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May 12, 2020

How rural hospitals overcome staffing shortages amid Covid-19

Daily Briefing

    Rural hospitals are no strangers to the difficulties of navigating staffing shortages, but the new coronavirus epidemic is prompting rural providers adopt new strategies to address this resourcing constraint.  

    The 4 key imperatives for your Covid-19 staffing strategy

    Experts warn that notoriously under-resourced rural communities could be the United States' next Covid-19 hot spot. Rural hospitals, already struggling financially, know the risk their organizations face if their communities suffer an outbreak. If more rural hospitals are forced to shut down, it could exacerbate health disparities between rural and urban areas.

    To address the unique needs of these organizations, we'll be breaking down the various ways rural hospitals can use their resourcefulness to mitigate the impact of a Covid-19 surge. First up: overcoming staff shortages.

    2 ways rural hospitals can overcome staff shortages

    There are 20 fewer physicians per 10,000 people in rural areas than in urban areas. Staff shortages stem from an overall declining rural population, rural underrepresentation in medical schools, and generational shifts in preferences for urban areas. The Covid-19 crisis threatens to worsen existing shortages as hospitals resort to layoffs and pay cuts and report elevated staff burnout and illness.

    However, smaller rural hospitals have always adapted to challenging conditions, in part because they have had no choice—these hospitals are lifelines to their communities. With the onset of Covid-19, rural hospitals had to pivot from primarily offering outpatient services to focus on inpatient care.

    Fortunately, there are two key ways rural hospitals can flex their staffing capacity to meet unexpected rises in demand.

    1. Pivot staff roles to fill immediate needs. The first place rural hospitals should look for support is internally. Rural hospitals have small but mighty teams that in some cases can be redeployed to support Covid-19 care. In Lutcher, Louisiana, St. James Parish Hospital witnessed a rapid Covid-19 surge. In the first two weeks, the local community saw the fastest growth rate of new cases in the world. In response, the 200-employee hospital quickly created ICU capacity and staffed it with surgical staff who functioned as nurses. Radiology staff restocked PPE, moved materials around the hospital, and helped with cleaning. Access registration staff began screening patients for Covid-19 symptoms at the front door. Anesthesiologists supported other staff as more Covid-19 cases arrived at the hospital.

    2. Supplement staff with urban volunteers. When redefining staff roles is not enough to ensure hospitals are functioning at their highest capacity, rural hospitals should look outside of their facility for support.  Relaxed licensing requirements make it easier for rural hospitals to attract volunteer health care professionals from less impacted areas, including across state lines.

    For example, since San Francisco had relative capacity compared with other urban hotspots, the University of California San Francisco (UCSF) sent a team of seven physicians and 14 nurses to lend a hand to hospitals serving the hard-hit Navajo Nation in Arizona and New Mexico. More than 1,200 Covid-19 cases have been reported in the Navajo Nation in a population of 175,000; in San Francisco, there are 1,624 coronavirus cases in a population of more than 883,000. This type of staffing partnership isn't just charity; urban centers have a stake in rural health, too. Rural patients could eventually end up on the doorsteps of big-city medical centers if small-town hospitals can't contain the spread on their own.

    The scale of health care challenges that Covid-19 presents is certainly unprecedented. However, rural providers can leverage their longstanding resourcefulness and adaptability to weather a Covid-19 surge. In our blog post series, we'll review more tactics rural hospitals can use, including how they can obtain scarce supplies, implement telehealth capabilities, and create rural/urban partnerships.

    Is your rural hospital implementing strategies to combat the impact of Covid-19? Email Darby Sullivan at to share your experience.

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