When Tawny Sandifer, MSN, RN, chief nursing officer at Columbus (Neb.) Community Hospital, looks at her nursing staff, she sees what she calls an “inverted experience pyramid”: a workforce weighted heavily toward newer graduates, with fewer of the seasoned nurses who once anchored the floor.
It is a dynamic she and other rural nursing leaders told Becker’s is reshaping how they think about staffing for 2027. Across rural hospitals, CNOs are redesigning care team structures, rethinking how experienced nurses are deployed, and in some cases reconsidering what rural nursing is and who it is for.
The challenge is not unique to any one facility. Nearly 70% of rural counties in the U.S. are designated as health professional shortage areas, according to the National Rural Health Association, and the pressure on rural nursing teams has grown alongside that gap.
Ms. Sandifer is responding by adding a dedicated resource nurse role to her staffing model in 2027. The position is designed to keep experienced nurses visible and active on the floor, giving newer staff a real-time resource without pulling charge nurses off their own responsibilities. She is also strengthening nurse residency and transition-to-practice support and expanding competency development and upskilling across her team.
“The goal is to create a stronger clinical safety net around newer nurses while protecting the experienced nurses whose judgment, coaching and expertise are increasingly critical,” Ms. Sandifer said. “Ultimately, this work is about stabilizing the nursing workforce by building a model designed for today’s inverted experience pyramid, rather than relying on staffing structures built for a workforce that no longer exists.”
At Hillsboro (Ill.) Health, Tommi Cline, DNP, RN, chief nursing and compliance officer, is approaching the same problem with a different set of tools. Her hospital has added task nurses to its care delivery model, allowing registered nurses to delegate work such as reviewing discharge instructions and completing lengthy admission assessments so they can focus on direct clinical care. Hillsboro Health has also built partnerships with local nursing schools, hosting clinical groups and serving on advisory boards to introduce students to the organization before they graduate.
In 2027, Dr. Cline plans to incorporate pharmacy education into the discharge process through a collaboration with one of the hospital’s pharmacists. She is also looking ahead to what technology might relieve.
“In 2027, we hope to further explore AI-supported nursing documentation,” Dr. Cline said. “We believe this technology could reduce clinicians’ documentation burden and help us recruit and retain clinical staff.”
The staffing redesign underway at rural hospitals is partly operational and partly about identity. Theresa Hollinger, MSN, RN, CNO at Grant Regional Health Center in Lancaster, Wis., has spent more than a decade in rural critical access hospitals and has developed what she calls “rural nursing as a specialty,” a framework for helping nurses see the breadth of rural practice as a strength rather than a limitation.
Since 2021, Ms. Hollinger has been working directly with college nursing programs to shift how instructors talk about rural careers. She said instructors have an outsize influence on how newly graduated nurses think about floating across service lines and how they choose specialties, and her outreach has been aimed directly at that influence.
“When our colleges help nurses to embrace rural nursing and the broad scope of practice as similar to how a family medicine physician sees their practice, the new nurse is more apt to see the benefit of the broad scope, rather than identifying it as a detriment,” Ms. Hollinger said. “Our rural nurses should be proud of multiskilled practice that includes all of medical, surgical, ER and OB.”
The question underneath all of it is whether any of it holds. At Hendry Regional Medical Center in Clewiston, Fla., Dakota Redd, RN, CNO and chief experience officer, has been building an answer for five years. His hospital sits within 50 miles of larger facilities, a geographic reality that once translated directly into turnover. Registered nurse turnover reached 30% in 2021 and climbed as high as 40% at points during the pandemic.
The response was not primarily financial. After investing in culture, turnover fell to 19% in 2022, dropped to 6% in 2023, rose to 10% in 2024, and came back down to 8% in 2025.
“We have much larger hospitals within 50 miles of us that offer better benefits, better pay, and quite honestly many more specialties to practice,” Mr. Redd said. “But the staff choose now not to drive by us, but to work with us.”
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