Rural Nursing vs. Urban NursingMar 7, 2014
A nurse’s job can vary greatly depending on the size of the hospital where they work. Chief Nursing Officer at Teton Valley Hospital, Angela Booker, has worked at large and small hospitals. She talks about the job and lifestyle differences between the two. She also shares why she’s excited about the recent formal agreement with University of Utah Health Care and how it will help her patients in Driggs, Idaho.
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Interviewer: The job description, if you are a nurse, can vary quite a bit depending on the size of the community that you are in. We are with Angela Booker, Chief Nursing Officer at Teton Valley Hospital, who has had some experience not only in the larger hospital, but also here at Teton Valley. And the first thing I want to talk about a little bit is, what is the difference? Because the nurse is not a nurse. She is not a nurse, necessarily.
Angela Booker: The biggest difference in working at a rural hospital compared to a larger hospital, like the University of Utah. It is that, we are considered generalists. So, we might take care of an emergency room patient, a patient having a heart attack or who has been in a car crash compared to a pediatric patient who is in for pneumonia. And then, take care of the patient reaching the end of his or her life and take care of the post-op patients, all in a single shift.
Interviewer: And very different training or it's the same training? I mean how does that work exactly?
Angela Booker: Same training. In a larger facility, the units are separated. You might have an oncology floor, an emergency department, a labor and delivery department. Whereas in a small hospital, there is one patient care area and one group of nurses to take care of those patients.
Interviewer: How do you manage all that knowledge? It sounds very difficult to me.
Angela Booker: Well, we don't have that specialty knowledge. So, I wouldn't be well versed in taking care of a patient with a particular type of cancer.
Interviewer: Yeah. So how would take care of that patient then here?
Angela Booker: Really, the patients are transferred out to a larger hospital, if they need that specialty care.
Interviewer: At the University of Utah, we have a nurse exchange program where rural or smaller hospital nurses will come to University of Utah and they'll learn from some of the specialties. And then vice-versa, we'll send some of our nurses to the smaller hospitals. As somebody who's been in both, what would you hope to take and learn in that exchange program? Which I understand you are going to participate in.
Angela Booker: Yeah. Well, we would expect to learn from that is, how to manage specific illness very well. How to handle larger volume of patients. Our patients volume being rural, is fairly low. Whereas, in a larger facility, you are busy most of the time. So, that would be one skill we'd pickup is how to multitask a little better with a wide variety of patients in a single shift.
Interviewer: What are some of the challenges here, at the Teton Valley Hospital, for nurses that you might want to learn more information about?
Angela Booker: A trauma. For a nurse coming to work in our facility that doesn't have emergency department experience, they might not see one or two traumas in their entire orientation period that might last 90 days. So, if we were to go to the U, where you are receiving facility for traumas, then we'd anticipate really getting a lot of experience in a short period of time.
Interviewer: Yeah, sure, and see some traumas. Trauma is an issue here, I take it with the beautiful outdoors.
Angela Booker: There are lots of outdoor activities. Skiing, snow machining, walking down the sidewalk where it's icy.
Interviewer: Yeah, sure. That could be dangerous. What do you think that your nursing staff here could bring to the nurses of the University of Utah? What do you feel your strengths are?
Angela Booker: Our strengths are taking care of different patients. We might have, in one room, someone who is struggling with pneumonia, perhaps is nearing the end of her life. And in the next room, we might have a patient, an 18 month old baby with R.S.V. Well, in a larger facility, one nurse would never take care of a geriatric and a pediatric patient because they are just not intermingled.
Interviewer: Since you've been in both sizes, do you find that smaller hospital nurses tend to be more patient centric?
Angela Booker: Well, we can't be because I don't have the volume of patients to take care.
Interviewer: More of personal relationship with the patient. You can take care of their mental needs as well, I suppose.
Angela Booker: Well, I probably know them. I shopped beside them in the grocery store, the single grocery store in town. So, I see them all over town. I can remember how they looked when I saw them the last time, compared to how they look today. I can remember what their allergies are because I've taken care of them, maybe four or five times in the last year. I can know what their medical history is when they come in unconscious on the ambulance because I recognize them by sight.
Interviewer: Tell me, what's the most exciting thing for you in this relationship?
Angela Booker: What we can learn. The services that you have, that we can refer our patients to, that that referral relationship will be in place and cemented and it won't be a blind call to the transfer center, which works well right now. But, that we'll be one of your affiliates.
Interviewer: In some of those specific services that we offer, what excites you? Tell, I hear a lot about telestroke.
Angela Booker: Telestroke very much excites me. Hemorrhagic patients with a hemorrhagic stroke go to the U already, because you are our closest experts. The teleburn is the next program. Alison [SP] psychiatry is very much in need in eastern Idaho, so those three, in particular, I am excited to get off the ground.
Interviewer: Tell me, specifically, how is this going to affect the level of patient care in Driggs?
Angela Booker: It'll improve an already good situation, and those services will be immediately available via the teleservices.
Recording: We are your daily dose of science, conversation and medicines. This is The Scope, University of Utah Health Sciences Radio.