COUNCIL GROVE, Kan. (AP) - Ashley Buchman started working at Morris County Hospital when she was 16. She helped with patients' care and answered call lights, among other duties.
Buchman, now 28, is studying to be a registered nurse and working at the hospital as a licensed practical nurse. And while she could and has worked at a larger facility, she chose to return to the 25-bed critical access hospital because its nurses provide a range of patient services.
"This is the best place in the world to get experience," she said.
Kansas has about 80 critical access hospitals, which are designed to improve rural health care access and reduce hospital closures.
James Reagan, chief executive officer at Morris County Hospital, said critical access hospitals are reimbursed by Medicare on a reasonable cost basis rather than a volume basis for services provided to Medicare patients. Sixty percent to 70 percent of the hospital's patients are Medicare or Medicaid recipients, he said.
Morris County Hospital has 114 employees, with about half being part of the nursing staff.
"We have to work together as a team and be trained in all aspects of the facility," Buchman said, explaining how nursing staff also answer the phones, prepare food in the middle of the night for patients and help doctors with procedures.
It didn't take long for staff at Morris County Hospital to recognize Buchman's potential and passion for nursing. The hospital encouraged her to complete certified nursing assistant training while she was still in high school and then reimbursed her for the fees associated with the class once she became certified.
After she graduated from high school, Buchman completed the licensed practical nursing program at Flint Hills Technical College in Emporia while continuing to work as a CNA at the Council Grove hospital. In 2003, she moved away and worked at a larger hospital. Six months later, she returned to Council Grove and Morris County Hospital.
She currently is completing her registered nursing degree at Manhattan Area Technical College. Morris County Hospital and the Kansas State Board of Nursing are paying her tuition; in return, she will work at the hospital for at least a year after she graduates.
"There are a lot of people who want to be a nurse, but don't have the money," said Rachel Bolen, a registered nurse and clinical nurse manager at the hospital. "It's a win-win: The hospital gets a nurse, and they get their schooling."
Buchman is IV-certified, which means she can start IVs and deliver intravenous medications under the direct supervision of a registered nurse. She also can help deliver babies and take care of patients in the intensive care unit and emergency room.
And like all LPNs and RNs at the hospital, she is certified in advanced cardiovascular life support and pediatric advanced life support and has completed a neonatal resuscitation program. She also is trained to work with the emergency medical services team.
"We find very few facilities (whose nurses) have all of this training," Bolen said.
As a registered nurse, Buchman will be able to triage patients in the emergency room and perform more complicated IV procedures and advanced assessments. She most wants to work in obstetrics.
If she were to work at a larger hospital, Buchman said, she likely would be assigned to one area, such as obstetrics or surgery. At a small rural hospital, she is able to work with all ages of patients and a range of medical conditions.
"I am always learning every day," she said.
Reagan said the nursing staff is essential to the hospital's operation and patient care.
"They're the front line of the hospital," he said. "They have to think more on their feet and have a larger knowledge base with a diverse set of skills. ... It's a lot more personal than in a larger facility."
Bolen, who worked as a home health nurse in St. Louis and in a surgical telemetry unit at Wesley Medical Center in Wichita before being hired in 1997 by Morris County Hospital, said the small hospital has little trouble recruiting and retaining nurses.
For the past two years, the hospital has had an agreement with the Newman Division of Nursing at Emporia State University that allows its senior nursing students to do their capstone at the facility.
Salaries for registered nurses are comparable to larger hospitals, she said, while pay for LPNs and CNAs is comparable to other small hospitals in the area.
The nurse-to-patient ratio is lower at Morris County Hospital than at larger facilities, she said. The census at the hospital on Jan. 5 was 12.
Morris County Hospital has two birthing rooms, an emergency room and a swing-bed unit, Bolen said. In addition to inpatient care, it provides outpatient physical, speech, occupational and aquatic therapies; outpatient services for chemotherapy, wound care and long-term antibiotics treatment; and monthly clinics with cardiologists, neurosurgeons and other medical specialists.
The hospital also operates as a subsidiary for the county health department and county emergency medical services.