Rural people with cardiovascular disease-and the nurses caring for them-face unique health care challenges. Obstacles facing patients living in small rural communities include lack of critical care specialists, inadequate technological support, and inconsistent or variable levels of 24-hour patient care services requiring patients to travel to distant tertiary centers for advanced cardiac care. Rural critical care nurses face reduced access to continuing education and inservice presentations, professional isolation, and lack of anonymity. This article introduces "Mr Smith," a rancher with cardiovascular disease living in a rural Western state. In so doing, it reviews the issues and challenges faced by rural patients and nurses. In addition, the article describes a continuing education course developed to enhance collaboration between nurses working in rural settings and a tertiary medical center.
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