Table 2.

Summary of results: challenges to implementing Peer Support Workers (PSWs) in emergency department settings.

System-Level Themes	Respondent Statements
PSW workforce shortages	The primary issue we had with hiring for the position was that we had a ton of folks who applied for the position without meeting the position qualifications. … We had a lot of people who were informal peer support workers but didn’t have the certification. I personally don’t feel like these folks are making enough money. I really don’t think it’s an appropriate wage for the type of work they are doing.
Reimbursement for peer services	We run a tight ship and there’s not a lot of money to bring in other staff and so that’s a real valid concern and I’d say that’s true for all rural hospitals. We are staffed to a minimum core. The major challenge is going to just be finances in general. We’re constantly having to keep an eye on our productivity. So adding another staff position without taking away a position that we already have filled would be the huge challenge.
Hospital-Level Themes
Buy-in from hospital leadership, providers, and staff	Selling our staff on the value and utilizing peer in the right ways would be the initial challenge. I think there’s not a lot of understanding about what a PSW is. I don’t know the exact role. I think there would be a lot of conversation about function between our counselor in the ED, social worker inpatient, and then how we would work as a whole team and what that would look like…. Be specific about the role of the PSW including job expectations, requirements, and specific duties.
Logistics related to integrating PSWs	It’s so ebb and flow. We don’t know. We can’t predict who’s going to walk in the door. And so it doesn’t make sense to have a PSW here all of the time… It’s important to have a clear process established on both sides so that everyone knows what is supposed to happen when a PSW is contacted. Otherwise, how are the ED staff going to know or remember in the chaos of everything going on…?
Concerns related to professionalism	[There are] worries that the peer would come in and in a small community like ours, whether there is going to be ‘chitter-chatter’ out in the community.
Individual-Level Themes
Need for appropriate supervision	It’s so important to have good supervision. Having a plan for what to do if you feel overwhelmed is important and the peer support worker needs to feel comfortable with this person.
Need for additional training	Current CPSW training does not include enough information on reporting or documentation [which] can be challenging for peers, especially in the ED.
Choosing a peer that is a good fit	Identifying the correct peer for the emergency room is the most difficult part of this endeavor. If a PSW has a background in substance use, going to the ED when someone has OD’d can be really triggering.