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Through a partnership with Avera Health, South Dakota State University's College of Nursing is working to address the rural nursing workforce shortage. 

The national trends paint a grim picture for rural health care. Across the United States, rural health care systems are facing "historic nursing shortages" and in largely rural states — like South Dakota — the shortage is severe and projected to get even worse. It's estimated that South Dakota will have roughly

South Dakota State University is taking steps to address this crisis head-on. SDSU's College of Nursing is continuing an academic-clinical partnership with Avera Health, one of the state's largest health care providers, to improve and increase interest in rural nursing careers by exposing undergraduate nursing students to both acute and long-term rural health care settings. The project is being led by SDSU assistant professor Theresa Garren-Grubbs.

"Over the last five years, my research has concentrated on various aspects of rural health and well-being," Garren-Grubbs said. "This includes the recruitment and retention of nurses in rural acute care settings, rural workplace violence and nursing incivility and resilience. Since the majority of South Dakota is considered rural or frontier, this research has significant implications for our state."

Rural hospitals and clinics face a myriad of issues. Rural populations tend to be older and sicker on average and recruiting and retaining enough personnel to manage all the patients has long been an issue for rural hospitals. Some rural hospitals also lack the funds to compete with larger health care systems in terms of salary, and it can be difficult to attract recent graduates to rural settings if they are not already from there.

By providing undergraduates with real-world, hands-on experience in rural health care settings through a clinical immersion program, Garren-Grubbs believes the program can help chip away at the nursing shortage.

The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, has provided SDSU and Avera Health $4 million over a four-year period to facilitate the project, titled "RETAIN-RNs: Partnering to Expand and Retain South Dakota's Nursing Workforce in Acute and Long-Term Care Settings." Students will spend around 80 hours in both rural acute and long-term health care settings during the summer months. They will work one-on-one with a nurse preceptor during one and will get a realistic look at what it is like to work in a rural health care facility. 

Garren-Grubbs has an intimate understanding of the challenges rural health care systems and professionals face. Before joining SDSU's faculty, she worked in a rural health care setting. 
Providing students with real-world exposure to these challenges, Garren-Grubbs says, can help students learn if rural health is right for them.

"Some students fall in love with rural health care settings but without that exposure, they might not have found out where their passion in health care lies," Garren-Grubbs said. "This project gives students direct exposure working in rural health care facilities."

The RETAIN-RNs project builds upon a previous rural health project, PREPARE-RNs, which wraps up near the end of 2026. In a similar manner, the PREPARE-RNs project, in partnership with Avera, provided students with real-world experience and exposure to a rural health care setting. The results were eye-opening, Garren-Grubbs said.

"Over half of the students who participated in PREPARE-RNs took jobs in a rural health setting," Garren-Grubbs said. "I was pleasantly surprised with the success of the program. This new project will help give more students rural health opportunities and experience and will help continue to address our rural health nursing shortage."

The RETAIN-RNs project is expected to begin this summer. Over 40 students are projected to participate in the project over the course of the funding period.

"Dr. Theresa Garren-Grubbs' leadership and passion for rural health is demonstrated clearly by this ongoing partnership with Avera and the awarded grant," said Sarah Mollman, associate dean of research for SDSU's College of Nursing. "By students understanding the complexity of rural health care and the challenges our rural residents face, they not only are more likely to work in rural areas but can be the change agents and innovators needed to advance rural health."