Rural Hospital & Critical Access Hospital Nurse Staffing Statistics
A sourced 2026 reference on RN turnover, vacancy, cost of turnover, rural workforce density, wages, and the Texas CAH picture. Every figure is citable and embeddable.
Compiled by Pradeep Pandey · Updated July 14, 2026 · Figures verified against primary sources (listed on each card and in Sources).
The short version
Rural and Critical Access Hospitals staff against the same national shortage as everyone else, from a thinner workforce and with almost no back office. There are 1,383 CAHs in the U.S.; average hospital RN turnover is 17.6% and each departure costs about $60,090. In Texas specifically, CAHs run a lower RN vacancy (11.6%) but the highest RN turnover (18.2%) of any hospital type, staffed by a nurse workforce that is only 61% RN. The cards below are individually sourced and embeddable.
Critical Access Hospital Landscape
Critical Access Hospitals (CAHs) are federally designated rural hospitals of 25 or fewer acute-care beds. For how scheduling actually works at that scale, see our guide to critical access hospital scheduling.
Rural hospitals of 25 or fewer acute-care beds, as of April 2026.
109 fully closed and 88 converted to another care model; 154 of them since 2010.
86% also reported retention challenges (survey of 155 CAH CEOs, March–May 2022).
National Nurse Staffing & Turnover
The national figures below come from the 2026 NSI report (calendar-year 2025 data, 527 hospitals across 40 states). They set the backdrop small hospitals staff against; the nurse scheduling software that fits a CAH has to move these numbers with far fewer resources.
18.6% median, ranging from 5.6% to 40.0% depending on hospital size.
One in three hospitals (33.1%) reports an RN vacancy rate above 10%.
The average hospital loses $4.2M–$6.2M a year to RN turnover; each 1% change is worth about $295,000 a year.
About 43 unfilled RN positions at the average hospital; 78 days to recruit an experienced RN.
Rural Access & Workforce Projections
Rural facilities do not just have fewer nurses; they draw from a thinner pool that is projected to thin further. This is the structural reason a single callout can leave a CAH unit uncovered.
Rural areas have roughly two-thirds the RN density of urban areas (2024 BLS OES data).
The nonmetro RN shortage is projected at 11%, versus 2% in metro areas.
Registered Nurse Wages
Wage figures matter because overtime is charged at 1.5 times these rates. Catching overtime before a schedule posts is a direct cost lever; see how AI nurse scheduling flags approaching thresholds.
About $46.90 per hour (BLS May 2025 OEWS wage data, via O*NET).
About $46.14 per hour (BLS May 2025 OEWS wage data, via O*NET).
The Texas Critical Access Hospital Picture
Texas has 91 Critical Access Hospitals today (Rural Health Information Hub, 2026), and it runs its own hospital nurse-staffing study, which lets us separate CAHs from other rural and non-rural hospitals. The figures below are from the Texas DSHS 2024 study (spring-2024 survey, published February 2025), which counted 86 CAHs in its survey frame at the time. For the compliance layer these facilities operate under, see Texas nursing overtime compliance.
The 2024 state survey counted 86 CAHs across 78 counties, of which 50 responded. The current federal count is 91 (Rural Health Information Hub, 2026).
Lower than rural non-CAH hospitals (14.3%) and non-rural hospitals (16.5%).
The highest of the three groups (rural non-CAH 15.4%, non-rural 17.4%).
Versus 80.5% at non-rural hospitals; LVNs make up 16.4% of CAH nursing staff (vs 3.6%).
Only 24% increased their budgeted RN FTEs, versus 36.3% no-change at non-rural hospitals.
Down from 17.6% in 2022; 8,575 of 52,369.8 RN FTEs statewide were vacant.
Down from 28.3% in 2022.
How to cite and embed these statistics
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Frequently Asked Questions
Rural and CAH nurse staffing, in numbers.
How many Critical Access Hospitals are there in the United States?
What is the average hospital RN turnover rate?
How much does it cost to replace a hospital nurse?
How many Critical Access Hospitals does Texas have?
Can I reuse these statistics?
Sources
National figures use the 2026 NSI report (calendar-year 2025 data). Texas figures use the Texas DSHS 2024 Hospital Nurse Staffing Study (spring-2024 survey, published February 2025). Wage figures reflect BLS May 2025 OEWS data republished by O*NET and sit at the median position. The CAH CEO recruiting figures are from a March–May 2022 survey.
- Flex Monitoring Team, Historical CAH Data. flexmonitoring.org.
- UNC Sheps Center, Rural Hospital Closures Tracker. shepscenter.unc.edu.
- Flex Monitoring Team, CAH workforce policy brief (February 2023). flexmonitoring.org (PDF).
- 2026 NSI National Health Care Retention & RN Staffing Report. nsinursingsolutions.com (PDF).
- Rural Health Information Hub, Health Care Workforce. ruralhealthinfo.org.
- HRSA / National Center for Health Workforce Analysis, workforce projections (December 2025). bhw.hrsa.gov.
- O*NET OnLine, 29-1141.00 local wages (BLS May 2025 OEWS). onetonline.org.
- Texas DSHS 2024 Hospital Nurse Staffing Study, Rural/CAH factsheet. dshs.texas.gov (PDF).
- Texas DSHS 2024 Hospital Nurse Staffing Study, Highlights factsheet. dshs.texas.gov (PDF).
Staffing a rural hospital against these numbers?
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