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Rural hospitals find local solutions to workforce development

Initiatives include incentives, training, early recruitment and fostering a better work-life balance, panelists said at the AHA Rural Health Care Leadership Conference.

5 min read


Fernando Zhiminaicela/Pixabay

Hospital leaders at the American Hospital Association Rural Health Care Leadership Conference in Orlando, Fla., showcased the creative initiatives developed locally to recruit and retain health care professionals. Here is a snapshot of their success stories. 

Jefferson Healthcare in Port Townsend, Wash.

This 25-bed critical access hospital near Seattle dealt with decreasing staff, partly due to burnout from the COVID-19 pandemic and attrition, along with a loss of staff connectedness by creating nurse residency and workforce development programs, cross-training nurses to work in multiple areas, and developing an apprentice program for medical assistants and lab technologists, and for the areas of respiratory therapy, surgical tech and sterile processing. 

Registered nurse Brandie Manuel, chief patient safety and quality officer, said the hospital was growing, which can create a culture change by itself, but after the pandemic, it had to respond to the new reality of a different workforce. “We needed to build the airplane while we’re flying it,” said Manuel, who added that the hospital filled positions, created strong leadership, invested in frontline professionals and then reconnected them to their purpose – and each other.  

The result was a 50% decrease in open positions between the fourth quarter of 2022 and the fourth quarter of 2023 and a reduction in the need to bring in travel nurses. 

Ohio County HealthCare in Kentucky

Work-life balance concerns linked to night and weekend nursing shifts led to staff attrition at this Kentucky health care system. Registered nurse Athena Minor, chief nursing and chief clinical officer, said the solution was to change the nursing staff from hourly to salaried employees. A six-month pilot program started in 2019 and was so successful that it was continued and expanded. Six full-time nurses were hired to help fill schedules. 

Minor noted that systems or hospitals considering this type of program should research state laws to ensure they can implement it, and get support from staff, human resources and administration.

The results included financial savings of $266,000 for each of the first two years. Only three nurses quit in the first two years of the program. Nurses worked fewer shifts and had more time with their families. There was less staffing competition, greater stability and more collaboration. “Retention helps all of us,” Minor said. “If we can keep staff, we can share staff better.”

Hannibal Regional Healthcare System in Hannibal, Mo.

A major renovation and expansion at the health system’s main campus created a need for more physicians and nurses, said Susan Wathen, vice president of human resources. Sign-on bonuses were implemented, along with a program to help pay education costs for nurses. 

But the health system went a step beyond, reaching out to help train and employ the next generation of workers. “We have worked really hard to think outside the box,” Wathen said. 

The results included a program that allows students enrolled in an eligible academic program – even if it is not health care – to work part time at the hospital to earn money and receive financial incentives for each quarter they are enrolled in school. The health system works with the Hannibal School District to provide training and then jobs for students with developmental and intellectual disabilities. It also accepts medical students on-site so they can learn from physicians, and a residency program is set to begin in 2026. 

 Sanford Wheaton Medical Center in Minn.

This Wheaton, Minn., medical center operates Scrubs Camp as a way to get high school students interested in health care careers with a goal of increasing the health care workforce in the years ahead. “It’s not just addressing the shortage (of health care professionals), it’s about inspiring the next generation of professionals,” said senior director Chelsie Falk, who called it an investment in the community. 

About a third of the time at the one-day camp focuses on speakers who talk about different health care careers, and the rest is spent on interactive activities related to those careers. Falk said it is a challenge to engage a room full of teens, so she shares her own health care career story and injects a little humor into the discussion. Hands-on activities include mixing IV bags using dyed water, administering shots to an orange, performing tuberculosis tests on hot dogs, taking vital signs and practicing suturing on chicken breasts. 

The results can be seen in the number of participants showing interest in nursing intern positions and several teens pursuing nursing, ultrasound and radiology programs. 

 Bothwell Regional Health Center in Sedalia, Mo.

Bothwell is a city-owned hospital with a large scope of services. Marvin Smoot, vice president of clinical operations, said it became evident around 2015 that the health center was starting to age out. It was failing to recruit and retain primary care physicians, and most of its physicians were about five to 10 years away from retirement. Smoot said the “crisis” threatened the future of the institution. 

The solution was a “grow your own” strategy by focusing on medical education with the University of Missouri. The health center created a Rural Scholars Program, an initiative that was developed in 1995 to give medical students experience in rural health care. The goal was to have students who complete the program stay in the area to practice.  

The results included a reduction in attrition at the center’s family medicine clinic, which is now where all new family medicine physicians are working. The challenge has shifted from recruiting physicians to finding space to place all the new ones. The program has led to grant funding to support rural health medical student education clinic space, which will include a 45-exam room primary care complex.


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