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A magazine from California State University, Chico -- On-line Edition  
Fall 2006
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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.
Photo by Thomas Del Brase

A Rural Calling

Student and graduate nurses from throughout California experience hands-on practice in small country clinics

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.