Healthcare institutions worldwide face a host of challenges that make it increasingly difficult to provide high-quality patient care. These challenges are especially profound in rural hospitals, many of which are a community’s sole resource for quality, affordable healthcare. Rural hospitals that experience staffing challenges and struggle to support their workforce often close. As a result, many rural Americans lose access to healthcare. To maintain effective services, hospitals must find ways to mitigate workplace violence and make healthcare jobs sustainable. Rural hospitals must seek ways to mitigate workplace violence in healthcare to effectively care for the people who depend upon them for their well-being. A hospital safety plan that facilitates immediate access to support and effective resource allocation makes employees safer and hospitals more financially stable. 

Rural Hospitals Face Constraints

The American healthcare industry is under pressure. Rural hospitals operate under unique constraints that further increase pressure on employees. These constraints have resulted in large numbers of rural hospital closures in recent years; as a result, rural Americans are losing access to care. The American Hospital Association identifies the following constraints that negatively impact rural hospitals:

  • Patient volume and health

Rural hospitals have low patient volumes. This makes it challenging to maintain fixed operating costs and to perform quality control assessments. Rural hospitals treat patients who are typically older, sicker, and poorer than the national average. Many patients are uninsured and lack access to transportation.

  • Low reimbursement rates

A high percentage of rural hospital revenue comes from Medicare and Medicaid, which reimburse less than the cost of care. Rural hospitals cannot offset this loss with revenue from patients with commercial coverage. Many insurance plans also restrict patient access to providers in rural areas.

  • Staffing shortages 

Nearly 70% of the primary care Health Professional Shortage Areas (HPSAs) are rural. In response to staffing demand caused by the COVID-19 pandemic, many hospitals turned to expensive contract labor firms during surges. These labor costs are untenable for rural hospitals, many of which operate at a deficit. 

  • High pandemic-related costs

Rural communities were hit especially hard by the pandemic, with sicker patients seeking care. Expenses for labor, drugs, purchased services, and personal protective equipment increased. Rural hospitals had to cancel or postpone non-emergent procedures to adjust for the influx of COVID-19 patients. The resulting loss of outpatient revenue significantly impacts rural hospitals’ financial viability. 

These constraints make it difficult for rural hospitals to provide quality care. When it is difficult for hospitals to meet the high overhead costs created by these constraints, it is almost impossible to siphon money toward non-revenue-generating initiatives like workplace safety. 

Workplace Violence in Rural Hospitals

 Hospital safety plan

Hospital safety plan

Since the beginning of the COVID-19 pandemic, workplace violence in healthcare has increased. According to the American Hospital Association, “the pandemic has placed significant stress on the entire health care system.”  In some situations, patients, visitors, and family members have attacked healthcare staff and jeopardized workers’ ability to provide care. Nationwide, 44% of nurses reported experiencing physical violence and 68% reported experiencing verbal abuse during the COVID-19 pandemic. 

Under these conditions, healthcare workers may become afraid, distracted, and traumatized. As a result, they are unable to provide the highest quality care. Studies show that workplace violence reduces patient satisfaction and employee productivity, and increases the potential for adverse medical events.

Substance Abuse Increases Likelihood of Violence

In rural hospitals, these adverse conditions are further exacerbated by high rates of substance abuse among patients. Substance use and abuse are documented risk factors for the perpetration of violence. According to the Centers for Disease Control and Prevention (CDC), “the rate of drug overdose deaths in rural areas has surpassed rates in urban areas, and it is a huge public health concern.” 

The effects of the opioid epidemic are profoundly felt in rural communities where employment opportunities are often limited and isolation is pervasive. Between 1999 and 2015, opioid death rates in rural areas have quadrupled among 18-to-25-year-olds and tripled for females. In areas with widespread substance abuse, patients under the influence of opioids and other drugs can display uncharacteristic, sometimes violent, behaviors. 

One hospital in rural La Grande, Oregon, has experienced the effects substance dependency can have inside hospitals. Grand Ronde Hospital Director of Facilities Elaine LaRochelle described a typical interaction with a drug-addicted patient: “When they don’t get their prescription, the people that take the brunt are our front-desk staff…and they don’t know how to cope with that. They are supposed to be customer service, and here’s this customer screaming and yelling and making threats.” Staff at every level faces the daily stress of trying to care for sometimes violent patients without the resources of larger urban hospitals. 

How Resource Allocation Protects Hospital Staff

 Hospital safety plan

Hospital safety plan

Hospitals can prevent and mitigate the effects of violence by instituting effective resource allocation practices. “Allocational efficiency” refers to the optimal distribution of goods and services to consumers in an economy. Under allocational efficiency, all goods, services, and capital are allotted and distributed to their very best use. In a hospital setting, allocational efficiency is accomplished by distributing employees strategically, according to their experience and qualifications. In short-staffed rural hospitals, every employee should be distributed to their “very best use.”

Effective resource allocation:

  • Ensures work is divided evenly among all resources to prevent staff burnout
  • Ensures teams have the skills, knowledge, and training necessary to complete allocated work
  • Optimizes engagement performance by matching the right resources, to the right task, at the right time

A hospital safety plan should be mindful of resource allocation and ensure that resources are distributed where most needed to prevent workplace violence. Administrators should allocate their staffing resources to the locations, situations, and times when workplace violence in healthcare is most likely to occur. Violent incidents occur more often during shift changes, for instance; increasing staff or ensuring that trained staff is present during these times can help de-escalate potentially violent incidents. Because rural hospitals are already short-staffed, administrators must be strategic in deploying their workers. Doing so makes hospitals safer places to work. 

Support Staff with a Data-Driven Hospital Safety Plan

Given the challenges staff members at rural hospitals face every day, safety measures are a necessity. The CENTEGIX CrisisAlert system features wearable safety buttons that allow staff members to call for help from anywhere on campus. These alerts generate data that inform administrators’ resource allocation decisions. By viewing the detailed CrisisAlert dashboard, hospital leaders can learn where, when, and why violent incidents occur, and deploy staff strategically. 

When equipped with CrisisAlert, hospital staff can summon immediate help from designated responders. In a hospital experiencing a staffing shortage, an instant alert can mean the difference between a threat and a violent incident. A hospital safety plan creates a culture of safety that aids in employee retention and increases job satisfaction. By making staff members safer, CrisisAlert enables them to care for patients to the best of their ability.

CENTEGIX is the leader in incident response solutions. Our CrisisAlert platform is the fastest and easiest way for staff to call for help in any emergency, from the everyday to the extreme. CENTEGIX creates safer spaces by innovating technology to empower and protect people, and leaders nationwide trust our safety solutions to provide peace of mind. To learn more about CENTEGIX, visit