Any Rural Health NP's out there?

Trauma Columnist · Nov 21, 2016

I work in several rural areas. These are concerns:

1. They don't want to travel to the big city so referrals are difficult

2. Rural pharmacies don't stock a lot of drugs I prescribe delaying care

3. I'm frequently taking care of family members of pts which can sometimes be problematic,

Psychcns · Nov 21, 2016

Is Kentucky independent practice. If not find out about barriers and cost of supervision/collaboration if you want to set up your own clinic.

PG2018 · Nov 21, 2016

I used to drive out to a very remote mountain town to provide psych services on a day off each month.

Interestingly, I felt the vast majority of patients were free of psychopathology. Rather, they were hillbillies, and the enlightened therapy staff that entered the village were of the impression they were SMI.

Disorganization, internally, and the distanced led me to quit. I learned some family practice doctor took the gig and is prescribing everyone Wellbutrin SR - no clue why. He probably doesn't know either.

anchorRN, BSN, MSN, RN, APRN · Nov 22, 2016

I used to drive out to a very remote mountain town to provide psych services on a day off each month.
Interestingly, I felt the vast majority of patients were free of psychopathology. Rather, they were hillbillies, and the enlightened therapy staff that entered the village were of the impression they were SMI.
Disorganization, internally, and the distanced led me to quit. I learned some family practice doctor took the gig and is prescribing everyone Wellbutrin SR - no clue why. He probably doesn't know either.

LOL i consider myself a Hillbilly :) This is why I can't wait to get back to the mountains of eastern Kentucky where i grew up.

Unfortunately KY isnt independent practice, rather requires a collaboration period of 4 years with a physician first, then can independently prescribe most common meds, with the exception of scheduled drugs, which still requires collaboration.

I'm hoping this will change in the coming years but KY is a bit more conservative than most states and that doesnt seem to bode well with NP practice.

I feel like the job market will be pretty good, as opposed to saturated markets in cities.

RuralNurseRN · Feb 1, 2017

I am an RN in a very rural practice and can offer you what I have noticed.

1. There isn't a hospital/ER/urgent care in town so providers in our clinic have to be prepared to treat or stabilize whatever walks in the door.

2. Patients do not want to travel for specialty care. Our providers have had meetings with specialists to get training on treatment of most common conditions that they would usually refer out.

3. It is good that you are from the area where you are planning to work. I am also in the Appalachian mountains. Sometimes there is a cultural barrier between providers and patients in our area (the provider leaves the room and the nurse/MA has to explain what the provider just said - in the local dialect).

4. In rural areas, provider to patient ratios can be pretty high. This means providers can't always see everyone who needs to be seen so they end up with a lot of telephone messages to answer or end up managing quite a few conditions with one office visit then several follow up phone calls.

Hope that helps!

TicTok411 · Feb 1, 2017

Rural health can be one of the most rewarding areas of practice. The patients you encounter always seemed grateful for the providers that they had access to and I always found them to be very trusting. I agree with what prior posters stated in that these people do NOT want to travel for a specialist and many times there are coverage issues and you are stuck with a patient who needs treatment beyond what you can provide but no way to pay for it or very long waits for assistance. It can be heartbreaking.

1. In general these patients are not coming to you after reading up online about their conditions like you see in more metropolitan areas.

2. I always found compliance to be a huge issue either with medication, diet or exercise and often compliance is dictated on ability to pay for meds or treatments.

3. You spend more time educating in rural care than anything. A sister's cousin said this or and uncle had a schoolmate who had this. You are constantly bringing them back to the evidence and not whatever they were told by someone else.

4. Scabies scabies scabies.....you will see it often

5. seems a lot more smokers in rural health and people do not trust vaccines. Anti-vax people make me crazy.

6. If you work in a federally funded clinic or have people on medicare/medicaid they come in every time they cough or burp. I cannot tell you how many people come in with a cold all while smoking and wanting abx to "cure" them.

7. When you have and appointment for Sue the whole damn family comes in and they all want treatment in the same visit. Those 15 minutes you have allowed for a follow up can quickly turn into 45 if you do not scoot them out the door.

8. Lots of underlying psych issues.....

best of luck....it can actually be fun when you actually make progress with a patient.

anchorRN, BSN, MSN, RN, APRN · Feb 1, 2017

Rural health can be one of the most rewarding areas of practice. The patients you encounter always seemed grateful for the providers that they had access to and I always found them to be very trusting. I agree with what prior posters stated in that these people do NOT want to travel for a specialist and many times there are coverage issues and you are stuck with a patient who needs treatment beyond what you can provide but no way to pay for it or very long waits for assistance. It can be heartbreaking.
1. In general these patients are not coming to you after reading up online about their conditions like you see in more metropolitan areas.
2. I always found compliance to be a huge issue either with medication, diet or exercise and often compliance is dictated on ability to pay for meds or treatments.
3. You spend more time educating in rural care than anything. A sister's cousin said this or and uncle had a schoolmate who had this. You are constantly bringing them back to the evidence and not whatever they were told by someone else.
4. Scabies scabies scabies.....you will see it often
5. seems a lot more smokers in rural health and people do not trust vaccines. Anti-vax people make me crazy.
6. If you work in a federally funded clinic or have people on medicare/medicaid they come in every time they cough or burp. I cannot tell you how many people come in with a cold all while smoking and wanting abx to "cure" them.
7. When you have and appointment for Sue the whole damn family comes in and they all want treatment in the same visit. Those 15 minutes you have allowed for a follow up can quickly turn into 45 if you do not scoot them out the door.
8. Lots of underlying psych issues.....
best of luck....it can actually be fun when you actually make progress with a patient.

Thanks this is great info I appreciate it. i cant wait to get started in my program. I was born and raised in a very rural area (and will return to practice there), so I can definitely see how Sue would bring all her family in to the doctor lol. One stop shopping! HAHA