Thursday, April 12, 2007

Open Forum - Questions from At Your Cervix

I will be tackling the questions posed to me separately in each post. Continue to post your questions for me in the comments of the original Open Forum post.

My first questions come from a Labour and Delivery Nurse @ At Your Cervix. She is curious about my feelings on Rural Nursing.

What do you love about small rural hospital nursing? What bugs the heck out of you about rural hospital nursing?

I happen to work in a very active rural hospital where we do acute care nursing. The services we offer here include Medicine, Surgery, Labour & Delivery, Post Partum, and Rehabilitation. We have our share of psych patients as well. There are 16 Acute care beds, 10 beds designated for Alternate Level of Care/Rehab and 1 observation bed for more critical patients such as Cardiacs. We also have a 24hour ER and an Outpatient clinic during the day. We mostly work 12 hour shifts and we are staffed as such..... on day shift, 2 RN's, 2 LPN's and 2 PCA's (only until noon). On night shift, 2 RN's, 2 LPN's (until 11pm, then one goes home) and 1 PCA until 11pm. So, as you can see, most of the time we are fairly busy. I work mostly night shifts, but we do bounce back and forth from days to nights.

I would have to say the thing I like most about working in the rural hospital is the sense of community. There is a camaraderie among the staff that is not typical. I think it may have something to do with being "in the trenches" together so much of the time. In our hospital in particular, there is no real division between the RN's, LPN's, PCA's, housekeeping, dietary, etc. We all work together, sit together at meal breaks, socialize together at functions. As a for instance, right now it is about 4:45am. in about 40 minutes the first kitchen staff member will be coming in to work. There is one of these girls that always takes note of whose cars are in the parking lot, then proceeds to make coffee and bring down a cup for each of us who drinks coffee. She even has memorized that I take only cream in my coffee, no sugar, because I am sweet enough. On busy days when we are run off our feet and don't make it down to the cafeteria for a meal break, the cook will often notice that we haven't come, and she will fix up a cart full of food and bring it down for us to grab as we run.....FREE OF CHARGE to us. Those are things that just do not happen in most larger centers.

A lot of the patients are people we know from the community as well. They aren't just patients to us. They are neighbours, friends, family.... You don't tend to reduce them to their condition, they are real people and they matter. And if you, as one of the co-workers, have the misfortune of being a patient, you are treated with the best of Tender Loving Care that can be found.

What I don't like about working in a small rural hospital is that there is always the uncertainty. On any given day, you have no clue what may come through the ER. Or if it will be someone you know, love, dislike...whatever....and whomever it is, they are looking to you to take care of them the absolute best way you can. We do not have residents that stay in the hospital 24/7. When something comes in to our hospital, we have to assess the patient, call the doctor on call, often waking them from a deep sleep, and try to convey our findings to them so they can make a decision about care. For the most part, our doctors here are good, and come to see all patients who come for care, whatever time of the day or night. As nurses, we also show the doctors courtesy and respect and if we feel there isn't urgency, we will "sit on" a patient until morning and not wake the doctor. I don't like always being the front line person. I don't like having a woman in labour come in pushing and having to catch a baby with no doctor in the room. I don't like having a patient take a turn for the worse and code on me without any code team to call and back me up. I don't like having to be a Jack of All Trades and expected to be Master of All Trades too. It would be so much easier to just have a specialty and stick to one thing. It is nothing for us to have a woman in labour and a cardiac walk in, and one or possibly two palliative patients circling bowl, so to speak. It is stressful, and we are terribly understaffed. We rely on our part time people to pick up the slack for vacation and sick coverage, because we don't have enough casual staff members. It is a constant struggle to walk the line between enough work, too much work, not enough time off, and family time. As a single mom, I am stretched even thinner.

For the most part, rural nursing is rewarding, but along with those rewards comes stress and frustration. I have worked in larger centers on specialized units....I know there is stress and frustration there too.....I think nursing as a whole in this country, Canada, and in the US as well, if fraught with major frustration.

My question for At Your Cervix is now......
What do you see as the major difference between what I do and what you do and do you feel that one is better than the other?? Why?? And do you have any ideas on how to ease the frustrations?? There are three questions, you can sue me back!!

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