With no float pools nor backup systems nearby, many rural hospitals have built cross-training programs out of necessity. The lessons they learned about confidence, sequencing and culture are increasingly relevant for health systems of every size.
As workforce vacancies and agency spend continue to pressure health systems across the country, the model that rural providers stress-tested out of necessity offers something most larger systems have not yet had to develop. The strategy is not new, but became more common during the COVID-19 pandemic to shoulder workforce shortages when resources were more limited.
The workforce results at Reeves Regional Health in Pecos, Texas, illustrate what that investment can produce. Chief Nursing Officer JohnRich Levine, DNP, said the RN vacancy rate has dropped to approximately 7%, with retention improving to around 75%. Dr. Levine attributes those results to several concurrent initiatives, with cross-training as a central driver.
But the outcome he pointed to first is not a metric. It is a shift in how staff approach every patient encounter.
“Rural healthcare is broader healthcare,” Dr. Levine told Becker’s. “For us, every nurse, nurse leader and department carries a broader scope of responsibility because patient needs arrive without regard to specialty, staffing plans, or departmental boundaries. Cross-training prepares our teams to act with confidence wherever the need arises.”
He added that cross-training has shaped the system’s culture, starting conversations with, “How do we help our patient?”
“That mindset has created a more adaptable workforce and strengthened collaboration across departments,” he said. “It also prepared us for the realities of rural healthcare, where readiness shapes every patient encounter.”
That cultural shift required revisiting the program itself. Early on, Reeves Regional built its approach around skills documentation: competencies assessed, checklists completed. Over time, leaders learned that competence and confidence develop differently: competency grows through education, while confidence grows through experience. The redesign that followed focused on readiness, building in simulation, mentoring, hands-on practice and interdisciplinary collaboration to reinforce each experience before the next.
“That approach prepares our teams for the uncommon situations that define rural,” Dr. Levine said. “In our healthcare, every day brings a different set of patient needs. But readiness gives our teams the confidence to respond effectively, regardless of what comes through the emergency department doors.”
Joplin, Mo.-based Freeman Health System has been intentional about cross-training colleagues where it makes sense, President and CEO Matt Fry told Becker’s. Many nurses are cross-trained to work across different nursing units, environmental services staff cover multiple areas in the hospital and system support colleagues manage functions across service lines. The results have been operational: a more adaptable workforce with lower labor expenses and fewer service disruptions, he said.
The lesson Mr. Fry pointed to, however, is about scope. Programs that try to cover too much too quickly undermine the outcomes they are designed to produce.
“It is really important that you don’t try and boil the ocean with your cross-training strategy,” he said. “I would recommend cross-training colleagues across similar services. I would limit the cross-training for any one colleague to one additional department at a time, only introducing additional training opportunities when they’ve demonstrated mastery with their current scope of work.
“The goal is to have cross-trained colleagues be high-functioning, which takes time, patience, a willingness to learn and tactical leadership.”
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