Date of Conferral

12-10-2025

Date of Award

December 2025

Degree

Doctor of Healthcare Administration (D.H.A.)

School

Management

Advisor

Matt Frederiksen-england

Abstract

Abstract The shortage of nursing staff in rural hospitals has created a critical workforce challenge in the United States, negatively affecting patient care, organizational performance, and community health. The purpose of this integrative review was to identify evidence-based strategies to improve the recruitment and retention of nurses in rural hospital settings. A search of literature published between 2021 and 2025 yielded 20 high-quality and good-quality studies that addressed the problem. Guided by Herzberg’s two-factor theory, thematic analysis revealed six overarching themes: (a) strategic improvements, (b) system efficiency and effectiveness, (c) service availability, (d) care models, (e) organizational support, and (f) performance improvements. The findings emphasized the importance of addressing both hygiene factors (such as compensation, work conditions, and geographic barriers) and motivators (such as recognition, professional growth, and leadership support) to achieve workforce sustainability. Recommended strategies include financial incentives, structured mentorship and professional development, expanded telehealth and education pipelines, and supportive leadership practices. This review provides healthcare administrators with a theory-informed framework to strengthen rural nurse recruitment and retention while advancing equity and improving health outcomes in underserved communities. By enhancing workforce stability in rural hospitals, these strategies address critical social determinants of health, such as access to quality healthcare, economic stability, and community well-being, thereby promoting health equity and driving positive social change for vulnerable and underserved populations.

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