What's it like being a nurse in a rural hospital?

[bear94, BSN, RN]

I made a post similar to this, simply asking for advice on making the switch from being a nurse at a level one trauma center to being a nurse/clinical supervisor at an eight bed, rural ER. I didn't really get many replies to my original post. I think my question stated above in the title may produce more answers I am looking for.

I start my new job in a couple of weeks. I will be the only RN present, on top of being in charge of scheduling, disciplinary action, and hiring processes. I will have two LPN's who get to utilize their full scope of practice (the only things they are not permitted to do is push IV medication, give narcotics, and initiate blood products), and a tech who also registers people at the front desk. I will also have RT in house. The manager is currently trying to move toward an all RN staff, but he still wants the LPN's to have a purpose.

I understand as a rural RN, I will wear many hats and learn to do different things on my own with limited resources. What I want to know is there anyone out there who works in an environment similar to the one I have described, and what is it like for you on a daily basis?

Do you have your own separate "team" of patients, or do you all kind of work together to get things done for patients, not really assigning yourself to any one patient in particular?

If you've gone from working in a big hospital to working in a smaller one, or even if you've always worked in a rural hospital, do you feel like you get to spend more time with your patients? I know sometimes it will be very busy and time will be limited for getting to know patients, but that is one thing I really have missed out on working in a big ER.

[HouTx, BSN, MSN, EdD]

Full disclosure: I do not/have not worked in a position like yours, but I served as a clinical operations consultant for a large health care system for 7 years... and they had numerous rural hospitals in with which I worked. I helped get one of "my" rural facilities designated as the very first Level IV (basic) trauma facility in the state.

Prior to that position, I had risen through the ranks in Critical Care, lots of high tech and complexity... so I thought I knew it all. HA! I was humbled the very first time I was on site in a 20 bed facility when an acute MI was brought in by the volunteer ambulance driver (and town pharmacist). Jessie, The RN (yep, she was the only one in the facility) had an efficient resuscitation team organized and ready to go by the time the patient arrived.

I was stunned when the maintenance guy came running in from outside, put a patient gown over his overalls and began compressions... he was the tallest and had the most upper body strength, so I guess that was why that was his job. The CNAs assembled equipment, applied electrodes and managed the documentation. The RT managed the airway. An LVN started IVs & hooked & hooked up fluids (lines had already been prepped by a CNA). Jessie conducted assessments, managed the team and they were on ACLS round 3 & had a pulse by the time the physician arrived. In the background, the unit secretary/receptionist/ambulance dispatcher had contacted Life Flight so they were on their way.

The helicopter arrived, patient was transported - BTW, he ended up with a CABG & recovered. Jessie led the team in a debriefing session as they cleaned up and restocked. EVERYONE cleaned - it was a team. It took me a while to process and fully appreciate what had happened. Yep, I was humbled very quickly. I tried to find out exactly how Jessie had developed such a high level of expertise, but it was difficult. She was busy & there was a laboring patient on the way, so she had to set up for a delivery.

I did find out about the Rural Nurse Organization & the National Rural Health Association. I joined both & I encourage you to do so as well. It's a great starting place.

[bear94, BSN, RN]

@houtex your comment was extremely inspirational and helped me gain a better understanding of what I will be in for. Thank you!