Inside One Rural Hospital’s Grassroots Workforce Blueprint

As labor shortages intensify, Unity Medical Center's CEO is leaning on early pipelines, staff flexibility, and lived experience to enhance recruitment and retention.

Rural hospitals are struggling to stay staffed, making it harder to stay open.

With financial constraints and labor shortages squeezing providers, small facilities often lack the resources or scale to compete for top talent. At Manchester, Tennessee-based Unity Medical Center, however, CEO Martha Henley is proving that a local, personalized approach can help level the playing field.

“We have been very blessed to have a great partnership with our high schools and our secondary schools,” Henley told HealthLeaders. “We have nurses or potential nurses coming in and rotating through. We've allowed some of our staff to go and help teach some of those courses. So that collaborative effort is grooming those people to know that they want to work for us.”

It’s a workforce pipeline rooted in proximity and familiarity, and it’s helping the hospital remain independent and weather a storm that’s closing rural facilities across the country. According to The Chartis Center for Rural Health, 182 rural hospitals have closed or converted to an operating model that excludes inpatient care since 2010, with staffing cited as one of the leading factors.

Henley’s approach of engaging students early, mentoring them through clinical exposure, and giving them space to grow, has since expanded to the other hospitals under her oversight through Java Medical Group, which she also serves as COO.

“If they don't come to work for us, they come to work for someone that is also helping us,” she said, highlighting that cultivating healthcare workers locally strengthens the broader rural health ecosystem.

Re-recruiting from within

The same philosophy carries over once someone joins the team. Rather than locking employees into a single role, Henley encourages cross-training and internal exploration to find the right fit.

“We may hire someone to be a Med Surg nurse and they could be a great nurse, but they just don't love it,” she said. “So if they have the flexibility to cross-train into a surgical department or another area, we can find what they love and they're going to stay.”

Henley says this approach directly combats burnout, which remains a significant post-pandemic threat, especially in smaller facilities that can’t offer scale-based relief. “If their quality of life at home is great, it's going to be reflected in the work as well—and vice versa,” she said.

That strategy also gives Unity a differentiator in a tight labor market, where rural providers often struggle to compete with urban systems offering higher wages and signing bonuses.

“The nursing shortage is real,” Henley said. “We're in competition with some people that have a lot bigger pockets than we do. So one of the things that we focus on is just that flexibility and allowing them to find something they can be passionate about.”

Leadership shaped by the front lines

Henley’s staffing philosophy is rooted in firsthand experience. Her own healthcare career started not in the C-suite, but in the operating room and emergency department. Over the years, she worked as a CNA, scrub tech, ER tech, phlebotomist, and ward clerk—mopping floors and cleaning rooms long before she stepped into a leadership position.

“I've literally done every job in a facility at one point or another,” she said. “That makes it interesting when people go to talk to me.”

That history pays dividends when leading by example. Henley recalled an instance when there was a facility merger and rooms needed to be cleaned, but housekeeping was booked. “I said, ‘Hey guys, we know how to clean the room. I've done this before.’ So I literally put on scrubs, went down and did it for them to show that it takes the village to make all of this work.”

That moment, she noted, helped reinforce to her staff that leadership is shared and that culture matters.

Strategic independence

Unity’s success in workforce development highlights a critical point for other rural hospitals: resilience doesn’t always require large-scale investments, but can instead be achieved by having deep community roots, flexibility, and leadership that understands the day-to-day.

For Henley, it starts with rethinking what it means to be independent. “To be independent does not mean you have to be alone,” she said.

Unity maintains partnerships with larger organizations for specialty care and shared services. For example, the hospital this week announced a clinically integrated alliance with Ascension Saint Thomas to expand specialty services like cardiology, neurosciences, and women’s health, while increasing access to telemedicine services like telestroke.

Meanwhile, the workforce model remains local. Henley encourages her peers to invest in long-term pipelines and to meet talent where they are.

She said: “If you can get involved with the schools, if you can work to develop those relationships with the colleges, you're going to secure your workforce.”