What exactly is Rural Nursing

grammyr · Apr 12, 2007

There is a textbook definition on the web somewhere but my definition of rural is where I work. My town has a population of about 3500. The facility I work at is 60 beds including a 14 bed gero-psych unit, 6 bed ICU, 4 bed ED and no OB or fulltime surgeon. Ancillary services on call after hours.

mom2michael, MSN, RN, NP · May 4, 2007

I work in a 6 bed M/S dept that is staff by 1 RN and 1 LPN 24/7, they see an average of 1-2 patients a day on the floor. They get lots of outpatient stuff though during the day time.

8 bed (in a crunch) ER where we see an average of 700 patient a month. We have an RN 24/7, a tech 24/7 and an overlap 11-23 RN.

RT and Pharm are gone by 1600. X-ray and lab are on call after 2300 at night.

Same Day Surg (just opened a couple of months ago) which does procedures on Thursdays and they see an average or 7 or so cases a month.

We share our ER with a foot and wound doc, the surgeon and a cardio guy as well.

Our next closest trauma center is 55 miles by ground, 15 mins. by air

grammyr · May 4, 2007

I work in a 6 bed M/S dept that is staff by 1 RN and 1 LPN 24/7, they see an average of 1-2 patients a day on the floor. They get lots of outpatient stuff though during the day time.
8 bed (in a crunch) ER where we see an average of 700 patient a month. We have an RN 24/7, a tech 24/7 and an overlap 11-23 RN.
RT and Pharm are gone by 1600. X-ray and lab are on call after 2300 at night.
Same Day Surg (just opened a couple of months ago) which does procedures on Thursdays and they see an average or 7 or so cases a month.
We share our ER with a foot and wound doc, the surgeon and a cardio guy as well.
Our next closest trauma center is 55 miles by ground, 15 mins. by air

Sounds like you are in my kind of facility. don't you love it????

NPinWCH · May 4, 2007

We are a small county hospital: 8 bed ER, 14 bed M/S, 5 bed OB, 5 bed ICU. No pharm after 1600, but we do have x ray and lab 24 hours. Surgery is on call after 1600 or after cases are finished for the day. All trauma, stroke and just about all MI cases are transferred to the big hospitals about 1hour away, often by helicopter.

TazziRN, RN · May 7, 2007

I am also in a rural facility. We are in a small town with a 6-bed ER, 4-bed ICU, and an attached LTC. The medsurg unit just expanded to at least 20 beds and OB/GYN expanded to 18 beds. The nearest tertiary facility is 50 miles away in any direction. We can stabilize anything but we cannot keep anything needing specialty care if the pt is serious to critical.

adoptionacres · May 7, 2007

Technically, we aren't the definition of rural, we are what is called Frontier Nursing. Our high desert county has 10,000 square miles and 7,000 residents. :penguin: We are moving into our NEW 25 bed critical care access hospital next month! :monkeydance: :w00t: We have 2 ICU beds, 3 ER beds, 3 OB beds, 1 (soon to be 2) OR suites. Our RNs need to be able to do everything. :pumpiron: We are 2 hours from a town of any size at all (75,000) and 6 hours from a big city (2 million). We do a lot of stabilization and transfer and a lot of cardiac drips. We won't do VBACs, but we will do L&D after 35-36 weeks and C-Sxns. Cradle to Grave, that's our range.

DutchgirlRN, ASN, RN · May 7, 2007

I thought I worked in a small hospital. When it first opened we had 3-6 patients at a time on med/surg but had 20+ beds available. X-ray, lab, pharmacy, etc closed shop at 1700. 6 bed ICU. Small ER.

Now 27 years later the med/surg stays full with 40+ beds, ICU has 16 beds, OB 60 deliveries a month, Very large, very busy ER and large busy outpatient surgery dept. The only things that haven't changed is that the cafeteria closes at 1830 and the pharmacy still goes home at 1700. We're slowly getting there.

Kudos to you guys in those really small rural hospitals!

bagladyrn, RN · May 16, 2007

I'm a traveler who works mainly rural hospitals (after 9 years working on a reservation). To my mind rural hospitals are the ones at which I know who my patients will be before arriving at work because the clerk in the local convenience store tells me when I stop in for coffee - "Oh - you'll be busy tonight - so-and-so's daughter went into labor". They are the units where I can obtain a hand from staff on another unit without raising my voice to call as long as the door is open. Where everyone really does pitch in because the staffing is so low that next time they may need you.

And as I describe my favorite res. hospital to people considering going there "110 mile to the nearest Walmart"!

ranchwife · Jun 10, 2007

Wow!!! Looks like I am TRULY "frontier" here!! Our town of 700 has a critical access hospital with 9 beds, 2 trauma rooms (with one bed each). Our lab and x-ray are here monday-friday and on call on weekends, holidays and "after hours"....NO surgery (our little place simply cannot afford the insurance)....NO OB (also an issue of insurance!!)....the nearest "trauma" hospital is a life-flight away of a few hours....anything "non-critical", but still needing surgical consult is an hour an a half drive by ambulance (completely made up of volunteer EMT-B's) and you'd better pray for good weather or the pass between us might hinder your "escape" :) We also staff with one RN and one LPN!!! "Feast or Famine", as we say!!

wizap · Aug 20, 2007

Hi,

I also work at a critical access hospital. We have 4 ER beds, 2 ICU beds, 2 OB beds, and 13 med/surg beds and 1 negative pressure room. We have 2-RN's, 1-CNA and 1ward secretary on at night. Lab and X-ray are in house 24/7, and surgery is on call at night. Strokes and AMI's are sent to the 200 bed hospital 80 miles away by lifeflight. ...when the weather is OK.

ruralnurs · Sep 10, 2007

What is Rural Nursing? We have about 12 RNs that work in our facility, we are Critical Access, about 80 miles away from a larger facility. We are rural, (actually acording to the US census we are Frontier) our county is in the mountains and butts up against a reservation, we have many people in our county that have no running water or electricity.

We have some very wealthy people that have moved here to "live in the mountains" and many that live way below the poverty level, many migrant fame workers and many that just want to "live off the grid".

We are in a big hunting and recreation area so we get ATV wrecks, horse injuries, snowmobiles, motorcycles (ever seen what happens to someone that hits a deer with a Harley?), farm injuries, hypothermia, MVAs (ofcourse), and anything else you can think of.

We take care of all kinds of people, to include our family, friends, old high school teachers, the woman that our husband had an affair with, the person we know was convicted of child molestation, we deliver babies of women we know are drug abusers, we care for our collegues, neighbors (including giving them a ride home from the ER) and many people we don't know.

We are what are known as "Rural nurses" kind of a "Jack of all trades but a master of none." We have great relationships with our docs, RTs and other personell, including the EMTs that bring pts in....we have to.

We have 10 rooms (16 beds), 2 are ICU, 2 are OB, one is a negative pressure, and then we have a 4 bed ER. We have 2 RNs on all the time, and have a "call nurse" to be called in when needed (up to an hour away). We sometimes have the luxury of having another nurse to make 4, at the most, when we have a big trauma. We don't have a pharmacy per say, we get drugs from the pyxis and mix pretty much everything our selves, RT on call, x-ray in house, docs in house or 10 minutes away (we have lots of standing orders for things like chest pain, anaphalaxis, trauma).

In the last year (that I can think of) we had 2 rattlesnake bites, one that went into anaphalactic shock, (if giving Pitocin scares you look up all the possible complications with anti-venom!); a psychotic man that had a methadone overdose then proceded to have an MI (had to ride on the ambulance with him 75 miles to a higher level facility...fun!); 2 teenagers from an MVA that just walked into the ER, bleeding, glass everywhere, one ended up having an IC bleed; a family of 6 in a van that hit 3 horses at night; a 4 month old with respiratory distress that couldn't be shipped out for awhile and ended up having botulism (from honey); 2 teenagers that were hit by a drunk driver, 16 and 18, one came in CPR in progress, never left alive, the 16 year old shipped out, brain had herniated and his mom had to decide on organ donation, and the drunk driver was the son of one of our nurses; plus "boring" old med/surg pts.

I (and all the nurses here) do ER, M/S, ICU, peds, help in surgery, and 4 (we are training some of the others) do all aspects of OB (no high risk). We delivered a VBAC (no we don't do those on purpose) in our ER as she came in by ambulance, crowning, we had to stabilize and ship a woman with twins that was having ctx at 28 weeks and membranes ruptured at our ER entrance (we had no history on either of these women as they were not our pts), we had a beautiful baby boy born to a first time mom with no complications and our nurse realized he was a bit dusky at 12 hours, alerted the doc, did and ultrasound and discovered transposition of the great vessels (average time to diagnosis is 3 days, us...12 hours), but we don't do high risk???

I LOVE my job, I love the nights I work in ER and get that rush when we have an ambulance come in, and I love the team work when we have an MI or a cardiac arrest and we all work together and get the job done. I loved the night I was the only OB nurse on and I helped deliver 2 babies 3 hours apart, had to clean the room in between the 2, I also love the high I get when I am a 1:1 with an ICU pt on a nitro drip, insulin drip, and ART/CVP lines, and I enjoy taking care of the 86 year old lady in with weakness when I have time (not real often) to sit and listen to her how nursing was 60 years ago when she was one.

I have coworkers I KNOW I can count on. I also teach the childbirth classes. It is so nice to see a woman as a CB instructor, be her L&D nurse and then teach her to breastfeed as her MB nurse!

That is what is so great about rural nursing, its like a fortune cookie, you never know what you will get!