Rural Nursing as a SPECIALTY!!

  1. Greetings, fellow rural nurses!! I have been discussing this very issue with several co-workers and would like the opinions of all of you as well!! In the 14 years experience I have as a "rural/frontier" hospital nurse, I have seen nurses of all shapes, sizes, colors and "specialties" come and go!! Nothing more annoying to a TRUE rural nurse than to have a new staff member come aboard with that "how quaint" attitude! You all know the ones...the ones from the bigger, "more modern" facilities...the ones with the "certifications" behind their initials...."I worked in ICU"...." I worked in OB"....."I worked in Med/Surg"....they all find frontier nursing "quaint" and have the attitude that small-town/rural/frontier nursing is their way of fading into their retirement years!! Isn't it funny, though, what happens when these same nurses hit their first day "on the floor" with 6 patients (all with IV's, foley, tele, tons of meds) and a busy ER day (even with only 2 ER rooms, they can be HOPPING!!)...then they realize that it is JUST THEM AND THIER LPN!!! NO RT....NO IV TEAM...NO HOUSEKEEPING....NO KITCHEN STAFF...NO CNA...NO SECRETARIAL STAFF TO REGISTER THE NEW PATIENT IN THE ER...5 CALL BELLS GOING OFF AT THE SAME TIME....AN AMBULANCE WITH A MVA IS ONLY 5 MINUTES OUT WITH 2 INURED...THE DOC IS 45 MINUTES AWAY...AND YOU ARE THE CODE TEAM!! I have seen too many "good nurses" hit the door running away when they realize that rural/frontier nursing truly is a specialty of it's own and not a walk in the park!!
  2. Visit ranchwife profile page

    About ranchwife

    Joined: Apr '07; Posts: 62; Likes: 8
    staff nurse at small 9 bed facility
    Specialty: 14 year(s) of experience in critical access, including ER


  3. by   mt33133
    Hi Ranchwife -

    Thank you for describing what your "typical" day is like. I had no idea!! I am in nusing school right now in Atlanta, GA. I definitely am interested in working in a rural area at some point in my career, i.e. after I gain some real experience and can bring useful skills to the table :spin: Do you have any suggestions for a newbie? Where is the best place to gain the necessary experience? Also, do rural hospitals recruit/hire nurse practioners, clinical nurse specialists, etc?

    By the way, the Madison Valley of Montana is some of the most beautiful country I have ever seen!! I worked on a dude ranch in the Gallatin Canyon for a few summers and I absolutely loved the land. I hope you know how very lucky you are to live in such a wonderful place
  4. by   ranchwife
    Greeting, mt33133----First, I want to wish you the very best in your schooling!! Our hospital hires new grads, but they often find if more challenging than they would have ever dreamed! So, I am glad to hear that you wish to get experience in a "bigger" place before jumping into rural nursing!! Smart....very, very smart!! Yes, most rural hospitals so hire nurse practitioners and many hire physician assistants....they are the backbone of our "providers" and many are MUCH better to work with since most of them have "been there"!! Some of the best "providers" i have worked with in my 14 years have been PA's and NP's!! By far!!! Rural nursing is GROSSLY underpaid, under-appreciated, but one of the most rewarding avenues of nursing I can imagine!! I would not (and will not) trade it for any big city hospital out there!! I know my patients and they know me...personally and professionally....heck, most are neighbors, friends, relatives...many taught my kids in school or on the basketball court and, more than likely, we have had dinner or a beer together at some point!!
  5. by   grammyr
    I have worked in bigger hospitals and would not go back to one. It's just a different world. Rural nursing is kinda like OB. Either you love it or you run hard and fast to get away from it. Me, I'm here for life in my place in the woods.
  6. by   CraigB-RN
    Quote from grammyr
    I have worked in bigger hospitals and would not go back to one. It's just a different world. Rural nursing is kinda like OB. Either you love it or you run hard and fast to get away from it. Me, I'm here for life in my place in the woods.

    Personally I was bored to tears. I was one of those big city nurses who moved to rural/frontier america. I worked in a 200+ patient/day ER. I knew what busy was and how to juggle all those tasks. That's what rural nursing is realy about. It's not the medicine, it's the "politics" (most of your patients are related to most of the staff or the other half of your patients) and the time management/triage that you have to do, becuse you don't have all that ancillary help. FOrtunatly for me, the hosp didn't do OB. THAT would have been more than I could handle. Yuck, OB!!!

    Get the alphabet soup initials for after your name, Knowledge is a good thing, in some cases you'll know more about things than the Doc or Mid-level will. Things like getting your EMT might even help. What do you do when the person with neck pain who just got thrown from their horse showes up at your back door in the back of a pickup? Which end of the chest tube is supposed to go into the patient. Why does that 16 yo wrestler look so sick. (he was taking granpa's lasix to loose weight"

    Be as prepared as you can get, because in most cases there isn't anyone to help you out there.
  7. by   catlover13

    I've landed in a rural area, our nearest "big city" of 75K is almost 1 hour away, and I've been balking at the idea of applying for a job there.

    Don't want the commute...

    We do have a local county hospital in my city of 1,500!!! I've been nervous, being a new grad about applying.

    Would this be a good place to start my nursing career? Or should I pursue some "big city" opportunity?

  8. by   Camelhappy1
    4 stabbings and one hit and run yesterday.... Only myself (RN) and my wonderful LPN. Challenging? Heck ya!

    I am a firm believer in rural nursing being a specialty - how is it not? I did a touch of ICU/ ER out of college for almost 2 years..... BUT when I took this job I knew from my first day by myself, in charge (as most rural RNs have to be) with no charge experience that this would be probably the luckiest job I will ever land. Let me tell you - I learnt NOTHING in my past ICU/ major trauma centre ER experience - compared to what I know now !

    The OP is completely correct - try doing a cardiac who's in SVT completely by yourself - IVs, O2, Cardiac Monitor, 12 lead, getting the adenosine ready while your LPN is busy trying to answer the floors callbells/ print out outpatient forms/ answer phones. Doctor? What Doctor - he doesn't want to come in! Or a 5 person MVA with one DOA (who the cops locked in trauma so the family wouldn't get to the body) and there's only 2 of you to answer the million phone calls, do all the trauma assess, get them all ready to fly out, help in Xray, paperwork, IVs, dressings, meds, crowd control the family who's taken over the hospital... (ok, I did call in another set of hands for that one!)

    I live in a small rural town in Alberta, Canada and am having the best nursing experience I could ever have asked for. My only regret? Not doing this right out of school.

    The 10 bed Inpatients are always so busy, then ER and clinic always make for interesting shifts. Do I always like my job? Nope. The biggest downside of a rural hospital is that because you are so understaffed, your work is your life. I am a newlywed and barely ever do I get to spend a day or night in bed with my hubby (he does shift work also as a cop)

    To all the Newgrads wanting to do rural - DO IT. Pick a busy centre with lots of trauma (Northern AB..haha) and I promise you will not regret it! You will be able to walk into ANY unit in ANY hospital and have your nursing skills under your belt.

    Oh yeah one more thing - you will get the courses behind you too - ACLS, TNCC, NRP, PALS... because it is reassuring to know that the knowledge is there to retrieve in those moments of "Duh... what do I do now???"
  9. by   country mom
    I went right into a 14 bed, 2-bay ER, rural hospital right out of nursing school. Went from university in the big city to the backwoods and never looked back. If you are going to go straight into rural practice, it helps if you are a self-motivated learner and willing to pursue the ACLS, PALS, etc. that will help you prepare. Another thing that helped alot is having supportive staff to work with- nurses who are willing to take you under their wing a little and share some wisdom with you. I think in the rural hospitals we tend to stick together a little more because we absolutely depend on one another to get through. My first post-grad job interview, I was told, "we all wear many hats here" and that has summed it up well. Your maintenance guy might also be the paramedic and has to leave when the ambulance gets paged out. Your X-ray tech might help you do CPR in a code. I agree that rural nursing is definetely a subspecialty onto itself. Where else but in rural nursing do you run a code with 2 people? (if you're lucky) By the time the doc gets there, you've already run through all the drugs.
  10. by   wizap
    Rural MT. nurse here. I have always worked in the same Rural hospital since I graduated from Montana State University. I LOVE what I do. Yes, it can go crazy quickly, but it is never boring. I have learned to love OB, feel at home in ER, and do just fine in Med/Surg. When they told me I would wear many hats in Nursing School, they weren't kidding. I am also responsable for salting the sidewalks for the ambulances in the winter!!!
    Sometimes I wonder if I have lost my when the doctor is doing a chest pain in the ER and I am telling an OB not to push.... Yes, I have delivered 2 babies by myself, both with cords around their necks x1. Keeps me on my toes, I guess.
    I can't imagine working anywhere else. I love what I do, and I have great co-workers, and lots of fun patients!!!
  11. by   karmil
    I trained in NY, but the CHALLENGE came when I took a job in a small rural hospital in MO. I learned to be a multi-tasker quickly. I nursed all ages and dealt with all sorts of illness and did OB. Now I am a Home Health/Hospice Nurse in this rural area. I have had 20 cats circle my car and some lay on it until I started to drive away... shooing chickhens (25) in order to get to the door...trudging through gravel roads, mud, snow and horse pies. I started taking photos of the sites I see on the road during my day in the country. Try explaining to your boss you were late because you had to wait for a cow to give birth in the road before you passed! Here, that's not an issue! Yes, KNOW that EVERYONE is related and politics reigns. Rural people appreciate the help because they get little. There is no pharmacy to deliver or meals on wheels to the homes. Family MUST do for them or neighbors. I LOVE IT! I would not go back to a big city for money, ever! Our patients love us and we love them!! We have a "country-connection".
  12. by   nkochrn
    This is so true!!! I think being a rural nurse you have to stay so much more on top of EVERYTHING rather than just one specialty area.
  13. by   rangerlil
    This is a message to Camelhappy or ranchwife. I'm new here and I can't yet post private messages. I am currently a nursing student in Alberta and I am very interested in the experiences both of you have written about.
    - Do you have any recommendations for areas in AB or BC? I love the mountains and would prefer to be within a 2 hour drive. BUT, if the job was right, I would make the sacrifice (I'm currently at least 4 hours away right now!)
    - Is it better to start off at a small hospital rotating through all the units or going directly to the ER?