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Barbara Hope, RN, thought there might be greener pastures
in the bluegrass of Kentucky. But as far as nursing
goes, what she found in taking a big step from Louisville
hospitals to the smallest of community facilities is
that it is different, not necessarily better.
With less than a year at Casey County Hospital in Liberty,
Ky., population 2,500, Hope is reserving judgment.
“I felt like I needed some peace and quiet. So
I moved to a small town,” Greensburg, population
2,000. From there, she commutes an hour through deer-rich
country to work the 7 a.m. to 7 p.m. shift at Casey
County, about 65 miles from Lexington. “It’s
easier in a small town,” she said, “to come
right into a day shift,” which was attractive
after six years of night shifts in the city.
“I work in a 15-bed hospital. Two doctors, one
floor, one emergency room and that’s it. We have
X-ray. We have a lab,” she said. Contrast that
with her first seven years of nursing at two metro Louisville
hospitals—three years in transplants and the last
four in intensive care and cardiac care units.
On the positive side, Hope, 34, said she can always
reach one of her hospital’s two physicians. “You
just call them at home or on their cell phones,”
she said. “And they know who you are. You don’t
get a resident who’s on call for them who doesn’t
know what’s going on with their patients. So that’s
a good thing.”
Familiarity with patients extends to nursing staff
and the patients themselves, too. “We’re
in the middle of Kentucky,” Hope said, and then
added, half-kidding, “They’re all related.
Everybody in this town knows everybody. All the patients
know each other.”
It’s not uncommon to have five patients, at least
two of whom have the same last names, she said. “It
just makes it interesting. It’s not a good or
bad thing, just interesting.”
At such a limited facility—which is classified
as a critical access hospital, meaning that the federal
government allows it some leeway in operating to preserve
care in a medically underserved area—cases run
the gamut from children with broken bones to elderly
patients with do-not-resuscitate orders and med/surg
patients admitted for transfer to larger facilities,
Hope said.
But if one thing stands out, it’s respiratory
problems. First, “about half of Kentucky smokes,”
she said. There are cases of pneumonia and chronic obstructive
pulmonary disorder in a largely elderly population,
and allergies for everyone. “There are funguses
that aren’t anywhere else in the world in people’s
lungs in Kentucky,” and histoplasmosis is not
unknown up and down the Ohio Valley, Hope said.
Her change of scenery also came with staffing issues,
wider responsibilities and accepting less pay, at least
psychologically.
“I do a lot of patient care and I don’t
always have enough people to have an aide,” Hope
said. With five or more patients, she said, she may
work with an LPN, a certified nurses aide and sometimes
a ward clerk. On the other hand, “If there’s
only three [patients], I might be the only one there,”
she said.
Of course, as in any hospital, “You can have
five people who are no trouble at all or three people
you can’t keep up with,” Hope said. “Even
if it’s a teeny, tiny place, you still have stress.
People don’t understand that you’re only
one person and you have only two hands and can be in
only one place at a time.
“When the pharmacist leaves at 2 o’clock
in the afternoon, I’m the pharmacist. I’m
the only one with keys to the drugs,” she said.
“I do everything: Answer a lot of phones. Talk
to a lot of families.”
Surprisingly, Hope said, “When I worked at bigger
hospitals, their nursing really focused on how to retain
employees.” That’s not been her experience
in rural Kentucky. “I had no orientation whatsoever,”
Hope said, not to mention a lower pay scale and poorer
benefits.
She said she took a pay cut of about $10,000 a year—more
than $5 an hour—to buy into the rural lifestyle.
“But the cost of living is less, too. Things are
cheaper, so it evens out,” Hope said.
For nurses who might be considering “dropping
out” into a rural setting, Hope said her best
advice is to stop and think about it. It’s difficult
to predict whether such a move would be right or wrong
for a career. The one certainty is that it will be different,
she said.
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