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!