As rural hospitals face the brunt of workforce shortages, their CEOs are taking a more proactive — and creative — approach to recruitment and retention.

Recruitment has become a greater strategic focus for Rozanna Penney, CRNA, president and CEO of Heywood Healthcare in Gardner, Mass., over the past year. While shortages are not unique to the region, their effect is felt most acutely in rural areas, she said.

“Unlike large systems, we do not have an active residency program that creates a natural pipeline of new providers,” Ms. Penney said. “Our practices are smaller and have less bench depth, so we seek clinicians who are comfortable practicing with greater independence and clinical breadth.”

Heywood Healthcare is intentionally recruiting physicians and advanced practice providers who are mission-driven and value a private-practice feel, she said.

“As one of the very few remaining independent community hospitals, we operate with significantly less red tape and bureaucracy than practices owned by large systems, allowing physicians and [advanced practice providers] not only to focus on patient care but also to actively partner with leadership in clinical and operational decision-making,” she said.

That approach has resonated especially in challenging times. Heywood Healthcare emerged from bankruptcy in 2024, a period that tested the organization under “extraordinary pressure.”

“We demonstrated not only our resilience but also how we lead, collaborate and uphold our values in the most challenging circumstances,” Ms. Penney said. “That experience resonates with motivated, high-performing physicians who want a meaningful voice in shaping care delivery and who are committed to improving the health and well-being of the communities in which they live and practice.”

She added that the organization offers a compelling value proposition for the right candidates.

“For providers who value proximity to nature, such as hiking and skiing, clean air, affordable land and housing, and strong school systems, our region is a hidden gem, just an hour from Boston,” Ms. Penney said. “Massachusetts is not often thought of as a rural healthcare market, but once providers experience our community and practice environment, they tend to stay for the entirety of their careers. Our challenge, and our opportunity, is to be strategic and intentional about telling that story and getting the word out.”

Recruitment also looks different in Hugo, Colo., where Lincoln Health CEO Kevin Stansbury said the system has partnered with an immigration law firm to support international nurse recruitment, primarily for its long-term care facility and, to a lesser extent, its acute care hospital.

Culture fit is a central element of Lincoln Health’s recruitment strategy, Mr. Stansbury said.

“First, we want to make sure that the physicians we recruit to our community understand what it’s like to live in a remote frontier community where it’s roughly 100 miles in any direction to the next closest hospital,” he said. “There are people who want to live in those communities, and that’s what we’ve been successful finding.”

Growing the local pipeline

In addition to international recruitment, Lincoln Health is investing in growing its local workforce. COO Carrie Owens, BSN, RN, recently began teaching a certified nursing assistant course for high school students through a local community college.

Heywood Healthcare is also working to strengthen its support workforce by expanding training programs for medical assistants, Ms. Penney said.

“Strengthening this pipeline not only supports our clinicians at the top of their licenses but also creates meaningful career pathways for local residents and helps ensure long-term workforce resilience,” she said.

At Scotland County Hospital in Memphis, Mo., recruitment has been a major focus for CEO Meagan Weber for the past three years. In 2022, the hospital launched high school medical clubs through its local school district, where a hospital coordinator works with school counselors to introduce students to various healthcare roles.

Students are offered observation hours across hospital departments. Since launching, the hospital has recruited and hired four nurses and one lab technician from the club.

“This is our biggest recruitment focus, along with adding funds to our education assistance programs through the hospital,” Ms. Weber said. “Leading a rural hospital means hiring people who understand and appreciate rural living, so growing our own is one of the best things we can do for our future healthcare team.”

Retention through culture

Recruitment remains a top priority for rural hospitals, but so does retention. At Lincoln Health, the latter has benefited from a strong, values-driven culture.

“We’re never going to be able to compete with the bigger systems financially, but I can give nurses an opportunity to do different things,” Mr. Stansbury said. “I can make sure they know how much I appreciate them.”

He said culture-driven gestures can have a significant impact.

“I can foster an environment where our medical staff is very respectful to other clinical staff, and that our service and support staff feel empowered to do the right thing,” he said. “Those are the kinds of things we can do, and it doesn’t cost me any money to do that.”

Lincoln Health has not used agency nurses for the past 15 to 20 years, he added.

“That’s just a testament to the community and the kind of folks that we have working here, and also a commitment from the board and the leadership that we’re really going to value people,” Mr. Stansbury said. “We can’t compete financially, but we can whip the urban systems with our culture.”

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