Rural or Community Hospital Role Transition - Essay Example

? Rural/Community Hospital Role Transition Unit: Lecturer: Introduction The following paper is a representation of my experience at the CentraCare hospital located in Sauk Center Minnesota. I was working there, and assigned to different RNs. Sauk center which is alevel 4 trauma center, handles patients with different needs and injuries. During my work period I had been allocated a couple of objectives and goals to achieve. My overall experience was positive, educational, rewarding, and appreciated. The staff were friendly; willing to teach and share their work experiences of the day to day work. This made it easier for me to understand and be incorporated into the system faster. As a result I was able to achieve my goals and make a clear report on what transpires in the hospital. Goals Set The goals set for my clinical experience while in the rural setting hospital in Sauk Centre were met. My first goal was to learn what the nurse to patient assignment ratio was, compared to other facilities and where I work. I was told that the nurse to patient ratio was 1:3 or occasionally 1:4 depending on the acuity of the patient needs. The first day of clinical the RN I was working with was assigned two patients. A comfort care patient that had just suffered from a stroke and a patient receiving GI prep for a colonoscopy scheduled for the following day. There was an elderly lady that was brought to the ER by ambulance due to a recent fall with symptoms of headache, increased weakness and left leg pain. Her head CT was positive for a subarachnoid hemorrhage. She was then transferred to St. Cloud Hospital by the very same ambulance and EMT’s that had brought her to the hospital. The second day of clinical experience I worked with an RN that had four surgical patients that had various types of surgeries. They were all scheduled for different times and were discharged at all different times throughout the day. The RN was responsible for preoperative admission or check in, medications and health history, preoperative and postoperative education and vital signs, as well as discharging of education. The patient needed to be able to eat without nausea and vomiting, was able to void, and able to ambulate before discharge. My second goal was to understand what staff positions were held, who, and how many staff made up the medical and nursing team to accommodate a well ran, highly functioning facility that was valued by its community. How did they function as a team with such a diversity of patient treatment? I learned that there are five family practice physicians and two physician assistants that see patients in the clinic, inpatient hospital, and in the ER. There were several RN’s which were mostly ADN’s with only three being BSN’s of the staff’s members. There are two LPN’s that remain on staff because they were grandfathered in at the time the hospital decided to have patient care provided by a RN’s. The hospital didn’t hire new LPN’s at that time of the year. Through my research is noted that LPN’s are assigned their own patients who they are responsible for, same as the RN would be for her patients. The LPN can give most medications except for blood products, IV push medications, and IV narcotics. The RN on the other hand would give the LPN the needed medicine so that it can be administered to the patients. Per shift on the days of my clinicalduties, there was a Patient Care Assistant (PCA) that assisted with bathing and toileting patients, documenting activity such as intake/output, and assisted with meals. Notably the PCAs could take vital signs from the patients and give a minute to minute analysis of the patients progress. But on the contrary the RNs preferred staying on their feet and monitoring every activity concerning their assigned patient. Clearly the RNs were committed, they gave an account of the patients that came in for outpatient treatments and surgeries, inpatient and emergency patients treated in the Emergency Room (ER) who were discharged after being assessed and treated, admitted for treatment or observation, or transferred to another hospital after stabilization that required an increased level of care. I noted that in an event where the RN is busy and engaged, the PCA would be left in charge. My third goal was to gain an understanding of the work atmosphere, attitude, and culture of the smaller rural hospital in comparison to a larger community hospital.Sauk Centre hospital was very laid back and relaxed with a casual setting. In my average work night working with a RN, LPN, PCA team we may have five to ten patients depending on the acuity of the patient needs. Sometimes I would take time to visit patients to find out how their day was, listen to them talk about family or their concerns, discuss what they like to do when they are not in the hospital, and provide them with the extra cares niceties that nurse take pride in doing, with their patients. This may have been the day that had not been a true example of the norm. My fourth goal was to learn what the process or protocol for how IV medications such as; IV fluids that include electrolytes, IV piggyback electrolytes and antibiotics are mixed and whose responsibility is it. I wanted to know if there was an in-house pharmacist and what is their role. There is a fulltime pharmacist on staff that works throughout the day. He does mix the mentioned medications, but many times need to be mixed by the staff as needed due to shelf life of certain medications. All my goals were met and I was able to complete my clinical experience gaining so much understanding and respect for the differences and similarities in the practices in nursing in a rural setting vs. the community that I know. Nurses in the rural settings usually have numerous problems that are not faced by the nurses in the urban setup. This challenges affect the nurse’s profession and the delivery of services to the patients. According to McCoy. C (2009) an urban area is an area that has a population density of 1000 individuals per square mile. One of the contrast between the rural and urban nurses is the level of education that each nurse has. Evidently nurses in the urban area are more knowledgeable due to the fact that they get to use high quality gadgets that institutions in the rural can’t get access to. Obviously repetition of the same thing over and over again becomes a habit and in this case one acquires the skills but the case doesn’t apply to the nurses located in rural areas. Therefore we can notice that nurses in urban areas are greatly involved in the hospitals than those in the rural areas since they are more skilled. Notably the nurses in the rural setup are more involved with their patients hence they get to be personally involved with each patient which is not the case in the urban areas due to the numerous number of patients. Nurses, physicians, pharmacist, and other health care disciplines treated each other with mutual respect and had positive relationships. I understand that nursing in general must inspire a strong sense of advocacy and support on behalf of nursing to provide high quality of care for their patients in either hospital setting. In my time at Sauk Centre I came across an LPN who had been a nurse for 30 plus years. She was impressively knowledgeable and caring. She often provided assistance with cares to patients that were not assigned to her as needed. She demonstrated great time management skills and had a calm and cool demeanor about her. This was noted to be positive example of a confident seasoned nurse. This are among some of the qualities that a nurse and other medical officers should have to ensure harmony and synchronization of undertakings. Rural nursing is a term that is used to point out nurses who work in a rural setting according to Idaho state University. Nursing models on the other hand means the process of reinventing nursing to suit the changes in the society. This models mainly change patient change delivery, one notable model is the nursing case management model that is used in the community health setting, similarly a third form of the case management model can be used in the rural setting which ensures disease management. The rural hospital requires more certifications because of their large scope of practice than does a RN working in specified units in a community hospital. I have not found material that proves this, but this is what I was told by a RN that works in rural hospital in Sauk Centre that had previously worked at St. Cloud hospital. There are five emergency trauma levels. The first level is the best level in the five levels since it is capable of providing solutions to every case of injury, Furthermore it is well equipped for the prevention and rehabilitation of trauma cases and operates on a 24 hour basis. The second level is a level which provides specialized care for all patients, and like the first level center it also operates on a 24 hour basis. The third level assesses the level of injury, and in case the case is serious a surgery is performed and the patient is stabilized. The fourth level assesses the level of injury, provides a life support and in case they can’t handle the injury the patient is transported to a higher level hospital. In the fifth level also acts as a life support level and provides basic service, where the patient is assessed, stabilized and transported to a higher level hospital. The critical access hospital provides an incentive to local based hospitals to acquire anesthesia at a subsidized cost to enable the rural hospitals have access to them. References McCoy. C (2009), Professional Development In Rural Nursing;Challenges And Opportunities. The Journal of Continuing Education In Nursing 40(3), 128-131 Nursing Link, Overview of Nursing Practice Models, nursinglink.monster.com/training/articles/967-overview-of-nursing-practice-models, Accessed on 26/03/2013 The Jama Network (2013), Opioid Dose and Risk of Road Trauma In Canada: A population Based Study,archinte.jamanetwork.com/article.aspx?articleid=1556791, vol 173, Athens National Institute of Health, Health and Human Services Freedom of information Act, pumed.gov, 2010, Rockville Pike Bethesda ,Maryland Accessed on 26/03/2013 Department of health and human services, Critical Access hospital: Rural Health fact sheet series, 2011. Read More