Would a Critical Access Hospital be a Good Place for a New Grad?

icuRNmaggie, BSN, RN · Oct 19, 2014

The purpose of a critical access hospital is to stabilize and ship critically ill pts, traumas, and high risk OB pts. If they cannot fly due to weather or go by ground transport, you may find yourself with a pt who needs services that your hospital can not provide and you have to do the best you can. You may be giving tPa to a pt who has a STEMI who needs to go to the cath lab. There may not be a resp therapist and you will be setting up the bipap or ventilator. Or doing Istat ABGs BNP and troponins. You are the IV team and you will get a lot of practice. You are responsible for your patients telemetry. You will learn skills that you can take with you anywhere in life.

A Med Surg position will be very doable. You will see lot of CHF, afib, pneumonia, DKA, appendectomies, and post op fractures if your facility is near a ski resort. You will see the same scenarios over and over. Make sure they will pair you with an experienced nurse for at least a year.

If you are mentored by highly skilled and experienced MDs and nurses, and you are a self directed learner, it will be a valuable experience. It is a huge learning curve for a new nurse. Do it if you like to be challenged. Get your ACLS PALS and TNCC and attend every learning opportunity possible.

These hospitals are like little families, some squabbles occur, don't get caught up in that. Go in with a positive spirit, respect for everyone, and desire to provide excellent care and you will thrive. The work environment is very nice and you won't have to deal with the kind of difficult personalities that you find in larger facilities.

It is common for the MDs to be fresh out of residency and working off a 5 year obligation to repay student loans. These young doctors are great to work with and like to teach. Best wishes.

icuRNmaggie, BSN, RN · Oct 19, 2014

You will have many opportunities to go on transports to DH. To me a nurse residency sounds boring in comparison but only you can decide how you can achieve your goals and aspirations. good luck whatever you decide.

ruralnurse84 · Nov 3, 2014

I am a new grad in a critical access hospital and the variety of patients I get is amazing. We do OB, ER, surgery, wound vacs, ICU, just everything. Yes we do ship off the critical cases, but we still have to stabilize them. The nurses and docs I work with are amazing. I don't feel terrified at work because everyone I work with are willing to answer any questions I have and will show me how to do things I have not come across yet. So I absolutely think a critical care access hospital is a great place for new grads to work as long as the people you work with are good teachers. Good luck.

CamillusRN, BSN · Jan 14, 2015

ctfrazie,

I was in your position a while back - I wanted to get down and dirty in trauma critical care nursing but didn't feel quite prepared enough. I asked a nursing instructor for advice; her opinion was to start out in critical access nursing and see if stabilizing critical patients appealed to me. To echo icuRNmaggie, working critical access means you are all things to your patients. I've had the exciting privilege of filling the roles of an ER, ICU, Med-Surg, and comfort-care nurse simultaneously in a single shift. It gets crazy when you also have to be the phlebotomist, respiratory therapist, physical therapy assistant, front-office receptionist, and security guard while also trying to execute your nursing duties! I'm fortunate enough to work with seasoned nurses who have my back, are ready and willing to teach, and incredible physicians who take the time to teach next-level pathophysiology.

At the end of the day, working at a critical access hospital makes you think like an ICU nurse, work like a Med-Surg nurse, act like an ER nurse, and gives you the opportunity to feel the pressure of caring for a critical patient and doing what you can while the on-call physician is a still a full 20 minutes away. I honestly think that critical care nursing is one of the best spring-boards for transitioning to any nursing specialty later on (like ruralnurse84 said, provided the other nurses are willing to teach). I've taken icuRNmaggie's advice, gotten my ACLS/PALS/TNCC and am currently working on ENPC and CEN in preparation to transition to a trauma center. Best of luck to you in your career as an RN!

WhoniverseNurse · Mar 10, 2015

I've been a nurse for almost 2 years and now and work (as of this past October) in an ER of a critical access hospital (CAH). Best job. Ever. A little bit of this. A little bit of that. Stabilize and ship is indeed the name of the game. CAH's can do A LOT more than you might think, but the really big stuff gets shipped out via air or ground to the nearest "big house". It is true sometimes if transport is grounded that you can get "stuck" with a patient whose needs exceed the equipment of a CAH. One time, we coded a hypothermic 2 year old for 3 hours waiting for transport to another hospital because the weather was bad and 2 hospitals that were closer were on diversion. Then there is the flip side. Nothing to do, slow, and a lot of time to spend... well, let your minds wander. But if you are willing to stick it out and you find a good facility, go for it. It will be challenging, but I feel I have already learned more in the 6ish months I've worked here than in the entire 4 years of nursing school and my 1st year of being an RN.

shir977 · Feb 3, 2016

I have worked in critical access for 10 of my 15 years in nursing. I couldn't imagine working in any other environment! Critical access hospitals get everything the big hospitals get, just fewer and farther between. We are like a MASH unit, keep what we can and stabilize then ship those we have to. Not only do you get the full spectrum of illnesses and injuries, you are also responsible for EVERYTHING, especially if you are on the night shift. I have done everything from delivering a baby then flying out a STEMI in less than an hour to caring for a hospice patient, gun shot wounds, MVCs, all sorts of chronic and acute illnesses to shoveling snow and standing between a hostile drug seeker and an ER doc. I do my own IV's, respiratory treatments, mix meds in the pharmacy, coordinate transfers for not just physically compromised, but psychiatric patients as well. My work girls are my family and hugs, shoulder rubs, and laughing and crying together are all a part of it. Critical access nursing will really hone your skills and give you skills you never though you would need.

Go go for it! Critical access is where it's at if you ask me :-)

heinz57 · Jun 13, 2016

It is going to depend on the size and location of the CAH, the local EMS protocols and what types of patients the hospital keeps. Some CAHs do not have OB. Some barely have an ICU which usually just means closer observation rather than critical care. Some may only have limited surgical services. Some CAHs may only have 1 - 6 patients on the med-surg floor and must take swing bed or convalescent patients to pay the bills. Some EMS agencies call the helicopter from scene to transport trauma and STEMIs to the city so you may not get the exciting stuff in the ER.

As a new grad, being exposed to a lot of high acuity patients and many different doctors will give you broader knowledge. CAHs will not have specialists such as Cardiologists, Pulmonologists, Ortho surgeons or intensivists. But, if you don't know what you don't know, you might not notice what you are missing.