Rural Hospital Vs. City Hospital ERS

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I'm thinking of switching from a rural county hospital to a small city ER position. My question is ....how much of a change is that gonna be and have i had enough experience. As a rural healthcare nurse, you do it all...I am the ER, OB, L/D, Peds, and Med surg nurse. We stablize and fly traumas. I am generally the only nurse along with a PA and handle the ER alone (not braggn but im dam good at it too)

Most of my fellow nurse friends that work in large city ERs say that I will have more experience then most nurses that work in the city ERs. And that the only difference is more ERs coming in, and more nurses to one patient. But I'm so nervous that I'm not "good enough" ???

Have any of you worked in rural health as well as larger hospitals...how much of a difference is it and which is harder?

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bumpn

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I have. I started out in an 18-bed ER and went to a rural setting where it was the doc, me, and a tech for 12 hours. There are advantages to going in either direction. Rural ERs drool over nurses with larger-ER experience because nothing phases them. Larger ERs like rural nurses because you have done EVERYTHING......mix your own meds, calc your own dosages, transferred pts quickly.......at the first ER we hardly did any transfers, so when we did do one it took a while to go through the paperwork because nobody was familiar with it. At larger ERs you see more volume and worse cases, partly because they get transferred in from smaller places. On the other hand. rural nurses know how to do anything to keep a pt alive until they can get to the larger place.

I think you'll do fine!!

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Geez I hope...anyone else got any input on this?

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This is a timely question for me - I'm moving from a rural ER to a small city ED. (I hate that term btw - ED stands for Erectile Dysfunction in my head). :uhoh3:

I'm a bit scared too. In the rural ER it was me, two medics and one doc and 3 beds. With one gyne room. And a triage room.

While I did do it all (med/surg, OB, etc.) . . . . I am wondering about the pace in the city ER. We had mostly "clinic" style patients. With MI's and stokes and trauma mixed in. I've put down 3 ng tubes in 9 years :uhoh3: and so worry about that first drug overdose . ..

steph

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ah i can stick a tube where ever it needs stuck ! lol and I am very good with iv's ..that part i got covered.

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I've got IV's down cold;) too . . .. we just don't see many drug overdoses up here.

When I was in Vietnam this summer I drew blood all day - we had someone come into our rural clinic with a heart attack which is unusual but we handled it fine.

I think it is the pace . . . how to handle that. A very busy day for us would be 18 patients in 12 hours.

steph

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Specializes in Rural Health.

I too work in a rural ER - 7 beds. We are busy (about 35-40) patients a day, but they are "clinic" type patients for the most part, with a trauma or MI thrown in there throughout the day. We fly everything that is critical, ground transport the rest and send a small amout to our own M/S floor for obs or acute stays as long as they are WAY stable.

I went ahead this last month and decided to work PRN at a larger facility. It's a 12 bed ER but it has trauma services, ortho and surgeons 24/7, so they take and KEEP everything that walks in the door. It's been crazy busy there for me learning what goes on past 1 hour from when the patient walks in the door (cause usually, that's about the time we are flying it out or sending them home). I like it though. I just went PRN and didn't make the full plunge into this ER because I wasn't sure because all my ER experience lies in rural ER nursing.

So far, I haven't sunk big time. Major huge traumas still scare the crap out of me but the support in this facility is awesome and you are never alone. MI's, drug OD's, codes, etc....all still run the same in both places. The support from the other RN's and the docs is great.....and it's so nice to have more than 1 RN with you when you are coding a patient.

The hardest part of this entire process is keeping that patient long term. I start my am's with patient's I still have when I leave in the evening.....and sometimes the pace keeps me crazy because I swear I just get 1 chest pain settled and the charge tells me I've got another CP coming in the room next door.

This week I'm the float from 10-10, so I won't have room assignments and I'm hoping that helps me get a better feel for the entire ER process.

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Anyone else ?

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Specializes in Med/Surg, ER, L&D, ICU, OR, Educator.

I think "rurals" require more adrenaline, as YOU ARE IT! This pressure is invigorating, and stressful ("I have to get the line" kind of stuff, so you do.).

The actual VOLUME of patients at a larger facility may well be less stressful(you are not alone!).

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