Small Hospitals

Double-Helix, BSN, RN · Dec 2, 2011

70 beds would definately be considered rural. Most city hospitals have several hundred beds.

belgarion · Dec 2, 2011

Exactly how do you define "rural?" If a 75 bed hospital were located in a urban area I don't see how you could call it rural. And yes, I can think of several small acute care facilities in the middle of "civilization."

I work in a hospital that has 35 official beds and we can expand to 45 in an emergengy. It is in a town that is as rural as they get. As far as facilities we have a 6 bed ER, our radiology dept. has everything you find at a big facility except an MRI which shows up every Tuesday on a truck. Our lab can handle all the usual tests but some are sent into the city. We have a very nice but under utilized surgery suite. Babies are no longer delivered here except in an extreme emergency. Dietary, ummmmm, less said the better.

As far as staffing goes we have more LVNs than RNs. This works because there are very few functions we are not allowed to perform. Save the "LVNs can't do this" rants. This is Texas where we have much more freedom than most states. We usually have an RN or two on the floor and one in the ER but sometimes the floor RN is downstairs as well. We don't have unit clerks so nurses are responsible for entering all orders. Respiratory therapy is only here during the day so the nurses are responsible for breathing treatments at night and on weekends. The lab isn't here 24 hours so if we need labs drawn at an oddball time or in the ER one of the techs has to wake up and come in. If the sample needs to go to the big hospital, the tech takes it before going back home.

As far as patients the ER may see anywhere from none to 25 in a shift. Acuity can range from "haven't been able to poop since yesterday afternoon" to acute MIs. We have a "rent-a-doc" in the ER and four locals on staff. Specilaists can come over from the city or do on-line consults. On the floor we may have 1 or 2 pts one night and 20 the next. The most popular dx is AECOPD with AMS and "general weakness and debility" close seconds. The overwhelming majotity of our pts are over the age of 70. We do a lot of swingbeds so sometimes the place feels like an LTC.

I've talked to nurses at similar facilities in a hundred mile radius and this seems typical. I probably didn't answer all of your questions but maybe this helps.

tvccrn, ASN, RN · Dec 2, 2011

Sheesh..I live in northern New Hampshire. Our hospital is slated for 25 beds, critical access. If we have more than 12 patients we are "crazy busy". Our ED is a total of 6 beds..no cath lab..anything with a TnI of 2.0 is sent to the closet tertiary center (Dartmouth) which is 2.5 hours away by ground and 1 hour away by helicopter (if you can get them to fly). Our MCU is three beds, 1 nurse. I haven't taken care of a vent for more than a couple of hours while transport was being arranged, we don't do hemodynamic monitoring outside of the very occasional art line or CVP. Central lines are a rarity and we don't do organ donation, just tissue donation as we are too far from any place for the organs to be of any use.

So, you think YOU'RE rural? I don't think so.

classicdame, MSN, EdD · Dec 2, 2011

I believe the term "rural" is defined by CMS because they pay rural, suburban and urban hospitals at different rates. Rural is determined, by them, to be measured not by location but more by the number of people living within a specific radius of your facility. We are a rural hospital in a town of 100,000 and have 130 beds. But we service people in communities in a larger radius (not sure of measurement)

Guest321574 · Dec 2, 2011

So, you think YOU'RE rural? I don't think so.

Hope you didnt mean this to me, I didn't call anything rural!

This hospital is probably about 1.5 hours from a major metro (think million+ people), but within 20 or 30 minutes of a couple of trauma-level-I'm not sure-what sized hospitals. So probably doesn't fit the technical definition of rural. Belgarion, thank you that was a helpful description.

Munch · Dec 2, 2011

When my father was getting his cancer treatment he got it at a smaller hospital with A LOT of affiliated hospitals, some big, some small. We had him treated at the smaller hospital because it has the same chemotherapy. But when he had to go for special tests or a pet scan, an eeg or MIBG scan(this hospital didn't have those) they would take him to the larger hospital affiliated with the smaller hospital and he would get tests/scans. They would then send him back and the results would be sent overnight the next day(unless it was urgent they would put a rush on it and the results would come back with the patient). My dad had metastatic pancreatic cancer so it didn't really matter what hospital he went to or what scans or tests he had. Oh and by the way the hospital we had him treated at had around 150-175 beds.

tvccrn, ASN, RN · Dec 3, 2011

Hope you didnt mean this to me, I didn't call anything rural!
This hospital is probably about 1.5 hours from a major metro (think million+ people), but within 20 or 30 minutes of a couple of trauma-level-I'm not sure-what sized hospitals. So probably doesn't fit the technical definition of rural. Belgarion, thank you that was a helpful description.

No, just a generic exclamation.

xtxrn, ASN, RN · Dec 3, 2011

Rural = size of town & proximity to a larger area, not bed size. :)

tokmom, BSN, RN · Dec 3, 2011

My hospital is critical access, but only minutes from larger hospitals and cities. We are just tucked into the hills for those that don't want to go to larger hospital, but we are part of a very large organization that boasts 4 other bigger hospitals.

We have 22 beds, 6 L&D suites, 2 OR rooms, 14 bed ED, 4 bed ICU, DI, Lab, etc..

the only thing we don't have are a variety of specialists that walk through our doors. Like another person said, if we have a STEMI they are airlifted to our sister hospitals. The same with acute stroke, unless a no code kind of thing.

I feel like I have the best of both worlds. The financial backing of a large organization with staff education, but don't have to deal with a large hospital setting.

stormy112 · Dec 3, 2011

I am on my way to a small hospital as a CST and i am excited. I have worked at some of the big name hospitals and have had the opportunity to work with some of the great medical inventors, but now its a welcoming chance to relax and breath. NH here I come, and thank you for having me.

tokmom, BSN, RN · Dec 3, 2011

I am on my way to a small hospital as a CST and i am excited. I have worked at some of the big name hospitals and have had the opportunity to work with some of the great medical inventors, but now its a welcoming chance to relax and breath. NH here I come, and thank you for having me.

I agree. I have done the big inner city hospitals, then medium sized, smaller and now critical access. I don't need all that to be happy. Give me an unstable person and I'm good to for my monthly adrenaline rush. :lol2:

The only downside of smaller hospitals that don't have all those specialists are in coming new grads. Many of ours stay just for a year or two, get bored and move on. Personally, I think they need to if they want to develop their skills, but it's sad to see them go.