Skip to main content

Voices from the Frontlines: A New Graduate Nurse in Rural America

Melanie* is a former student who took a job in a rural hospital, deciding she would rather have a job sooner than later so her career could begin moving forward after graduation.  In a recent letter, she reflected on her first year's experiences.


"The hospital has its pluses and minuses - I always, quite often, remember what you said to me about how accepting this job would be wise in my long-term plan, because it would give me an understanding of how different systems work in different areas. It really has done so. It has been an eye-opening journey into the difficulties rural health systems face.

Rural hospitals have unique challenges that come from both their revenue sources and the locally available talent pool.  They can be great places to get experience with a wide range of patients.

     "The good: The step down unit is 24 beds, with a ratio of 4:1. Because of the hospital's small size and inability to specialize, it's a kitchen sink as to what we get, which skills and experience-wise has been undeniably great. Lots of cardio stuff, most people on tele, CABG, PCI,  pacemakers etc - those are the best patients. Tons of fresh strokes, lots of run-of-the-mill but more end-stage COPD, CHF. Surgically we get everything that the other floors won't take: fem-pops, abdominal surgeries, could be anything. Lots of end-of-life palliative/comfort care, too." 

There are also challenges, but like urban hospitals, most of the time they come down to the quality of management.

       "The bad: Staffing is terrible. There are many nights when the floor has no aide, or only 1 aide.We are supposed to always have 2, which can be insufficient at times even.  I try to always help out the ones we are lucky enough to get when they're around because they are overworked, but sometimes, as you know, you just can't do everything. It's frustrating and burnout-inducing when you are trying to tend to your patient whose vitals are changing and they're having an acute change in condition, and have to simultaneously take vitals and toilet your other patients. It's just physically impossible most of the time. When you get 4 total-care, incontinent, confused, very sick patients, it's just impossible. I try not to be a baby and just take a deep breath and do my best, but there are some mornings where I get home and just bawl because it's just too much. Other RNs do our absolute best to help each other out, but everyone's patients are sick and needy. The hospital has ridiculous RN turnover because of this." 

Melanie has been in her job less than a year and she recognizes signs of burnout in herself.  Turnover is really your best indicator of how well a hospital manages its nurses.  Management practices can affect the hospital in other ways.

       "We just lost Magnet status and I (professionally, politely) told my nurse manager at a staff meeting that this is not shocking and I saw it coming from a mile away. Our nurses don't have the support they need to do their job, leave in droves every year, feel burnt out and underpaid, among other things. No one on staff was surprised that we lost this designation. The hospital insists it's working on beefing up ancillary staff, especially on nights, but it has yet to happen. Part of it is because pay is crappy - we make shy of 25/hr with night differential. Larger cities about an hour or two away from here all pay well over 30/hr. Many nurses who have kids and families and are more settled in the area end up at these hospitals." 

Melanie's annual salary works out to just over US$50,000 per year while nurses a short distance away are making around $60K.  Yes, you can say that cost of living differences would make things cheaper in a rural area, but gas prices are slowly eliminating cost of living differences in the part of the country where she works.  Unfortunately, Melanie knows she won't stay at the rural hospital, just 9 months into her job.

      "I'm incredibly grateful to have gotten this job and be obtaining the kind of versatile, varied experience I'm getting. I recognize that the facility does the best it can with what it's got sometimes. However, I feel on the whole it's got a lot of improving and waking up to do. I look forward to maybe transferring to a bigger, more urban hospital with hopefully better staffing patterns, and a little more organizational appreciation for the work nurses do. Not sure where I will go next."

Melanie's situation could just as easily have occurred in an urban setting.  No matter where you go, nurse turnover is costly and drives up the price of patient care.  A nurse has to work at a hospital for two years for the hospital to recoup the recruitment and orientation costs from the initial hire. Not all new graduates leave in their first year and many do so for other reasons than management, , as a study by Brewer et al (2012) demonstrated.

Perhaps one thing the any healthcare system can do is work on their management techniques to promote retention and reduce turnover.  That alone could generate millions in cost savings.

*Names and locations have been changed.

Comments

Popular posts from this blog

There Are Other Masters Degrees Besides a Nurse Practitioner - Part I

It strikes me that many students and nurses do not seem to know about the "other" masters degree options for nurses.  Everyone seems to want to be a nurse practitioner these days.  Now, that's great news for the primary care provider shortage, but we need nurses with masters degrees who can work in other positions and have other skill sets.
Let's review the other masters degrees in nursing.  Nearest and dearest to my own heart is Nursing Education.  Remember that really cool clinical instructor you had in your entry-level nursing program --that could be you!  Do you like precepting new hires?  Are you the person on your unit who unofficially keeps everyone up-to-date on the latest evidence?  Do you really enjoy patient teaching, whether in the hospital or community setting?  Do you just like to teach?  Nursing education is the right masters for you.  Skills learned in a nursing education masters cannot be learned on the job.  Curriculum writing and program developmen…

Why You Will Get a "Bad" Grade in Nursing School & Why It Will be the Best Thing to Happen to You

Perhaps you have been a straight A student all your life.

Perhaps you had one subject you struggled with, got Bs in it, but mostly As in the rest of your classes.

Then you started nursing school.

Most students quickly discover that nursing is one of the hardest majors at any university. Not only do you have a lot of time in class, your "lab" equivalent involves learning how to care for really sick people. Most nursing students spend between 24 to 30 hours per week in class --and THEN have lots of reading and other assignments they need to do to prepare for their "labs." After all, in a chemistry lab you probably won't harm or kill anyone due to the highly controlled conditions. When any health profession student is learning, there is always the risk for mistakes and it's why they are so closely supervised.

Inevitably, every nursing student gets their definition of a "bad" grade. For some, this is an actual failure of a class and that can happen fo…

Language Barriers and Your Patients - Let the Evidence Guide Your Decisions so You Can Comply with the Law

In almost every health care setting in the United States (US) these days, nurses and other health care providers are dealing with language barriers as part of care delivery more than ever before. In fact, most countries in the world run into some kind of language barrier issue in the health care setting. Global migration means more tourists and immigrants for every country in the world. 
In the US, language access--meaning the availability of interpreters and their services-- is a civil right. The Affordable Care Act (ACA) also added new provisions for health care services providers around language access that are important for you to know. From CME Learning:
New rules on language access were implemented on July 18, 2016. These changes are sweeping in scope as they apply to “every [federal] health program or activity, any part of which receives Federal financial assistance.” Section 1557 is a “non-discrimination” provision that broadly prohibits discrimination in health care or health c…

Translate