At the same time that rural hospitals are finding it difficult to hire enough nurses, rural nursing students, who are more likely to work in their communities, are facing challenges getting into training programs.
Chrissy Curcio, chief nursing officer at A.O. Fox Hospital in Oneonta, New York, leads the teaching at Maria College’s LPN program. She said in some rural hospitals, about a quarter of nursing positions are unfilled.
“I know some hospitals like Albany Med have a 25% vacancy, and depending on the time of year, it can climb as high as 30% or 40%,” Curcio said in an interview with the Daily Yonder. “There’s less and less interest (in nursing). When I started 18 years ago, there was a lot of competition to get into the nursing school. Now, the nursing schools have positions open, it’s just a matter of really trying to pull people into these positions. There’s just not the same funnel there was in the past.”
Across the country, rural hospitals are struggling to fill empty nursing positions. According to HRSA Nurse Workforce Projections, non-urban areas face a 24% shortage of registered nurses (RN), compared to just 5% in metropolitan areas. A workforce projection model in North Carolina, NC Nursecast, predicts that the state will see a shortage of nearly 12,500 RNs and 5,000 Licensed Practical Nurses (LPN) by 2033. As of July 2026, roughly one-third of LPN positions across the state were vacant. Historically, studies show that metro counties average nearly 30 more registered nurses per 10,000 residents than non-metro counties, according to the National Rural Health Association.
Even when rural students are interested in nursing, they face challenges getting into colleges with nursing programs. One issue is the distance the students face in just getting to classes, Curcio said.
“Another piece of it is just locality,” she said. “I came from Schenectady, New York, where I first started, and I could turn 15 minutes to the left, 15 minutes to the right, and I had a hospital or a school I could attend.” That changed when she moved to the northern Susquehanna River valley between the Finger Lakes region and the capital region around Albany. “In our area, there’s a selection of a few different schools around us, so some of the students have to drive one- or two–plus hours to get to them. That makes (college) less realistic because of the physical distance.”
One innovative solution, a former hospital executive said, is to hire from within.
For Ryan Gates, senior vice president and dean at the Michael O. Leavitt School of Health at Western Governors University near Salt Lake City, Utah, the problem in his experience was competition among prospective nursing students.
Gates grew up in McFarland, California, and previously led Kaweah Health in Visalia, a public hospital system serving California’s rural Central Valley. What he saw was that rural students were losing in the competition for college slots in nursing programs. While local students could only afford to apply to one school, students from more affluent areas with better grades, more volunteer hours and more extracurricular activities would apply to all of the schools and move to wherever they were admitted.
“We had four nursing schools, two were community colleges and two were state universities, but because they were all state-funded schools, they had to adhere to the admissions rubric to admit students to the program, and they could not provide or offer any preference points on that rubric towards the local kids,” Gates said in an interview with the Daily Yonder. “The local kids didn’t have the economic means to apply to every school in the state, but they could apply to the junior college across the street. Because of the competitive nature of many of the programs, they never got in, and so they just gave up, paid a for-profit tech school significant amounts of money to get a CNA or medical assistant certificate, and then went to work in my rural health clinic for barely above minimum wage.”
Instead of making a bigger path for aspiring nurses, Gates said he created a new one. At Kaweah Health, Gates looked at the support employees already in the hospital system to help them get their nursing degrees.
“The health system partnered with an online private higher education institution,” he said. “That allowed us the ability to dictate who got enrolled into the program. We set the criteria, and the first criteria was that they had to be employed by the hospital. We didn’t care if they worked in the cafeteria or in the rural health clinic, if you wanted to become a nurse and you’re an employee of ours, we wanted to give you that opportunity.”
The online college provided all of the coursework, he said, and the healthcare system provided the access to hands-on training and required clinical rotations. Together, they were able to provide the totality of training for the nurse candidates.
More than just creating more nurses, he said, it created more loyal workers and helped with recruitment for other positions.
“Health system leaders, rural health system leaders out there are struggling with recruitment and retention of talent,” he said. “I strongly suggest they consider evaluating the possibility of creating a ‘grow your own’ model.”
Partnering with a school like WGU allows rural health systems to upskill their current talent within their own employee base,” he explained. “They [the employees] don’t have to quit their jobs and create a further workforce shortage. They can complete their didactics while staying gainfully employed and providing for their families.”
Curcio agrees that more rural hospitals need to find new ways to get local students into healthcare programs. They also need to work with nearby school systems to get students interested in healthcare fields at a younger age.
“We have a program at our hospital starting at a young age,” she said. “We’ve talked about building a nursing program where you start off even in elementary school teaching kids how to listen to a heartbeat, or to take a pulse, or to wrap a dressing, just to gain their interest,” she said.
“Before, I used to focus on high school, but we’re starting to go into younger populations. By the time high school happens, there’s so much competition for ideas and trades and work, especially in rural America, there’s a lot of competition, so you’ve got to get in when they’re younger to just plant the seed.”
The post Looking Local Could Be a Solution to Rural Nursing Shortage appeared first on The Daily Yonder.
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