Editor's
Note
Badge
of honor
Rural
nurses take on roles beyond the scope of practice in their
communities
Carol Bradley, MSN,
RN, California Editor
April
9, 2001
There
has never been a doubt in my mind that rural nursing is
a unique specialty within the practice of nursing. Despite
the stereotypes, it is probably one of the most challenging
practice settings for nurses today.
My first
taste of nursing was a nurses aide course offered by my
hometown hospital in rural Nebraska. It was a 14-bed hospital
in a structure that originally had been designed as a private
home. Not too long after I had learned how to take blood
pressure and pass meal trays, a new hospital was constructed,
which was considered significant progress for a town of
1,500 people.
Even
as young as I was at the time, I was impressed with how
symbolic the hospital’s presence seemed to be for the community.
For a small town, maintaining a local hospital was a sign
of survival. Closing it was one big step toward gradual
decline.
As I
moved on to college and experienced much larger and more
complex health care settings, I remained impressed with
the role of that small hospital within my hometown. In fact,
my best friend from high school, also a nurse, returned
home after college to work there, where she eventually served
as the director of nursing.
In a
strange way, her career and mine seemed similar, yet so
dramatically different.
As a
senior nursing student, I once again was exposed to rural
health when I took a community health elective in another
small Nebraska town. I was amazed at the span of knowledge
and expertise of the nurses who worked in this setting.
They
were as adept at managing to rule out myocardial infarction,
delivering a baby and scrubbing for surgery, as they were
dealing with public health concerns within their community.
I was impressed that all the nurses within the community
knew each other and did not hesitate to tap each other’s
unique knowledge and skill. They were known throughout the
community as nurses, as essential resources, often volunteering
for health-related community activities.
The
nature of our rural health care delivery system is based
on the essential value of "community," often supported
by a spirit of volunteerism. Almost all ancillary health
care services—from the local ambulance/emergency services
to blood drives—are provided by volunteer members of the
community.
Those
who work within the official health care system most likely
grew up in the community and know both the patients as well
as the children of the patients. Being sick in a small town
is almost a community event, what with the community resources
that can be brought to bear for the benefit of the patient
or loved ones, and the requisite remarks in church on Sunday
or in the hometown newspaper.
Despite
the common portrayal of California as one massive metropolitan
area stretching from San Diego to Fort Bragg, we have quite
a lot of rural health care in our state. As in the community
in which I was raised, nurses within California’s rural
health care environment play a role that is unique within
the community, far beyond the normal boundaries of their
actual rural nursing practice. They are known as nurses
across the community.
While
it is possible for big-city nurses to maintain their professional
anonymity in their community, rural nurses wear their profession
on their sleeves. Perhaps without the benefit of all the
needed resources or latest technology, rural nurses are
shaping one of the most complex and demanding areas of practice
for nursing today.
