How small is your small rural hospital?

Reabock · Mar 29, 2002

Ted, I'm surprised that there are no other responses to your query. Our rural hospital,( the only one in the county, closest hospital is 45 minutes in any direction,) used to be rated at 120 beds, then we did a multi million dollar renovation and add on construction and, lo and behold, now are at less than 90!!

We have been told that to make payroll, we need to have 40 inpts a day and there have been times when we don't have that high a census even with OB and a Neuropsych unit that holds 16.

Right now, business is booming, at least on our Med surg floor and our 6 bed ICU was full tonight

Ted · Mar 29, 2002

Joanne:

Yea, I'm surprised too to the low rate of response.

Our hospital is doing restructuring too. There're going to combine the ICU/CCU (where I work) and the Med/Surg floor so that everything is located in one space. We're losing an ICU bed (currently have five) and I think the Med/Surg floor is losing 2 beds. However, we're increasing the number of potental telemetry beds to five (in addition to the ICU beds). The administration is telling us that there will be no layoffs with this restructuring.

Interestingly, the hospital is "modernizing" its O.R. suites and moving the whole Same Day Surgery beds to the same floor as the O.R. It seems that the money is in the same day surgery stuff.

There are a lot of staffing issues to work out. Many med/surg staff do not want to do ICU/CCU/Telemetry nursing and visa versa. One question is will the Med/Surg staff be expected to train as ICU-type nurses?? We already float to each other's units (which is really o.k. in my opinion). It would be a shame to expect nurses to work in an other field they may not want to work in.

Our hospital services a fairly large area including town located in the neighboring states. The nearest hospital is about 35 miles away. Our hospital is the second smallest in the state.

There's interesting times ahead for our hospital as it undergoes its major restructuring. I'm taking a "wait and see" attitude. I love working here and really don't want to change jobs. However, I'm updating my resume just in case.

Ted

MQ Edna · Mar 29, 2002

Hi Ted, just saw your post.

I work in a rural hospital, but it sure is bigger than yours! We have a 131 bed hospital, 32 of them on med/surg where I work. The 131 also includes the nursing home in the basement, so don't get too excited! :) Our census has been pretty full since about November, although we have had days when we've been down to 7 or so.

I love working in a small, community setting. The downside is, I know I don't get as much exposure to more critical patients.

Laura

http://www.valleyhealthlink.com/frameset_wmh.html

If this works, this is a link to my hospital.

Scarlette · Mar 29, 2002

I think we can squeeze in 35 pts on the med/surg floor. Last Saturday night we had 6 pts. Sunday night we started the shift with 7 and ended with 9.

We have 3 beds in ICU but with only 1 nurse per shift we can only have 2 pts in there. Not sure how many beds in OB, I think it's 4.

Ted · Mar 29, 2002

LauraRN0501 -

I share your concern with regards to having more exposure to critical care patients. We may have 3 or 4 PA-lines per year, which in my mind is scary!! Definately maintaining competency for both RN's and MD's is an issue. I just read and re-read the "How To's" and attend extra ICU/CCU inservices to help keep my knowledge skills up. Still, though, I love working in my unit. The patient/nurse ration is the tops.

Scarlette-

Your ICU is smaller than ours! :eek: Like you, one nurse can be in the ICU and care for up to two patient, three patients if the acuity is low! Usually, though, the census is 4 to 5 patients which enables us to be fully staffed with two RN's.

The acuity to our ICU/CCU is never really high. If a patient does turn very sour, we'll do the best we can to stablize them then "med-fly" them to the nearest appropriate hospital.

Our general ICU/CCU population are role-out MI's; old people with MI's; syncopy of unknow origin; COPD exacerbation; DKA's; drug overdoses; new strokes - usually embolic; people requiring cardiac pacer placement/adjustment; acute asthmatics (infants/ children requiring continuous pulse-oxmetry and O2 therapy); and lots and lots of "Med/surg overflows".

As an ICU/CCU nurse, we are expected to float to the ER and act as PACU nurses when our one and only hired PACU nurse is off-duty.

What I especially love about my job is being able to start care on a patient in the ER (let's say for a newly diagnosed MI) and follow the patient to the CCU/ICU. That type of continuity in care is way cool in my opinion!

Ted

allevi · Mar 29, 2002

The hospital i work in i believe can only have 25 patients. It is called a critical acess hospital. That includes OB i believe. The most patients i have had since there has been 6.

Huganurse · Mar 29, 2002

I'll never forget the time I ended up in a small rural hospital with a badly dislocated elbow. The ER was open, but couldn't do anything for me, not even give me pain relief! What a nightmare! Are all small rural hospitals like this? Is there often no Doc to care for patients when the ER is open? I hope not but was wondering.

Level2Trauma · Mar 29, 2002

Well, unfortunately I work at the largest "Rural Hospital" nationwide (or at least I have been informed so). It is a >500 bed hospital (not counting the OB/GYN or Psych). We have a 42 bed ER (level 2 trauma) with 12 of those allocated to Fast Track. Annual patient load at this facility is 60,000 to 75,000. WHEW!!! Is a right to hire (fire)state. Always short-staffed (not according to the PR officer in the media though).

MQ Edna · Mar 29, 2002

Huganurse, I had no idea there were ERs that had no docs. What's the point of the ER if they can't do anything??? I've worked in two small hospital and both of them had docs 24-7. How bizarre.

petiteflower · Mar 29, 2002

I work in a 25 bed hospital, we do everything from surgery to obstetrics to long term care and a very busy ER. Two nurses do OB, everyone does everything else. There is a lot of good things about it though, I went to work there from an ICU and could take care of ventillators and cardiac drips etc, but had no clue how to take care of someone not critically ill. We cover ER with a combination of docs, PAs, ARNP and occasionally travelling docs.

oldhag · Mar 30, 2002

Well, I work as a LPN in a 3 bed acute care with 24 hour urgent/emergency care. Been there for almost 25 years and wouldn't trade it for the world. We used to be a 10 bed hospital but downsized when we added 21 LTC beds. Used to be that you worked with on RN and LPN per shift and if we got too busy in ER we would call in extra if the need arises. We have always had a Doc on call.

The least amount of patients we've had is zero. Try working a Christmas shift with no one to look after and no phone calls.We picked up the phone several times to see if it was working. We ended up having wheelchair races up and down our hall.