Liz McGee now works as a nurse-practitioner at Plumas District
Hospital in Quincy after participating in the Rural California Nursing Preceptorship
Program in Bieber.
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A Rural
Calling
Student and graduate nurses from throughout California experience
hands-on practice in small country clinics
By Stephen Metzger
If it weren’t for CSU, Chico’s Rural California Nursing
Preceptorship Program (RCNP), Liz McGee might still be tooling
around Los Angeles in her Mazda Miata and high heels, or perhaps
preparing gnocchi in an upscale ristorante in the Napa Valley or
even in Rome. Instead, she’s working as an adult/geriatric
nurse-practitioner at Plumas District Hospital in Quincy on the
western slope of the Sierra Nevada, about 80 miles east of Chico,
and happily sharing three and a half acres of mountain-valley property
with horses, Queensland heelers, and goats.
“My second day in the program,” McGee says, sitting
on a bench outside the clinic in Quincy, “I looked around
at the mountains and said, ‘This is it. I’m staying.’ ” In
fact, she adds, even Quincy (population 1,900) was “too much
city” at first. “I really wanted to stay in Bieber,” with
a population of only 600.
Begun in 1975, the RCNP has a straightforward, if rather ambitious,
mission: to “give student nurses and graduate nurses an opportunity
to work in a rural clinical setting one on one with a preceptor,
engaging in as much independent nursing practice as their skills
permit.” Originally, the program placed only a half dozen
or so students a year. Today, the program annually places some
70 student nurses in 36 rural clinics and hospitals up and down
central and Northern California, from Bishop and Hollister to Crescent
City and Alturas.
In addition to offering the advantages of working in rural settings,
the RCNP program is also relatively affordable: $110 per unit,
for either two- or four-unit preceptorships (four and eight weeks
long, respectively). The program also has developed an extensive
database of housing providers, who not only open their homes to
the students for free housing but who frequently stay in touch
with the students long after the preceptorships have been completed.
McGee, who graduated from the California State University, Long
Beach nursing program in 1996, didn’t always plan to go into
nursing. “Actually, I wanted to go to culinary school,” she
says. “I’d been living in Italy and traveling around.
I really wanted to be a chef.” But after hearing about the
RCNP from the program’s coordinator, Kathleen Kirby, she
decided to give it a try, hoping at least to be “placed somewhere
near the wine country.”
Instead, she was sent to the Big Valley Medical Center in Bieber,
in the mountains about two and a half hours northeast of Chico.
But she was so smitten with the area that she signed up for a second
term and never looked back. It probably helped that on her way
to Bieber that November day, she met with Kirby, who loaned her
a good pair of snow boots.
“Working in these rural areas is so different,” says
McGee, a snow-dotted granite peak towering over her shoulder this
late-July
afternoon. “The doctor wears so many hats. He’s the
cardiologist, pulmonologist, oncologist, everything—so we
have a lot more variety of cases to work with. In the city, we’d
be referring most of them out.”
Which is exactly the experience that Kirby, who has been the program
coordinator for seven years, is hoping RCNP students get. “It’s
that one-on-one work with their preceptors, the apprenticeship
model, that I feel is so important in nursing,” says Kirby
in her office on Salem Street, just a block from the CSU, Chico
campus. Indeed, at rural hospitals, medical services tend to be
less sophisticated than those in urban centers: specialists are
fewer and farther between, emergency services are apt to be more
primitive, and transportation problems are ever present. Nurses
must learn to be both flexible and independent, incorporating their
classroom educations in often-unexpected ways, and by the time
they’re done, they’ve often had a far wider range of
experience than they would have at an urban clinic or hospital.
Along the way, they gain not only knowledge and experience but
also confidence. “They go from feeling like insecure students
with nothing to offer,” Kirby explains, “to being able
to say, with complete confidence, ‘I’m a nurse now.’ ”
In addition to attending to their regular nursing duties, the students
are still effectively “in class,” part of which entails
identifying their placement goals and objectives. Each student
must also do an oral presentation on a patient of his or her choosing
as well as write a paper on a topic relevant to rural health, both
evaluated by Kirby.
Kirby, who got an associate degree in nursing (RN) at Santa Rosa
Community College after graduating from CSU, Chico in 1992 with
an MA in Latin American Studies, returned to Chico after working
in rural health care herself. Among her positions was that of director
of nursing at the nonprofit Del Norte Clinics, Inc., which serves
61,000 medically underserved patients in Butte, Colusa, Glenn,
Sutter, Tehama, and Yuba counties. She also worked at Feather River
Hospital in Paradise.
Payton Wong, who finished his RCNP placement in August, has a degree
in fire science from San Francisco City College and will receive
his RN degree from De Anza Community College in December of this
year. A native San Franciscan, Wong has also worked as a machinist,
manufacturing a variety of medical devices. He applied for the
RCNP program after hearing one of Kirby’s presentations at
De Anza. “It sounded interesting and like a relatively inexpensive
way to gain additional clinical experience,” he says, and
the 72-bed Tahoe Forest Hospital in Truckee, where he was placed,
couldn’t have provided a better fit: Wong is an avid cyclist
who also enjoys camping and backpacking and worked for 10 years
as a ski patrol member at Northstar at Tahoe.
Another distinguishing feature of rural nursing is the relationships
that the medical staff establish with the community. Nurses in
rural areas are often known by their patients not only professionally
but personally as well, frequently experiencing close personal
contact with their patients and their patients’ families.
Says Wong, “The staff at Tahoe Forest know that they are
taking care of friends and neighbors. They see their patients at
the grocery store and gas station. They have a closer connection
to the people they take care of.”
While this is usually beneficial—to both the medical staff
and the community—Wong admits, “There are also downsides
to having your friends and neighbors for patients.” During
one of his shifts at Tahoe Forest, a fellow nurse, just beginning
a shift, received a report on a new patient and immediately began
to weep. Then, against advice from staff, the nurse chose to care
for the patient—newly diagnosed with cancer and her close
friend.
On Wong’s last day at Tahoe Forest, just before packing up
and heading back to San Jose, he learned that one of his patients—a
69-year-old woman visiting from out of town—was supposed
to be a member of a wedding party but, confined to the hospital,
would be unable to take part. Wong acted quickly—in the spirit
demanded of rural nurses—and arranged for the wedding to
take place in the hospital’s solarium, or waiting area, where
Wong’s patient attended “dragging an IV pole and pump.” While
Wong acknowledges that such a ceremony could certainly have happened
in a large metropolitan hospital, he claims that the “spontaneity” and
the ability to identify a problem, confront it, and solve it quickly “reflect
a large part of the true spirit of rural nursing.”
It’s that same spirit that keeps nurses like Liz McGee at
rural clinics and hospitals. To see McGee at work—or talking
between shifts under the pines on the lawn outside the clinic—is
to see a woman who has found not only a way to provide a service
for a community but also her place in the world. In fact, she seems
to have found herself.
Shortly before McGee finished her second preceptorship in Bieber,
she drove over to Reno and traded that little tan Miata for a dark
blue Ford F250 four-wheel-drive pickup.
Perfect for hauling hay and Queensland heelers. And for driving
through raging mountain snowstorms to her work at the clinic.
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