Assignments in these settings not only can offer a different perspective, but also can open up a plethora of professional opportunities.

(Photo: Getty Images/Digital Vision/Stewart Cohen)

"Inpatient operating rooms still make up the largest demand for nurses, but in the past few years, we have seen significant job growth created in ambulatory surgical settings," comments Betty Wageman, senior vice president of account management for San Diego, California-based AMN Healthcare. "This is good news because as healthcare systems look to function more efficiently while maintaining quality care, they will increase their network of multi- and single-specialty outpatient surgery centers. This, in turn, will create more need for perioperative professionals in both environments."

The question is, do practice styles and responsibilities differ for those mobile clinicians assigned to the ORs in any of the nation's 1,997 rural community hospitals? Also, what are the pros and cons to accepting a contract in these smaller ORs?

Read on to find out how two travelers, who were used to practicing in urban facilities, adjusted to the country life. Then check out what the future looks like for these unique opportunities.

Seeking something new

In 4½ years as a mobile clinician, Ron Chatelain, CST, has traveled to some picturesque destinations, such as Napa Valley, California; Denver, Colorado; and Albuquerque, New Mexico. He has also witnessed cutting-edge techniques in action with contracts at Massachusetts General Hospital and Brigham and Women's Hospital, both in Boston, Massachusetts. "I chose those assignments because I was excited at the chance to work alongside doctors who trained at prestigious institutions like Harvard Medical School," says the traveler who is registered exclusively with Curastat Healthcare Group, a staffing agency located in Phoenix, Arizona. "Every assignment so far has been wonderful, but for my current contract, I wanted something entirely different. I chose to go to an area I had never visited before so I could experience a change."

Indeed, Ron's latest assignment—at 40-bed Banner Churchill Community Hospital in Fallon, Nevada—is the most rural contract (and smallest facility) he's chosen to date. "There is an excitement that comes with starting somewhere completely new."

Ron began his career as a surgical technologist more than 20 years ago, at the suggestion of his then-wife. "She was attending nursing school and told me being a tech entailed handling instruments and tools, which intrigued me," he explains. "What I really learned to value about my job is that I am part of a team that can make a difference in patients' lives," Ron points out. "Plus, when technologists do their jobs well, they help surgeons become more efficient."

When it comes time to choose a contract, this technologist prefers those assignments that push him to elevate his skill set. "As a traveler, I believe you should be able to scrub in for anything," Ron asserts. "Fibula flaps or aneurysm clippings? I can do those. I also have experience in orthopedics, neuro, gynecological and obstetrics, and plastics procedures."

As it turns out, that wide berth of knowledge prepared Ron well for his current assignment in a town with a population of 8,473. "I assisted in a Caesarean section recently, which was new for me. In other facilities, those patients are diverted to obstetrics-dedicated rooms. But here, they do not have the space to designate ORs like that."

Possessing a broad repertoire is also important when considering rural contracts because you likely will need to compensate for the overall smaller staff size at most facilities. "If someone calls in sick here, there are fewer people to function as a backup," he states. Case in point was Ron's first day in Fallon. He recalls, "The hospital had just lost one of its staff CSTs, and I was asked if I could jump in on an orthopedic case. My response was to immediately scrub in. The circumstances helped the team develop a confidence in me from the very beginning and accept me more quickly."

In addition, you will likely work with a greater number of mobile colleagues in rural areas than you may in urban settings. Notes Ron, "The other tech here is a traveler, as is the new circulating nurse. We've all come together and worked as a team very well. It is a nice environment and everyone here is great."

Of course, while developing a rapport with your peers is always a necessary step in establishing yourself in a new assignment, the task takes on a unique perspective in a rural town. "In a small community, there is a great likelihood that the patient is a friend, neighbor, or family member of one of your colleagues, which makes everything a bit more personal," Ron explains. "Also, they expect their community hospital to be just as good as those in big cities, and there is no reason it should not be."

A welcomed change of pace

For 17 years, Claire Boulanger, RN, enjoyed practicing in the OR of a teaching hospital in Texas. "There came a time, however, that I felt like I was stuck in a rut. I was doing the same thing over and over again with no variety in my days." That is when Claire remembered the words of advice from her father. She explains, "My dad was a surgeon, and he said that nursing had so many career options, like traveling."

So 12 months ago, Claire signed up with West Chester, Ohio-based Advantage RN and began accepting contracts. First, she headed to Providence, Rhode Island. Afterward she moved on to New Bern, North Carolina, the second oldest city in the state, where she just wrapped up a 3-month assignment. The county seat, with a population of 28,170, supports the 313-bed Craven Regional Medical Center. "It has 14 ORs that are kept busy by many cases from outlying towns."

Despite a full caseload, Claire found herself adjusting to a different pace of life, both on and off the job. "I did notice a decrease in the patient population compared with my previous experiences. For example, we did not accept any traumas. Those patients were typically transferred to a larger hospital that was better equipped to care for the more critical cases," she says. "I assisted with some joint replacements, as well as laparoscopies and general surgeries, but I mainly scrubbed in for a lot of vascular operations during my 10-hour shifts."

Although procedures are often performed similarly from facility to facility, you are likely to encounter different sets of instruments, monitors, and other equipment at contract locales. In particular, rural hospitals might employ older models than their urban counterparts or may not have access to the same technology.

"The surgeries are similar from one place to another, but it is a give and take in terms of technology, especially when comparing urban and rural hospitals," notes Claire. "Coming from a teaching hospital environment, I was used to more high-tech devices, such as high-definition digital cameras for laparoscopic surgeries, and those were not available at this facility. On the other hand, I found the administration was willing to dedicate resources in other areas. For example, the quality of gloves we used regularly was top-notch—typically reserved for only certain critical operations in other places I've worked."

Perhaps the most positive difference she experienced involved the community's residents. "New Bern is one of those small towns where strangers will call out greetings to everyone they meet." In fact, she explains, this became a common occurrence on her walks. "Since I do not have a car, I was fortunate that my housing was near the hospital and most of the businesses. I was impressed by the friendliness of everyone—the people were so warm. I have made some great friends in just 1 year on the road."