Date of Conferral

8-12-2026

Date of Award

August 2026

Degree

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

School

Health Sciences

Advisor

Donna Clews

Abstract

Vacancy rates are a current problem in a freestanding outpatient dialysis clinic in rural communities. From an administrative perspective, vacancy rates increase costs associated with recruitment, onboarding, training, overtime and compromise the quality and safety of patient care. The purpose of this integrative review was to identify evidence-based strategies to decrease vacancy rates in rural Georgia dialysis clinics. Donabedian’s framework of structure, process, and outcome was used for this integrative review. The integrative review question explored evidence-based strategies that can decrease vacancy rates in dialysis clinics in rural Georgia. Out of 50 articles reviewed using the John Hopkins Evidence-Based Practice Model, 24 met content and quality requirements for thematic analysis. Analysis revealed three themes: recruitment, staffing models, and retention. Recruitment subthemes are rural clinic partnerships, hiring incentives, and workforce pipeline. The staffing model subthemes include staffing adequacy, staffing ratios, and workforce planning. The subthemes related to retention include professional development, mentorship, and workforce stability. Workforce pipeline development includes partnerships with local nursing programs, technical colleges, and apprenticeship or earn-and-learning pathways to support a steady pool of dialysis-ready nurses and patient care technicians. Structured onboarding and mentoring may include competency-based orientation, preceptor support, regular check-ins, and progress tracking using benchmarks such as turnover, retention, and vacancy rates below 5-7%. Within a social determinant of health framework, strengthening the rural dialysis workforce supports positive social change by improving equitable access to life-sustaining dialysis care for communities facing geographic and resource-related health disparities.

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