Oh my gosh!!! (found the rural nursing forum) - page 2
I JUST found this forum! (Got to get away from the "Off Topic" forum more often!!!!) I'll be posting here more often. (Be afraid. Be very afraid.) Just for the books. I work for probably... Read More
Jun 16, '03We are a Critical Care Access Hospital too.
Census usually around 12-13, 120 deliveries/year, 3 bed ICU, great general surgeon, busy ER.
You gotta love a small community hospital, where absolutely anything can walk in the door at any minute and you are personally responsible to respond appropriately, and no two days are ever the same!
I'd never go back to something more specialized! I'd be bored!
Jun 16, '03Originally posted by renerian
What are you coming to Columbus for Ted? A conference or something?
Check your PM!
Jun 18, '03Hi Ted and everyone else. I work in a similar situation. 15 acute beds. One delivery room but there are four other beds available just in case. ER. Outpatient surgery. LTC. We used to have a "Special Care Unit" - sort of a step below true ICU . .those kinds of patients we'd ship out. But now the SCU is OP and those patients come out on the floor - we moved the cardiac monitors. The RN's do all these areas.
My question for rural nurses is how do you feel about knowing a little bit about alot of areas? I started out thinking that this was great as I'd never get bored. I've been told that THIS IS rural nursing but I'm starting to think about getting more specialized training in ER. I've put in one NG tube in five years. Involved in fewer than 10 codes. Most of the nursing I do in the acute side is pushing pills to elderly COPD patients. I find that I AM a bit bored. There are OB deliveries . .maybe 4-5 a month. The fact that we do so few scares me. Do you feel like you get a little rusty if you don't do stuff all the time?
I would hate to do OB and only OB. I do like the variety. Just want to feel more comfortable that I know what the heck I'm doing. Just started in the ER . . .maybe that's why I'm questioning my abilities.
Anyhooo . . .any thoughts? Is this really rural nursing and I just have to live with it?
Jun 18, '03Stevielynn - work in the ER for a while. I love it. I can't imagine going back to a huge teaching hospital. And the ER probably sees alot of stuff that transfers out - so you never seen it on the floor. And you have to keep your skills up. Because you will be the one that is called for hard sticks, or hard NGT placements, etc.
Ted - we haven't had to use any "swing" beds in a while. At one time we had three pt in swing beds and administration went crazy. We do get close to the magic "15" sometimes. And administration gets crazy then. We (the ER) usually starts hearing about it when the numbers hit 12-13. And we just start reminding the MD's that the admission needs to be an observation admission. Usually doesn't end up being a big deal. The one time that I recall hitting "15" administration starting calling MD offices and telling them that their patients were going to have to be transferred to our "mother hospital" It was amazing how fast some of the patients got discharged. I think that crisis lasted about 3 hours.
Jun 19, '03I also work in a rural hospital. I think we have less than 60 beds. We are considered to be Frontier Medicine!Our nearest hospital is 100 miles away. We have to transfer all major cardiacs(120-150 miles), major trauma(120)! It definately keeps us on our toes! All OB crisises have to go to Denver or Salt Lake 250-300miles. We are on Interstate 80 and the weather does not always co-operate. We also have major staffing problems because of our location and the pay scale! I must say that it is a great place to learn alot in a short time span and I am really glad for the expierience I am getting!
Jun 22, '03"Haven't had to use Swing Beds?" I guess I don't understand that philosophy. I'm the DON at a CAH and I"d just as soon have Swing beds as acute. As long as they are true swing beds, not just acute patients who have been there longer than 3 midnights. Reimbursments are close to the same as Acute and the cost's should be lower. It all comes out on the cost report at the end of the year.
As to admiting patients as obervation and not acute, you have to watch that also. If your mix is wrong you won't get as much money back from medicare at the end of the year.
In some communitied becoming CAH is the only way to go. We dropped out drain on the county from $300k to only about $175K. YOu do have to pay more attention to your patient population and sometimes cash flow gets a bit slow, but I was able to keep and actually carry more nurses than I need because of that.
Jun 30, '03Hey Craig - I don't really understand all the $ stuff involved. Our DON doesn't want swing beds. Don't really know why. The only swing beds we have had are not what you call true swing beds. They have been there longer than 3 nights - so they get converted. Don't really get involved with it too much - just an old ER nurse. Just admit them!!!!
Jul 2, '03Well think I've got you all beat. Until I started traveling 2 years ago, I worked full time in a rural hospital in Maine. 4 ER and 9 Acute/Critical beds. Think it is the smallest hospital east of the Mississippi. Left because of politics in hospital, with it being that small you couldn't escape the problems. What I'd give to go back to an ER that sees 12-15 pts on a real busy day.
Jul 2, '03Hmm Yup that's smaller than mine. I've got 16 acute/SSB and 2 ER. What a change from doing critical care agency work in baltimore. I actually travel 4 hours to moonlight in critical care so I don't loose those skills. I worked in Northern Maine in the late 80 & early 90's. I used to love that 3 hour ambulance drive in the snow with a high risk preg 13 yo.
If anyone told me that I'd be discusing medicare reimbursment for the hours spent providing nursing care, when I started this I would have told them they were crazy.
Jul 3, '03My mother is an RN at a 25 bed rural hospital. I'm always like GAAAK, why do you stay there Mom? But she loves it. She does everything, trauma, surgery, ER, L&D, Hospice, medsurge, psych, waiting for LTC placement.......
They're always threatening to close the place b/c they can never atract experienced nurses and are always shortstaffed.
It's not my cup of tea, but hey, she loves it.
Aug 24, '03My hospital is a CAH also, but we only have 8 beds in our hospital and 32 in the attached LTC. An LPN manages the LTC, an RN manages the ER/Hosp, and 2-4 CNA's work (mostly the LTC). It's quite different from the great big hospitals I'm doing my RN clinicals at! Swing beds are great, they're just LTC admits that need more skilled care (our LTC is intermediate care); at our facility it's just the same paperwork as an LTC admit.
Aug 27, '03This is so neat! A forum for rural nurses. I too work at a CAH we have a total of 24 beds 9 of which are designated Swing Beds. We do not do OB except for emergency deliveries in the ER. We have a 2 bed ER. We do not have an ICU...we call it a monitored bed unit. Our average daily census is 7-8 patients but we occ. get down to one or two (that includes the swing beds)
Swing beds do make money...the paperwork is a pain though.
I love working at our hospital, I have been able to do a little of everything from working in the ER to riding on the ambulance with an unstable transfer and also the less exciting things like taking care of the patients awaiting the nursing home beds.
It is true one or two people on medical leave cause a staffing crisis. I am currently the acting director of nursing since our DON retired and we are unable to recruit a DON. We have had to use some agency staff this summer to meet our staffing needs, our census would go up when everyone wanted vacation.
Aug 27, '03Well I'm the SDC here, which at least in rural places is a catch-all for a little of everything. I do staffing (we use agency a lot, can't find anyone out here), teach CNA classes, and generally do administrative junk under the DON. You really have to have an appreciation for this type of thing to be able to handle the rural setting.