Working in a small hospital....

  1. I work in small hospital which is about 80 beds. We have M/S, tele, peds on one unit. We have a 5 bed OB and a 5 bed nursery. 22 skilled nursing beds, 4 ICU beds, and some psych beds, plus ER. I think we have a good hospital but like a lot of small facilities we have a reputation for being a band aid station. Of course there are things we can't handle like cardiac caths, transplants, dialysis, CABG and stuff like that. We can give whatever clot busting drug is current now for MI's that need them and transfer them to a larger facility. We can at least stabilize the pt and have them transported. So, how do we go about improving the image of our facility? Anyone else have this problem? I would like to hear from you. Thanks.
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  2. 14 Comments

  3. by   jode
    I worked in a small rural hospital in New York located between Rochester and Buffalo, both which have major teaching medical centers and universities. We earned a good reputation with the ED's and CCU's and OB/NICU at these facilities by staying up to date....attending seminars and staying networked. Make good contacts and remember that they can learn from you too! Clinical skills and differential diagnosis have to go a long way without all the gadgets..........!!!!
  4. by   deespoohbear
    Oh, most of the nursing staff has a decent reputation, it is the some of the medical staff and the ER that brings us down. The nurses in the ER are quite competent, it is their attitude that gets them in trouble. And there is one doc who is just a jerk, period. Administration knows, we know, and the public knows it but nothing is done. I always believe that first impressions are the most important and if the ER screws that up the rest of the admission has a dark cloud over it for that pt and their family. Our department almost always scores high in customer satisfaction and nursing staff. Our upper management just lets the ER do as it pleases.

    I try to stay current with nursing. I subscribe to two nursing journals and like to research stuff. I am always eager to learn something new.
  5. by   oh-agnurse
    I work in a small hosp. in Western NY also, and the key for us is to involve the community. The community knows the hospital is the only one within a 30 or more mile radius, and transport may occur to the larger city hosp.. However, if it was gone services in the rural areas would be gone. Our hosp. has only 22 beds, and 4 CCU beds, cardiac rehab, OB, urology, and psych. services, and an ER.
  6. by   tattooednursie
    I work in a small hospital too. We dont have much of a "hospital" here, but out long term care cnter ise about 70 beds, and we are very understaffed, so It kind of sucks. But I like the rural nursing alot better than I would like the city nursing. I would get burnt out fast. Rural nursing is stressful enough.
  7. by   cactus wren
    I work in a 56 bed hospital about 80 miles from phoenix,Az. We are the only hospital , next stop is the valley. HAve a 4 bed icu, m/s er,l&d etc. When a patient asks what they can do to show their appreciation for the care they got, I always tell them" No doughnuts or candy, just write a letter to the editor of our weekly newspaper, telling the community what a great place this is"And sometimes they do, sometimes both.......
  8. by   sonnie
    I work in a 40 bed hospital that was forecasted to close along with 4 or 5 other hospitals about 15 years ago. Needless to say we are still alive and kicking!! Our success is rooted in our belief that all staff is family and we treat each other as such. We don't try to be every thing to everybody we just do what we do very very well. We focus on patient care and individual care of patients and their families. Many of our patients would rather stay with us than go to the larger facility just because they feel we care more about their health and welfare. We have had many people come from the larger city nearby just to get this individual care. We've worked hard to turn things around and we are fortunate to have a good working relationship with medical staff, and administration. Oh those other hospitals all are closed now mainly because they made bad financial decisions. I wouldn't work anywhere else but a small rural facility.
  9. by   cwazycwissyRN
    I worked rual America for nearly ten years and to me a bandaid station is far from what I felt we were doing. My hat is off to all rual American nurses. Perhaps a mash unit felt more appropriate. Keeping people alive and stablizing in order to ship to a larger facility in order to accomidate a patients need can be a very tall order, not to mention the stress levels involved. M/S was my home, however crosstraining is common in small hospitals. I worked ER part time, recovery nurse, SCU , OR, and helped with "bad baby's in OB. Off couse if a ward clerk was not at work we also was able to assume their responsabilities, let alone the housekeeping, dietary, and pt. education responsabilies that were an ongoing event. Rual American nurses are tremendous nurses that are not always treated accordingly. I am now in a larger facility. I wanted to narrow my scope. Had for urban American to understand I would guess. No one can truly imagine what it's like to try to keep your own family member alive, or neibor , or friend, or friends child... routinely until you've lived it. Keep up the great work. Don't let the politics get you down. Keep your head held high and pat each other on the back routinely
  10. by   deespoohbear
    Originally posted by cwazycwissyRN
    No one can truly imagine what it's like to try to keep your own family member alive, or neibor , or friend, or friends child... routinely until you've lived it.

    I have found myself in this situation several times, and it is very scary. One of our nurses collapsed one evening with a grand mal seizure (no prior history of ANYTHING). This gal seized, big time. I remember cutting off her uniform pants so we could insert a foley...and giving her IV meds to try and stop the seizures...we transferred her to a larger facility for further treatment...I have also been called at work by my husband and told that my nephew had been hit by a car and was on the way in via EMS. Nice thing is I didn't have any trouble getting into the ER and got to speak to the physician personally about my nephew...(who suffered a fractured tibia, but recovered fully)....Working in a small facility has definitely given me a wider scope of knowledge. I feel like a jack of all trades, and master of none....
  11. by   ceecel.dee
    Originally posted by deespoohbear
    So, how do we go about improving the image of our facility? Anyone else have this problem? I would like to hear from you. Thanks.
    Your local paper can help! Rather than print just the names of the admits and discharges (with their permission) - yes, our paper still does this, along with the police log so you can read about everyone pulled over for speeding or whatever - we are putting in the statistics on what is actually happening at our busy place weekly. For instance, how many people participated in cardiac rehab, how many visited outreach doctors, how many were seen in ER, how many were admitted as BOP and acute, and ICU and OB (the new privacy stuff has really decreased how many patients agree to their actual name in print, and it has made us appear extremely non-busy) ,how many lab tests were run, how many pictures/procedures occured in the X-ray dept, PT/OT/ST appointments...you get the picture. It gives the accurate impression that an awful lot goes on here!

    There are also, always letters of thanks in the classified section under "personals" to the EMS, doctors and nurses, etc.

    We have a reputation for much more personal care than the patients receive at some of the larger hospitals, where "I hardly saw my nurse at all". --In fairness, I know that the bigger hospitals around here must handle larger patient loads per nurse than we do here....our management is good about that.
  12. by   adidas99
    I work right now as a CNA(i'm a nursing student) at a rural hospital.
    Last edit by adidas99 on Jan 30, '07
  13. by   deespoohbear
    Sounds like a mess at that one hospital. About the cardiac enzymes vs. r/o MI I have a theory. Maybe writing r/o MI the insurance company or Medicare won't pay for that but will pay for elevated cardiac enzymes. Not sure. Insurance companies and Medicare are pretty stupid sometimes when it comes to wording and reimbursement issues. The other stuff you mention I have no theory for except for maybe laziness or a lack of knowledge on the staff's part. The other thing is maybe some of it is a dictation screw up. Those docs can be pretty hard to understand at times when it comes to dictation. Again this is just theory.

    From what I have seen at our hospital the H & P's seem to correlate with the patient and their c/o and symptoms. We have one ER doc who is a real jerk but otherwise most of our docs are pretty decent. This one ER doc once prescribed IV Phenergan for a pt and the family said he was allergic to it. Actually the pt would have hallucinations after getting Phenergan but if a pt or family tells you someone is allergic to a certain drug I sure don't want to be the one testing to see if the pt is truly allergic or if it is just a bad reaction.

    Thanks for your input.
  14. by   Betty_SPN_KS
    I work as a CNA in a LTCU at our local hospital. We have about 40 beds and a 11-bed SCU (Alzheimer's). Not sure how many beds the hospital has, maybe 20. We are in a town of about 3000.
    I am also a student nurse (LPN program). Some of my fellow CNAs are assuming I'm going to work there when I graduate and be their "boss". They seem to like the idea because I'm fairly easy-going and try to get along with everyone. I'm not sure I want to work there as a nurse. At least not exclusively. I'd also like some experience in a city hospital where I can work under other nurses and learn more.
    I guess one advantage is I already know the residents and staff. Also, it's just a 5 minute drive to work (could even walk or ride bike on a nice day). I guess I could start there and add another job later on. But I don't want to limit my experience to a small town nursing home.
    I never applied for a nursing service scholarship or asked my employer to sponsor me, because I didn't want to make a commitment to work there after graduation.

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