Workforce Shortage in Rural Hospitals: The Georgia Experience

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Rural hospitals are an integral part of the community as not only the main, and at times only, source of health care, but also as one of the major employers and as the hub for public health, wellness, and social services. Hospitals across the nation are facing an acute shortage of both nursing and non-nursing staff. The situation is more critical for the rural hospitals; in some staff categories, 21 to 29 percent of the budgeted positions were unfilled in 2001. Staff shortages not only result in diminished capacity of the hospitals to treat patients, there is also a very high cost associated with turnovers, which eventually results in high patient costs and lower profits for the hospitals. Just a few vacancies can be disastrous for small rural hospitals because typically there are only a few professionals per job class and often the gap cannot be filled by overtime and there is limited access to temporary agency staff. Many rural hospitals compete with the urban hospitals for staff recruitment. The purpose of the study was to identify and evaluate the factors affecting workforce shortage in rural hospitals in the State Service Delivery Regions 7, 9, 11, and 12 of Georgia. There are 35 hospitals in the 44 rural counties in these four regions. A telephone-interview was conducted with the CEO or a designated senior administrator of each hospital followed by a detailed mail survey. The questions covered issues such as staff-patient ratios, staff shortages in different categories, overtime, staff autonomy and/or control over work schedule, staff participation in organizational policy decision, staff satisfaction and loyalty, recruitment, and retention. Additional data were gathered on challenges and issues specific to each hospital and the region, as well as measures taken by the hospital administrations to address staffing issues. Findings indicated that most rural hospitals in the region are understaffed and at competitive disadvantages, both in terms of wages and community amenities, in recruiting from distant areas. Issues such as local origin, on the job training, career advancement opportunities, and innovative methods, such as financial assistance for housing and education can positively influence employee retention. Most hospital administrators emphasized the need for creating a framework for local solutions to staffing problems, especially developing local sources of employees by collaborating with the educational institutions. Suggestions for future research and policy guidelines for addressing workforce shortages in rural hospitals are provided.


American Public Health Association Annual Meeting (APHA)


San Francisco, CA