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Andrew J. Johnson, APRN, CRNA, grew up in a rural area and always knew that it was the exact type of setting where he wanted to work. As the sole anesthesia provider for a critical access hospital in Olivia, Minnesota, Johnson loves what he does. But he does face quite a lot of challenges.
He took some time to tell us about his work. What follows is an edited version of our interview.
What kind of work do you do?
I am the sole anesthesia provider for our critical access hospital. I opened a pain clinic at our facility because access to care for those suffering with chronic pain was lacking. Fortunately, I was able to find an incredible mentor, Keith Barnhill, to teach me chronic pain management. I was then accepted into the post master’s advanced pain certificate program through Hamline University. The pain clinic has definitely benefitted our community.
I also provide anesthesia for obstetrics, emergency room, and surgical cases including general, podiatry, gynecological, ENT, orthopedics, and urology. In 2017, we became the first critical access hospital in Minnesota to get a Da Vinci surgical robot. This has definitely increased the number and complexity of general surgical cases we are able to do at our facility. We have been performing total hip and knee replacements the last 2 years, which was a much-needed service in our community.
Working in a rural area is quite different from what most nurses do. Have you worked in a more urban or suburban area before this? If so, how does working in a rural area differ from those places? If the facility you work in large or small?
Rural anesthesia is much different from that in urban and suburban facilities. Although the anesthesia doesn’t change, the number of resources available to trouble shoot and help in difficult situations is severely limited. I have always found that the toughest decision I make is what cases I shouldn’t perform at my facility.
What kinds of patients do you tend to see? How are they different from those you saw in a more urban setting?
I feel like the patients and staff have closer relationships in small communities. We all know each other, and many times are related to each other. I hear weekly from patients that they feel so comfortable knowing I will be doing their anesthesia because of our relationships in the community.
What have you learned from working as a nurse in a rural area?
There are many individuals and organizations that want to limit scope of practice for advanced practice nurses, especially nurse anesthetists, and thereby limit access to care for rural comminutes. It is easy to get busy with work and family and lose track of the politics of anesthesia, but it is vitally important to stay vigilant about what is going on in the medical and political arena.
Because it’s a rural setting, do you tend to know more of the patients or their families, as in a small-town? Do you get a lot of patients who have to travel a long way to get to you? How many miles might some patients travel? Are people ever helicoptered in? Brought by ambulance? How far?
I know most of the patients that I see for anesthesia and pain injections. In a town with a population of about 2,500, it is no surprise to run into people I have seen in the community. Most patients do not need to travel more than 45 miles to see us. There are about six hospitals in a 45-mile radius of Olivia. Some of these facilities provide a higher level of care, so we are able to transport to these facilities if we are unable to provide the level of care needed. For bad traumas, often the flight crews will land at the scene of the accident and evacuate the patient from the scene instead of delaying high-level care by coming through our emergency room. Certainly, there are times when these patients need to come to our emergency room for stabilization prior to transport.
What are the biggest challenges of working in a rural setting?
Call is always tough in rural settings. If can be tough to achieve a work/life balance because of the need to be available and within call range of the hospital. Because of this, my family has several hobbies that we can do together on our acreage including gardening, yard work, blacksmithing, exercising, hunting, and sports.
What are the greatest rewards?
It’s fun to be recognized in the community by patients that have been through the surgery department or pain clinic. They are appreciative of being able to be cared for in their hometown where they have friends and family to help with their recovery. I feel that community recognition makes it easier for my family to accept me not being home. My wife and kids can become frustrated with me getting called to work, but when they find out later I was helping one of their friends, they understand the importance of my job and are happy that I do what I do.
What would you say to someone considering moving to work in a rural area? What do they need to be willing to do or deal with?
Deciding to work in a rural facility is not a decision that can be made lightly. It is not just a job, but a lifestyle. My family has to take two vehicles to the movies, dinner, church, etc. Calling in sick to work is not an option. There is no additional help when emergencies arise.
Personally, I think there is no better place to raise a family that in a rural community, but I may be a little biased. To work in the setting, confidence is an absolute requirement. Someone will always try to challenge your decisions. As long as you can always make decisions with the patient’s best interest in mind, you will have the respect of your medical staff, and this will make for a satisfying career.
Also, you can’t decide not to see particular patients because there are no other options. As an example, I had to do the anesthesia for my wife’s caesarian section. I had someone hired to do her case, but her water broke a week before her schedule C-section. Another example of an interesting rural experience is when the locum I had hired to do my colonoscopy got the schedule confused and didn’t show up for the day. I had to do anesthesia for 6 procedures and was finally able to get someone to do my anesthesia in the afternoon.
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