The pitfalls of a small rural hospital

  1. I am working at a small rural hospital as a charge nurse on a med surg floor. In fact, the hospital only has med surg and an ER. It is very different. There is no 24 hour pharmacy, no RT, and no doctor (Nurse Practitioner or PA admits the patients). I am working here because I relocated and all larger hospitals are an hour away. I have to admit that I am nervous because of the lack of resources available to me. I have only worked ICU in large hospitals and I am use to having a lot of support. This little hospital is busy, some of the patients admitted were actually ICU patients. What would be your advice?
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    About loveishope

    Joined: Jul '11; Posts: 56; Likes: 40


  3. by   blueyesue
    I don't have advice, but IMO working in a rural hospital will most likely give you a chance to work with more diseases and levels of patient care than in a large hospital where they place patients on specific floors for specific health issues. In a rural hospital you get to deal with everything that comes in.
  4. by   nurseprnRN
    think about all the other stuff you'll learn, dive in, and enjoy it!
  5. by   loveishope
    I was thinking the same thing. I even go to the pharmacy at mix meds like antibiotics, etc.. I also get to play respiratory tech. The only thing that concerns me is that I will not be able to work in ICU again because I am afraid I won't be hired because I am not working in ICU anymore. And I really love ICU.
  6. by   elkpark
    I don't have any "advice," but I started out my career in a small, rural community hospital like you describe (after training in a large, urban teaching hospital) and had a great experience. Best wishes!
  7. by   brownbook
    I think your experience will be great. You will be a jack of all trades. Many nurses have no idea how to get a 12 lead EKG, give nebulizer treatments, draw blood, etc. because they call for that tech when they need those services.

    I am optimistic your skills will be greatly appreciated when you return to the big city.
  8. by   carolmaccas66
    What u describe doing OP isn't anything new for Aussie RNs. We mix meds all the time, and rarely have physios (PTs) & we don't have RTs. We do everything.
    I've worked in country hospitals & u have to be more savvy & expect to do a lot more. Use your NP for advice though & work more closely with the doctors. Also expect to do more, like we used to hand out meals & return them as there was only one girl for the whole hospital to do this. We had to re-stock linen, IV supplies, drugs etc. There are a lot more duties than in a bigger hosp.
    And BTW, I don't know why everyone seems to think an hours drive is far away for work; I've either had to move to another state to get nursing experience and I've always had to travel over an hour for work. You do what u have to do to get the job, which judging by this board, many people seem to think they should find a job 15 minutes away. This has always baffled me.
    Learn as much as u can & rely on ur instinct. ED experience is great too.
  9. by   nerdtonurse?
    Welcome to rural nursing! As a fellow resident of Be - Freakin' - Nowhere, let me give you a few tips.

    • Everyone in a small town is related to everyone else. So the nurse, patient, or visitor you complain about is probably related to the person you're complaining to. Happened to me, and it's not pretty when they say, "oh, that's my uncle." Ooops!
    • Gossip is the county sport, and the hospital could gossip for Team America in the next Olympics. Anything you say can and will be all over town (and probably be repeated incorrectly) in the blink of an eye. Never, ever, ever bite the hand that feeds you. Your boss stinks, the hospital's stupid, the ER is a great place to die, vent here or with your SO. Not to the locals.

    They may be crazy. They may have never learned to read, or had much education. They may not remember how to spell the county you live in. But they'll remember you and speak to you in the grocery store, you'll be "their" nurse wherever you go.

    Treat'm like family, and you'll be fine.
  10. by   Mutt's Wife, RN
    I too work in a small rural hospital at an ER with only 5 beds. I learned so many new skills - as you said, mixing my own meds, giving RT treatments, obtaining EKGs, starting my patients IVs and drawing blood from them, obtaining ABGs - things I never was allowed to do in the larger city hospital.

    I have not found any pitfalls... Now when you go back to critical care, you will be much more versatile and not have to depend on other people if you need something quickly.
  11. by   joanna73
    I moved from a large city to a small town a year ago. You will learn to be more resourceful, because you're on your own. As people mentioned, gossip is rampant, because there's little else to do. Be careful who you befriend. I enjoy the small town, but this experience has taught me that I'm definitely a city girl.
  12. by   miss_anneRN
    I too work in a rural hospital and our big sister medical center is an hour away. To quote a nurse from Canada "You've got to be an hour smarter" with assessing a patient, ? need to transfer and predicting what their condition might be 60min later. We have access to an e-pharmacy via telephone for mixing, rates, compatabilities etc. We recently insistuted hospitalists 24/7 in house. Before that we had only docs on call at home for gen surg, ob, peds, ortho, Internal med and family practice. About 15yrs ago there was no MD in the Ed, just those docs on call that would come in after a medsurg nurse triaged the pt in ED!

    I am thinking that you know how fast a pt could crump..and then what? Who's gonna help? Most likely, the pt's at the rural hospital are less acute. But when you are used to having monitors in front of you, CVP's and all those ancillary staff you may feel lost. You will find that the floor staff will all pitch in and the ED is always available in a "code" or "rapid response" type scenario. Comfort levels will increase when you really get to know who your working with.

    Also, think about what you have to offer! Perhaps you could host a staff in-service on some ICU type topic that could enhance pt care/outcomes, or, help develope protocols, or assist in instituting a rapid resonse team. Hopeully your unit manager would be open to hearing new ideas you may have to increase patient safety or acheiving PI goals.
    Every experience is a learning experience! You learn from new job, new job learns from you! It's a win-win!
  13. by   kool-aide, RN
    Bad things about small, rural hospitals is when you have an emergency things don't always go too well. I don't like that feeling of helplessness.
  14. by   RNforLongTime
    I work at a small community hospital in a 6 bed ICU/CCU on night shift. The RT goes home at 11pm...housekeeping leaves at 10pm, pharmacy goes home at 8pm, dietary leaves at 7pm. So, on night shift I do it all! I draw(and sometimes run) my own ABG's. I'm pretty good at it too so if another unit needs an abg, I'm sent to do it by the nursing supervisor. I also have to do my own vent checks, administer my own neb treatments, start my own IV's(another thing that the nursing supervisor asks me to do). If we are full and getting another ICU pt, I gotta move the pt out as we have no house orderly at ALL(even on day shift), then clean the room myself. Gotta mix my own IVPB's, et al.......