Small Community Hospitals

I feel ya. I've worked in all types of facilities from nationally known level one trauma centers to small community hospitals. While some of the smaller ones earn the reputations of being bandaid stations at best most actually functioned very well. In fact, a community ER I worked in routinely saw 100-120 more patients in a 24 hour period than the big university ER that had more beds. And don't tell me that was because the big ER saw sicker patients. I work in that hospital now and it simply isn't true. Case in point. I and a number of my co-workers from the community hospital went to TNCC. One of the level one trauma centers had also sent a contingent of nurses (glamorously decked out in their shiny "----Hospital Trauma Team" jackets:barf01:)One of them had the audacity to look at us and say "What are you doing here?" followed by snickering and knowing glances to each other (uh, can anybody say highschool ). I rounded on them as follows: "Do you remember that trauma patient you got last week, you know the one that was in the news, well he came to us FIRST. When he came to us he was DEAD. The helicopters weren't flying. We have about a third of the resources you have. When you finally got him he was not only ALIVE but also OG'd, tubed, chest tubed (bilaterally), foley'd, 3 large bore IV's, fluid bolused, transfused, labbed, antibiotic'd, FAST scanned, hemodynamically stable, splinted, and CT scanned for good measure since transport was delayed for weather.Why don't you try that with one doc, two nurses, a paramedic and a tech! The ONLY thing left for you to do was take all the credit for saving him. Which you did...frequently.. and all over the news." They kind of slunk away red-faced but spent the rest of the class glaring at me. Seriously, after more than 2 decades in this environment I've finally figured out that we are literally re-enacting highschool behavior and it sickens me. I didn't like it much the first time around and I'm not enjoying it anymore this time.

"There was a comment made in the allnurses forum about an RN ill with salmonella & going to the small community ER, they told her to take immodium for loose stools, they are trying to treat the symptoms to help you feel more comfortable until the antibiotics take affect, medications take time to start working & can't be expected to be healthy the next hour. There is nothing wrong with that! "

Personally, I find a great deal wrong with delaying the evacuation of salmonella from the intestinal tract. I would never expect, nor would I take, an anti-diarrheal medicine if salmonella or any other bacterial infection were suspected.

Not to nitpick on just one point in your post, but you did use that point to illustrate your position....

Aside from nitpicking I will say I have been an RN for a very long time and recieved my best "on-hands" education in a small rural hospital in appalacian areas of rural Kentucky/W.Virgina. I have worked in major teaching and level 1 trauma centers also and none of them compared to the education and experience I recieved in this smaller rural area. I am originally from Miami and had to not only overcome what some would call culture shock but the skeletal availablity of medical doctors and other health professions in these areas. We didnt have residents/IV teams/MD's on call, etc. All we had after 5pm was 1 ER doc to depend on if needed. Which by the way we had one (the ER Doc) code while treating in the mist of coding an MVA on night with no other MD on the premises. Wow talk about an experience there. We had to learn very quickly and routinely to fend for ourselves in an automous way to overcome difficult or limited availabilty of services. We started our own arterial lines, intubated, etc. When I returned to larger hospitals I felt limited and restricted. I value the few years I was in the rural setting and again learned more there than any experience I have had since. You are correct though in what you are stating that it isnt fair one bad apple should ruin the reputation of the entire facility. I have high respect for rural area hospital nurses, you are a special group and deserve the utmost respect in what you do.

I have the nursing skills I have largely due to small town hospitals. I worked as a CNA in a small hospital while in nursing school. My first job after graduation was in a small town hospital....staffed with 1 nurse and 1 CNA each shift. We did a lot of stabilize and ship; and whether a patient survived or not often depended on how quickly we could recognize what we were dealing with. I was RT, phlebotemist, IV team all rolled into one. And in those small town hospiotals I truly DID make a difference. Be proud that you can handle it; I have met nurses who could not.

I worked in a very large hospital in Houston and then I worked in a very tiny rural hosptial in Texas. They were entirely different experiences.

The big hospital was high tech and modern and had a hugh support staff.

The rural hospital was like jungle medicine and often at night I was the only RN in the building and we would have no doctors in the building at all. The doctor on call would be at home asleep. So as charge nurse and the only RN, I would have the ER to myself as well. I would have standing orders for any trauma or cardiac patient etc and would then call in the doctor. Trial by fire.

I saw some horrible things. Never in my wildest dreams did I think I would have so much responsibility.

I have worked in some of the largest hospitals in the US. I have also worked in small hospitals. They all have their place. And no matter what anyone says, we are all out there doing basically the same work. Sure, I don't work at the level I trauma center any more but does that make me less of a nurse because I don't? Just because you/we work in a small hospital does not mean that we don't get sick people. Just try being in a small hospital at night as the only RN on duty and see how you like it. I agree with the post above. It is great to be in a big hospital where you have lots of support staff around. Try doing that same job in a small hospital when some guy drives up to the ED in the back of a pick up truck with a gun shot wound to the chest. Its a new experience then.

Yep gun shot wounds, chain saw accidents, rodeo accidents, car accidents, auto versas bovine (this is Texas, happens al lot), factory accidents. A small hosptial ER gets some nasty stuff and usually, I was the only nurse at night. Prett tough sometimes and boy did I learn!