Recruitment and Retention of First Year of Service Registered Nurses in Rural Hospitals in Alabama

Date of Award


Document Type


Degree Name

Doctor of Healthcare Administration (DHA)

Committee Chair

David Meckstroth

Committee Member

Leslie Mathew

Committee Member

Karen Lankisch


Healthcare leaders around the United States are facing nursing shortages. It is a staffing challenge that has been cyclical throughout the decades but to date has had no resolution. The shortages are a symptom of basic economic terms, supply and demand. Nurses are retiring and not enough are entering in the workforce to offset those that are retiring. The general population is getting older but living longer and at the same time suffering from multiple chronic conditions that require more frequent hospitalizations. The literature search for this research sought out both historical and current research specifically outlining rural healthcare. While the healthcare industry as a whole struggles with the recruitment and retention of registered nurses, rural healthcare has geographical challenges that make it even more challenging as generational preferences may drive the new graduate nurses to more urban hospitals purely for lifestyle preference.

This research conducted an exploratory qualitative survey of healthcare executives in rural hospitals in the State of Alabama to gain a better understanding of the recruitment and retention of first year of service registered nurses in rural hospitals in Alabama. This research included in-depth one on one interviews with forty-five executive leaders using a standard interview protocol developing by the researcher. The research questions probed specifically into each hospital’s specific registered nurse recruitment as well as registered nurse first year of service retention challenges.

The research concluded that all of the rural hospitals involved in this study struggle with registered nurse recruitment and first year of service retention. The dynamics that caused the challenges differed somewhat depending on the location of the hospital. Some hospitals may be designated rural but are in larger cities or neighbor a large metropolitan area. This created a unique challenge for some of those rural hospitals who competed with urban hospitals for the same talent. This is because those registered nurses could in fact live in the rural community and commute to the urban hospital for work in order to make more money, specialize in their role, and be in a hospital with far more resources available to keep patient ratios lower and have more advanced technology.