Strengthening the Culture of Well-Being in Rural Hospitals Through RISE Peer Support

Highlights: What are the main findings? Implementation of the RISE peer support program in two rural hospital systems led to modest reductions in anxiety and burnout and early, significant increases in workforce resilience. Staff reported major improvements in awareness, accessibility, and perceived usefulness of peer support, reflecting a strengthened culture of well-being within rural healthcare settings. What are the implications of the main findings? Peer support programs such as RISE are feasible, acceptable, and impactful even in resource-limited rural hospitals, offering a scalable model for workforce well-being. Rural health systems can enhance clinician retention, psychological safety, and organizational support culture by adopting structured emotional-support interventions tailored to local context. Background: Burnout among healthcare workers (HCWs) threatens workforce stability and patient care, particularly in rural hospitals where staff shortages, limited resources, and professional isolation amplify stress. Peer support interventions have demonstrated promise in urban centers, but their feasibility and impact in rural settings remain underexplored. Methods: We implemented and evaluated the Johns Hopkins RISE (Resilience in Stressful Events) peer support program across two rural hospital systems in the Mid-Atlantic United States. Using pre- and post-implementation surveys, we assessed anxiety (GAD-7), burnout (Maslach Burnout Inventory), resilience (CD-RISC), and perceptions of organizational culture of well-being. Linear and logistic regression models adjusted for age, site, and employment duration were used to evaluate outcomes over time. Results: A total of 868 respondents participated across three time points. Burnout and anxiety declined modestly post-implementation, while resilience improved initially but was not sustained at 2-year follow-up. Older employees demonstrated lower anxiety and burnout, while mid-career employees (3–10 years of employment) reported significantly higher distress. Importantly, access to peer support and perceived availability of supportive resources improved significantly over time, reflecting growing program integration. Conclusions: RISE was adapted successfully in rural hospital settings, with evidence of reduced burnout, lower anxiety, and increased perceived access to peer support. While resilience gains were not sustained, results suggest that a peer support program tailored to each organization can mitigate workforce distress in rural health systems. Addressing implementation and contextual barriers and sustaining organizational commitment are important for long-term impact. Expanding peer support to rural hospitals may improve workforce retention and care delivery in underserved communities.