they don't always go too hot in big places either, and helplessness comes from the situation more than the location
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    I'm a traveler who "specializes" in small rural hospitals. By that I mean when given a choice I pick the small rural facilities over the big urban/suburban hospitals. (Though I can and have worked both) My recruiters even know this and will call me with "Here's one right up your alley". I do occasionally take a contract in larger facilities to keep up my skills in certain high risk conditions knowing that I'll be dealing with them in the rural facilities until the can be transferred.
    The gossip and inter-relatedness of everyone is worth remembering - I've had patients come up to me in the grocery store and want to discuss so-and-so who is a patient or the latest doings of the hospital board!
    To those who are new to the rural setting, be careful not to seem disdainful of the quality of the care or lack of sophisticated technology. Remarks about "hick towns" will get you the freeze out faster than anything - everyone WILL hear about it even if you only say it to one person!
    I love doing care in these facilities precisely because I get to do more and participate in many more aspects of my patients' care. (Though I could give up cleaning my own delivery rooms)
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    I am going to start to work as a charge nurse in a rural hospital with 25 bed in west texas. Does anyone work on west texas. I do not have any hospital experience. The previous two years I work in LTC. Please advise!!! Help!!!
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    Be smart- learn, learn, learn, all you can. Read. Subscribe to one of those nursing journals and keep a little file folder of stuff you can use. Anytime the hospital offers to send you to a conference or for some kind of training, take them up on the offer.
    KaroSnowQueen likes this.
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    I work at a rural hospital in nevada. 2 er beds, and 11 acute beds. I have 6 years of experience there. I want to go to a bigger hospital, in order to get more experience, in surgery and wound care. Does anyone think it is a stigma to work in a rural hospital? Is it going against me, when i apply at bigger hospitals? What can i do or say, when the nurse recruiter talks to me about my rural hospital experience.
    funmi Esema likes this.
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    Quote from ANNIENURSEANGEL
    I work at a rural hospital in nevada. 2 er beds, and 11 acute beds. I have 6 years of experience there. I want to go to a bigger hospital, in order to get more experience, in surgery and wound care. Does anyone think it is a stigma to work in a rural hospital? Is it going against me, when i apply at bigger hospitals? What can i do or say, when the nurse recruiter talks to me about my rural hospital experience.
    Annie, I think u got it backwards, girl!!!

    "Hi my name is Annie and I'm interviewing for this amazing opening at your Trauma 1 inner city hospital.

    My experience in my rural hospital has provided me with a vast array of knowledge and independance. Often I was the only RN working the floor and delt with our entire ER. Because the larger hospitals were so far away, I often single handedly provided nursing care to our most tramatic patients in an effort to stabilize them before forwarding them to one of the larger hospitals.

    Sometimes at night it was only myself and a Nurse Practitioner and due to our limited supplies for certain occassions we were forced to rely on our ingenuity like when our supply of finger splints was exhausted and I combined two halfs of a tongue depressor to make a splint. It was always a wild ride with just a skeleton staff. I think my 6 years of independant experience would an invaluable asset if were able serve your hospital. "

    Ta da!!! You're gonna kick butt, Annienurse!
    LG1137, Maritimer, fireball78, and 1 other like this.


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