Rural Health Nursing

[Robmoo, ADN, BSN, RN]

The challenges in access to health care are large the fault of our system which pays less for health care delivered in rural areas.  We have many nurses who drive in an hour or more because they can't find jobs that pay well in the surrounding smaller towns.  Why do they pay less?  Because they get reimbursed less.  This is a crisis largely of the system's creating.  Why?  Unless you grow you own groceries they are more expensive in the country.  Gasoline is more expensive in the country.  Is it a prejudice against people who don't live in the cities?  If you honestly want easier access to healthcare for people who live in the country then don't discriminate against them when it come to reimbursement.

[CommunityRNBSN, BSN, RN]

I would totally love this. At the moment I work in an FQHC in a very urban, poor, inner-city environment. The locale is different but the duties are similar— it is an underserved population, often with low health literacy and sometimes illiterate, few resources, and we have to patch together healthcare. 

[Hoosier_RN, MSN]

I live in a rural area in Indiana. The area is very saturated with nurses who have to drive to Indy, Louisville, and Cincy for that first job. The hospitals in the area I live know that there's a saturation and only take experienced nurses. The pay may be lower, but many view not driving an hour+ as a good tradeoff for $$$. Area nursing schools around pumping out hundreds of nurses every year, with the promise of tons of local jobs waiting...NOT, except some of the not so good LTCs. So, not every rural area needs nurses. That's a misconception that needs to stop. Every prospective student needs to take a good look at the job market in the area in which they wish to work, and get an accurate picture of job availability 

[TheMoonisMyLantern, ADN, LPN, RN]

I worked at a very rural, very small hospital for a few years. In the community we were mocked as not being able to handle more than a papercut. We certainly weren't taking neurosurgery or nicu patients but we were the only hospital around for a pretty good distance so often complicated patients would come to us to be stabilized and transported to other facilities so you still got exposed to quite a bit. In addition to this, some patients requiring higher levels of care would refuse transfer due to the distance, lack of trust in other providers, etc. so our hospitalist would manage them there so once again there was exposure to more complex patients. Another cool thing about being in such a small hospital was that it was not uncommon to help out in other departments of the hospital during the shift when a particular area got busy, for instance you might be called from the floor to the ER, or to the ICU, the house supervisor had to be able to scrub in the OR if our single surgeon happened to be on call that night to come in for emergency surgeries. No pharmacist at night, so one time I had to mix my own TPN for a patient. If there were no ICU patients, and your patient became unstable then congratulations you are the ICU nurse until the on call nurse comes in to take over. Because of this you had to be really flexible. We got a lot of palliative and end of life patients due to lack of access to home hospice in the area. This was a plus for me because I really enjoy providing end of life care.

That said, there were some bad points as well. Lack of resources was a big one. Lack of access to an MD overnight was an issue at times, sure we had an on call, but sometimes you just need someone in a white coat to take a look at someone and most of the docs wouldn't come in no matter the situation and would just order to transfer them or let the ER doc attend the code blue when it came to that. Which leads to another issue, some of the medical management from the physicians was sub par and tolerated due to the fact that MD's are so hard to find for rural hospitals. It could also be hard to get your hours in, when census was low and the other departments were slow or have coverage, in that scenario you don't get to work. That really hurt financially, and the years I was there I had to maintain a second job in order to make sure I got my hours each week. My co-workers were good people, but they were not very tolerant or accepting people so that made it difficult to "fit in" while I was there.

Nowadays I live in a moderate sized city and left the rural world behind. I don't regret working there, in fact it was one of my favorite jobs. While medical care wasn't really great, the nursing care was on point and really superior to many other places I worked, our patients were spoiled rotten. I will admit it wasn't really a resume builder because no matter how you try market yourself, people in big facilities just tend to look down on the little house on the prairie hospitals. Interestingly enough, jobs openings aren't really plentiful there, since most the employees are locals and have been there generations, the turnover is quite low. As hoosier said not all rural areas are bleeding staff.

[9kidsmomRN]

Themoonismylantern’s story is very much like mine. We did have an on call surgery team, but to help out, we ICU nurses would recover post ops in the middle of the night as a favor to the PACU staff. In this 120 bed hospital, ICU nurses carried pharmacy keys in case a new admit in the night needed something stat. No access to narcs in the pharmacy because every unit had a narc cabinet and counts were done every shift... it was mostly abx-vancomycin, ancef, etc but we mixed them. Also mixed our own pressors from stock kept in the  ICU. I didn’t have problems fitting in at work, but felt like an outsider in the small town because I wasn’t a “lifer”—born lived died for generations there. 
I also moved to a larger community (actually live rural and commute 30 minutes to work in a small city 200 bed hospital) on the “edge of town”. Staff here drive over an hour to work at my hospital. I have also worked at the other medium size hospital half an hour the other direction, and a very rural hospital about 50 bed with a LTC attached that has 2-3 “ICU” beds that usually sends their criticals to us. There are lots of clinics-almost in every tiny town so seeing a doctor is not difficult for the residents. People expect to travel for anything more than check ups, although specialties also travel to small clinics to see patients in their communities. 
The concept of rural nursing is interesting, somewhat like parish nursing.