Administrative & Support Staff Workforce

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Introduction

Critical Access Hospital (CAH) administrative staff, support staff, and technicians are crucial roles for providing the best care possible in rural communities. Administrative personnel handle essential tasks like patient records, scheduling, and billing, thereby ensuring operational efficiency and financial stability. Additionally, these personnel are often the first people that patients and family members interact with when seeking care and are crucial representatives of the hospital.1 Support staff, including custodial and facilities management staff, maintain a clean, safe, and functional environment, crucial for infection control and overall safety.2 Technicians, such as patient care technicians, x-ray technicians, and phlebotomists, perform vital diagnostic and patient care tasks, directly contributing to accurate diagnoses and effective treatments. Together, these roles form the backbone of hospital operations, enabling health care providers to deliver high-quality patient care.3

Recruitment and retention of administrative, support, and technician staff are especially important in rural hospitals, particularly in CAHs, due to limited resources and the critical need for comprehensive care in these areas. CAHs often face challenges in attracting qualified personnel, making it essential to maintain a stable workforce to ensure uninterrupted, high-quality patient care. Given the smaller staff sizes and fewer specialized services available in rural settings, every staff member's role becomes even more crucial, making effective recruitment and retention strategies vital for the hospital's sustainability and the community's health.4–6

CAHs often face significant challenges in competing with local employers for labor. Due to financial constraints related to lower volumes and revenue challenges, CAHs may have difficulty offering competitive wages even as their operating costs have increased.7 This disparity makes it difficult for small hospitals to retain and recruit staff, as workers are more likely to choose higher-paying opportunities elsewhere. This section focuses on resources and strategies CAHs may use to compete with non-health care employers, which is of particular importance for attracting administrative and support staff who may have ample opportunities in other sectors.

This module has three sections, which discuss unique considerations for addressing staffing barriers associated with administrative staff, support staff, and technicians in CAHs while also offering strategies to boost recruitment and retention of these employees. The first section focuses on ways CAHs can make their workplaces more enticing to potential employees when raising wages isn’t a viable option. The second section provides strategies to decrease barriers to entry for roles that require technical knowledge or training. The final section discusses the need for employees to feel safe in their workplace and lists key resources available to promote safety and wellness in the workplace.

Enhancing Recruitment and Retention Beyond Raising Wages

CAHs can adopt innovative strategies to enhance their appeal to administrative and support staff beyond just raising wages. Doing so can help employees feel more engaged in and enriched by the work they are performing each day. These approaches can also position CAHs to bolster their reputation as an employer in the community and attract a wider pool of applicants. Several strategies which may help with recruitment and retention of these staff include:

  • Prioritize Work-Life Balance – CAHs can support their staff by implementing flexible work schedules, such as offering part-time positions, job sharing, and adjustable shifts. Additionally, they can promote work-life balance by providing access to wellness programs, mental health resources, and ample time off, thereby ensuring their employees feel valued and supported.8 As an example resource to help employees balance work and personal commitments, the U.S. Department of Veterans Affairs has created a page on Tips and Resources for Work-Life Integration as part of their Whole Health Library.
  • Offer Remote or Hybrid Work Opportunities – Leaders can attract and retain certain administrative or clerical staff by offering remote or hybrid work options to those who don’t necessarily need to be onsite at a given time. These arrangements allow employees the flexibility to balance their professional and personal lives while still meeting the hospital's operational needs. Additionally, in cases where multiple hospitals use shared services for administrative functions, the ability for staff to work remotely allows them to more effectively support multiple facilities. 9,10 Further, employees who live in more rural areas are more likely to commute longer distances to work, and the flexibility to work in a hybrid arrangement can help staff spend less time commuting and less money on transportation.11 
  • Facilitate Professional Development – CAHs can facilitate professional development and growth for their administrative and support staff workforce through on-the-job training, mentorship programs, and access to other continuing education opportunities, helping them to advance their careers and contribute more effectively to the organization.12,13
  • Consider Total Compensation – Hospitals can also make their positions more enticing by enhancing total compensation through benefits such as comprehensive health care plans, retirement savings options, tuition reimbursement, and performance-based bonuses, creating a more attractive and supportive employment package.14
  • Emphasize Employee Appreciation and Engagement – CAHs can focus on employee recognition and appreciation by regularly acknowledging achievements, providing awards, and fostering a culture of gratitude, which can help administrative and support staff feel more engaged and valued. As an example of these activities, Clark Fork Valley Hospital (CFVH), a CAH in Plains, Montana, was able to decrease turnover in their facility by implementing creative employee recognition and appreciation activities, such as pizza parties, appreciation gifts, and an “employee of the month” board. CFVH was awarded the Best Practices Recognition by The National Rural Health Resource Center for their employee retention strategies, which are described in greater detail here. Additionally, Module 1 of this toolkit offers more detailed resources related to employee appreciation and engagement.

Decreasing Barriers to Entry

Entering administrative, support, or technical roles in health care can present higher barriers compared to similar wage jobs outside the industry due to the specialized skills and training required for some positions. Health care positions often necessitate possession of specialized skills, plus knowledge of medical terminology, patient care protocols, and regulatory compliance, which can require additional education and certifications. This need for specialized training, coupled with the demanding nature of the health care environment, can make entry into these fields more challenging for prospective employees.

CAHs can reduce barriers to entry for technical staff by implementing targeted strategies to make it easier for individuals to enter these roles, thereby expanding their applicant pool and filling important positions more effectively. Below are some ideas for reducing such barriers.

  • Training Programs – CAHs can develop robust training programs that allow those newly entering their fields to learn necessary skills while working, reducing the need for prior technical experience. Such programs can include or be paired with apprenticeships or internships for health careers students as well.
  • Partnerships with Local Educational Institutions – There is potential to collaborate with local community colleges, vocational schools, and training centers to create tailored programs that align with the hospital’s needs, ensuring a steady pool of qualified candidates. Module 2 of this toolkit provides examples of such partnerships between educational institutions and CAHs.
  • Clear Job Descriptions and Expectations – CAHs should make sure their job descriptions are clear and concise about the skills and experience absolutely required and emphasize that comprehensive training beyond those requirements will be provided, making the roles more accessible. 3RNET is funded by the Federal Office of Rural Health Policy (FORHP) to support CAHs in addressing workforce shortages, and 3RNET specifically offers several resources CAHs may use to enhance their recruitment efforts. 3RNET’s Recruiting for Retention Academy provides online training and resources specifically targeted for recruitment and retention of health care workforce in rural areas. 3RNET also hosts a job board where CAHs can post openings for administrative and clerical staff, technicians and medical assistants, and facilities and maintenance professionals, among many other clinical and non-clinical staff roles.
  • Tuition Reimbursement and Scholarships – CAHs and rural health systems can consider providing financial support for employees to pursue relevant certifications or training programs, removing financial barriers to skill acquisition. OSF HealthCare, a Midwestern health system provides up to $5,250 in tuition reimbursement and education assistance for employees per year. Similarly, Essentia Health provides up to $2,500 in tuition reimbursement per year for those working at least 50% full-time equivalent.

CAH Example in Action

Aspirus Health, a non-profit health system that operates several CAHs across Wisconsin, Michigan, and Minnesota, has created training programs to address shortages of certified nursing assistants (CNAs), medical assistants (MAs), and phlebotomists. They also offer shadowing and internship opportunities for non-clinical roles such as accounting, information technology, insurance and billing, and human resources.

Promoting Employee Safety

Ensuring the safety and well-being of staff in CAHs is crucial for maintaining a stable workforce and delivering high-quality patient care. Staff in CAHs, including administrative, support, and technical personnel, might feel unsafe due to the heightened risk of infection from exposure to contagious patients and pathogens, as the nature of their work often involves close contact with patients and contaminated surfaces, increasing their vulnerability to infections.15–17 The physical demands associated with working in a hospital, such as lifting patients or heavy equipment, can also lead to musculoskeletal injuries.18,19 Additionally, some staff types in health care, including custodial staff and food service workers, are at increased risk of certain occupational hazards when compared to health care workers at large. Such hazards or injuries can include exposure to blood and body fluid, bruises and burns from industrial equipment, and accidental sticks from needles or other sharp waste items.20,21 Below are some strategies and resources to support employee wellness and decrease risks of occupational injuries to staff.

  • Safety Training – Provide thorough and ongoing training on workplace safety protocols, proper use of personal protective equipment (PPE), and infection control procedures. Regular refreshers can help ensure that all staff are up-to-date with the latest safety practices.22,23
  • Accessible Safety Equipment – Ensure that all necessary safety equipment and PPE are readily available and easily accessible. This includes gloves, masks, gowns, face shields, and sanitizing supplies.24
  • Regular Safety Audits and Measures – Conduct regular safety audits and risk assessments to identify and mitigate potential hazards in the workplace.25 Involving employees in these audits can also help them become more aware of safety practices. One example of supporting safety is from the Minnesota Department of Health, which funds the Health Care Workplace Safety Grant. This grant supports health care facilities with efforts to increase workplace safety.

Conclusion

Recruitment and retention of administrative, support, and technical staff in CAHs are paramount due to their integral roles and the unique challenges faced in rural settings. By implementing tailored strategies such as promoting work-life balance, offering professional development opportunities, and enhancing overall compensation, CAHs can effectively attract and retain a dedicated workforce. Additionally, reducing barriers to entry and ensuring a safe work environment are crucial steps toward maintaining a stable and competent staff, ultimately supporting the delivery of high-quality care to rural communities.

Appendix

This appendix lists all resources referenced in the above module, organized according to the module headings. This appendix also features additional resources that were not included in the module. Each of the listed resources includes a description and link to the corresponding resource.

General Resources

Resource DescriptionLink
3RNETThis website is for 3RNET, an organization funded by the Federal Office of Rural Health Policy (FORHP) to support rural health care providers, including CAHs, in addressing workforce shortages. Their website offers resources CAHs may use to enhance recruitment efforts.https://www.3rnet.org/
3RNET Job Board3RNET also has a job board, funded by the Federal Office of Rural Health Policy (FORHP), where CAHs and other rural facilities can post openings for all health care providers and staff, including administrative and clerical staff, technicians and medical assistants, and facilities and maintenance professionals.https://www.3rnet.org/jobs
3RNET Recruiting for Retention AcademyThis program provides online training and resources specifically targeted for recruitment and retention of health care workforce in rural areas.https://academy.3rnet.org/
Appreciation and Retention Example – Clark Fork Valley HospitalThis webpage highlights a Best Practices Recognition of a Montana CAH from the National Rural Health Resource Center and details the CAH’s efforts to decrease turnover by implementing creative employee recognition and appreciation activities.https://www.ruralcenter.org/resources/articles/clark-fork-valley-hospital-plains-montana
Work-Life Integration: Tips and Resources – U.S. Department of Veterans AffairsThis resource provides tips for employees to establish a healthy balance between work and personal commitments.https://www.va.gov/WHOLEHEALTHLIBRARY/tools/work-life-integration-tips-and-resources.asp

Resources to Decrease Barriers to Entry

Resource DescriptionLink
Job Shadowing Example – Aspirus HealthThis webpage describes a health system’s job shadowing opportunities, which include a variety of clinical and non-clinical roles in the hospital. The non-clinical shadowing opportunities are available in “any department or specialty available at Aspirus,” which can include accounting, information technology, insurance and billing, and human resources.https://www.aspirus.org/job-shadows-non-clinical
Non-Clinical Internships Example – Aspirus HealthThis is a webpage describing a health system’s non-clinical internship opportunities, which allows students to gain introductory experience in fields such as accounting, information technology, insurance and billing, and human resources.https://www.aspirus.org/non-clinical-internship1
Paid Job Training Example – Aspirus HealthThis is a webpage describing a health system’s paid job training programs with local community colleges, including phlebotomy and medical assistant roles. These programs provide students with paid tuition, supplemental stipends, mentor guidance, and a guaranteed staff position upon program completion.https://www.aspirus.org/paid-job-training
Tuition Reimbursement Example – Essentia HealthThis article describes the successes of a tuition reimbursement program implemented by a health system with several CAHs. This program is available to all staff working at least 50% full-time equivalent.https://www.essentiahealth.org/about/essentia-health-newsroom/how-essentias-tuition-reimbursement-program-helped-a-mother-and
Tuition Reimbursement Example – OSF HealthCare This page describes the tuition reimbursement and other education-related employee benefits available to all staff—including administrative staff support staff, and technicians—at a Midwest health system with many CAHs.https://osf.guildeducation.com/partner/

Workplace Safety and Emergency Preparedness Resources

Resource DescriptionLink
Accessing Emergency Preparedness and Response Resources for Rural Communities – RHIhubThis recording of an RHIhub webinar provides insights on how rural communities can obtain essential resources for disaster or emergency response and recovery from the local, state, and federal levels.https://www.ruralhealthinfo.org/webinars/accessing-emergency-preparedness-resources
Building Local Level Partnerships for Rural Emergency Preparedness – RHIhubThis recording of an RHIhub webinar emphasizes the potential for partnerships and collaboration in rural communities related to disaster and emergency planning, response, and recovery.https://www.ruralhealthinfo.org/webinars/partnerships-for-rural-emergency
Emergency Preparedness and Response Efforts in Critical Access Hospitals – RHIhubThis recording of an RHIhub webinar provides several examples of how CAHs have managed disaster planning, response, and recovery in the past, and shares essential strategies for CAHs to use in these situations.https://www.ruralhealthinfo.org/webinars/critical-access-hospital-emergency-response
Rural Emergency Preparedness and Response Toolkit – RHIhubThis toolkit presents innovative, evidence-based models and resources to support rural health care organizations with emergency planning, response, and recovery initiatives.https://www.ruralhealthinfo.org/toolkits/emergency-preparedness
Workplace Safety Grants for Health Care Entities – Minnesota Department of HealthThis program, which seeks to prevent workplace violence, provides grants to enhance safety measures in health care settings and develop or expand staff training on de-escalation and positive support services. https://www.health.state.mn.us/facilities/ruralhealth/funding/grants/docs/hcwpsrfp.pdf

References

1.         Berry P. A Third Pillar of Patient Safety: Exploring the Critical Role of Administration and Clerical Staff. Journal of Hospital Management and Health Policy. 2023;7. doi:10.21037/jhmhp-23-124

2.         Dodd J, Smithwick J, Call S, Kasana D. Modeling of Healthcare Facility Maintenance Staff Using Publicly Reported Hospital Metrics. Presented at: Associated Schools of Construction 57th Annual International Conference; 2021; Virtual.

3.         Saxon RL, Gray MA, Oprescu FI. Extended Roles for Allied Health Professionals: An Updated Systematic Review of the Evidence. Journal of Multidisciplinary Healthcare. 2014;7:479-488. doi:10.2147/JMDH.S66746

4.         Vaughan L, Edwards N. The Problems of Smaller, Rural and Remote Hospitals: Separating Facts from Fiction. Future Healthcare Journal. 2020;7(1):38-45. doi:10.7861/fhj.2019-0066

5.         Schou PM. Critical Access Hospital Leaders Beat Challenges to Support Their Communities and Staffs. Frontiers of Health Services Management. 2021;38(1):27-31. doi:10.1097/HAP.0000000000000119

6.         Granger A. Maintaining a Skilled Critical Access Hospital Workforce in the Post COVID-19 Era. The College of St. Scholastica; 2021. https://www.proquest.com/docview/2572628837/abstract/975C3040A2554979PQ/1

7.         National Rural Health Association. CMS Request for Information: Promoting Efficiency and Equity Within CMS Programs. Accessed July 8, 2024. https://www.ruralhealth.us/getmedia/5d0715bf-6266-40ef-bab0-43961441ec69/CMS-Equity-and-PHE-RFI.pdf

8.         Schwartz SP, Adair KC, Bae J, et al. Work-Life Balance Behaviours Cluster in Work Settings and Relate to Burnout and Safety Culture: A Cross-Sectional Survey Analysis. BMJ Quality & Safety. 2019;28(2):142-150. doi:10.1136/bmjqs-2018-007933

9.         McChesney C, Powis ML, Espin-Garcia O, Hack S, Morley L, Krzyzanowska MK. Staff Experiences with Remote Work in a Comprehensive Cancer Center During the COVID-19 Pandemic and Recommendations for Long-Term Adoption. JCO Oncology Practice. 2023;19(5):e732-e744. doi:10.1200/OP.22.00649

10.       Young J. Exploring the Perceptions and Experiences of Remote Work Among Administrative Healthcare Personnel at an Academic Medical Center in the Southeastern United States: A Qualitative Investigation. Medical University of South Carolina; 2024. https://medica-musc.researchcommons.org/theses/852

11.       de Vos D, Meijers E, van Ham M. Working from Home and the Willingness to Accept a Longer Commute. The Annals of Regional Science. 2018;61(2):375-398. doi:10.1007/s00168-018-0873-6

12.       Summerlin J, Duvall L, Hopton S, Vasko A, Graham A, Mehta BH. Pharmacy Technician Development: Insight into Training, Preparedness, and Career-Path Perceptions. Journal of the American Pharmacists Association. 2024;64(1):120-125. doi:10.1016/j.japh.2023.09.006

13.       Berndt A, Murray CM, Kennedy K, Stanley MJ, Gilbert-Hunt S. Effectiveness of Distance Learning Strategies for Continuing Professional Development (CPD) for Rural Allied Health Practitioners: A Systematic Review. BMC Medical Education. 2017;17(1):117. doi:10.1186/s12909-017-0949-5

14.       Fulmer IS, Li J. Compensation, Benefits, and Total Rewards: A Bird’s-Eye (Re)View. Annual Review of Organizational Psychology and Organizational Behavior. 2022;9:147-169. doi:10.1146/annurev-orgpsych-012420-055903

15.       Ahmad IA, Osei E. Occupational Health and Safety Measures in Healthcare Settings During COVID-19: Strategies for Protecting Staff, Patients and Visitors. Disaster Medicine and Public Health Preparedness. 2023;17:e48. doi:10.1017/dmp.2021.294

16.       Ghosh T. Occupational Health and Hazards Among Health Care Workers. International Journal of Occupational Safety and Health. 2013;3(1):1-4. doi:10.3126/ijosh.v3i1.9096

17.       Haagsma JA, Tariq L, Heederik DJ, Havelaar AH. Infectious Disease Risks Associated with Occupational Exposure: A Systematic Review of the Literature. Occupational and Environmental Medicine. 2012;69(2):140-146. doi:10.1136/oemed-2011-100068

18.       Anderson SP, Oakman J. Allied Health Professionals and Work-Related Musculoskeletal Disorders: A Systematic Review. Safety and Health at Work. 2016;7(4):259-267. doi:10.1016/j.shaw.2016.04.001

19.       Ngan K, Drebit S, Siow S, Yu S, Keen D, Alamgir H. Risks and Causes of Musculoskeletal Injuries Among Health Care Workers. Occupational Medicine. 2010;60(5):389-394. doi:10.1093/occmed/kqq052

20.       Alamgir H, Yu S. Epidemiology of Occupational Injury Among Cleaners in the Healthcare Sector. Occupational Medicine. 2008;58(6):393-399. doi:10.1093/occmed/kqn028

21.       Alamgir H, Swinkels H, Yu S, Yassi A. Occupational Injury Among Cooks and Food Service Workers in the Healthcare Sector. American Journal of Industrial Medicine. 2007;50(7):528-535. doi:10.1002/ajim.20475

22.       Ghasemi F, Aghaei H, Askaripoor T, Ghamari F. Analysis of Occupational Accidents Among Nurses Working in Hospitals Based on Safety Climate and Safety Performance: A Bayesian Network Analysis. International Journal of Occupational Safety and Ergonomics. 2022;28(1):440-446. doi:10.1080/10803548.2020.1768759

23.       McGhan GE, Ludlow NC, Rathert C, McCaughey D. Variations in Workplace Safety Climate Perceptions and Outcomes Across Healthcare Provider Positions. Journal of Healthcare Management. 2020;65(3):202. doi:10.1097/JHM-D-19-00112

24.       Ludy S, Eyre AJ. 49 - Personal Protective Equipment. In: Ciottone G, ed. Ciottone’s Disaster Medicine (Third Edition). Elsevier; 2024:323-329. doi:10.1016/B978-0-323-80932-0.00049-5

25.       Tweedy JT. Healthcare Hazard Control and Safety Management. Taylor & Francis; 2005.

26.       Sauer LM, McCarthy ML, Knebel A, Brewster P. Major Influences on Hospital Emergency Management and Disaster Preparedness. Disaster Medicine and Public Health Preparedness. 2009;3(2 Suppl):S68-73. doi:10.1097/DMP.0b013e31819ef060

27.       Barbera JA, Yeatts DJ, Macintyre AG. Challenge of Hospital Emergency Preparedness: Analysis and Recommendations. Disaster Medicine and Public Health Preparedness. 2009;3(2 Suppl):S74-82. doi:10.1097/DMP.0b013e31819f754c