Cottage Hospital, a 35-bed critical access hospital in Woodsville, N.H., reduced its use of travel staff by 70% in 2025 — a shift driven by workforce investments that focused on stabilizing staffing and reducing costs.
Like many rural hospitals, Cottage struggled with rising labor costs during and after the COVID-19 pandemic. By April 2024, the hospital hit an all-time high in contract labor — even exceeding its pandemic peak.
“We had tried several different things trying to figure out how to turn that around, and we were just unsuccessful at it,” Holly McCormack, DNP, RN, president and CEO of Cottage Hospital, said in a December interview on the Becker’s Healthcare Podcast. “We were at the point where we had the highest number of travelers in this organization historically — ever.”
That tipping point led to a strategic shift: “We said we have to put money into people, not into things,” Dr. McCormack said. The hospital began redirecting resources to its workforce — approximately 250 employees — by increasing salaries, maintaining employee health insurance costs, and reassessing benefit structures.
The result was a 70% reduction in traveler use between late May and the end of 2025.
“That investment has paid off exponentially and has allowed us to now be forward thinking about where Cottage can continue to go and grow,” she said. “And don’t get me wrong, there’s still work that has to be done, but it is just amazing to see.”
In addition to financial investments, Dr. McCormack and Chief Nursing Officer Natalie Kennett, MSN, RN, restructured nursing leadership and reintroduced a nurse educator position — a role the hospital hadn’t had in years.
“That’s very important for the nurses we’re hiring and orienting — to feel supported through the process,” Dr. McCormack said. “It was a big investment, but it was absolutely the best thing that we did in 2025.”
This strategy builds on a longer-term “grow our own” approach to workforce development at Cottage, which Dr. McCormack outlined in a November 2024 interview with Becker’s. At the time, she described efforts such as creating internal travel contracts for per diem staff, launching a licensed nursing assistant program in local high schools, and restructuring leadership roles to create clearer career pathways.
Now in her fourth year as CEO — after serving as chief nursing officer and director of inpatient services — Dr. McCormack said the workforce investment has positioned Cottage Hospital to focus on future growth and stability.
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