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Rural America is facing a nursing shortage. Theresa Garren-Grubbs, clinical assistant professor in South à£à£Ö±²¥Ðã State University's College of Nursing, is addressing the problem head-on through research and education. 

The COVID-19 pandemic revealed many things. For one, it put on a spotlight on the importance of nurses in our nationwide health care system. By April 2020, it was abundantly clear just how crucial front-line health care workers were to keeping the U.S. populace healthy.

The pandemic also revealed systematic problems in the health care system. Primarily, there weren't enough nurses, and the number of nurses needed was growing.

Before the pandemic, there was a clear but underreported nursing shortage. After the pandemic, the problem became worse. According to research from the National Council of State Boards of Nursing, roughly 100,000 registered nurses left the profession during the pandemic. On top of that, almost 900,000 registered nurses intend to leave the workforce by 2027, per a national nursing workforce study.

In primarily rural states like South à£à£Ö±²¥Ðã, the nursing workforce shortage is even worse, and the issue is compounded by great distances between health care facilities, higher rates of chronic disease and economic challenges. In fact, nearly all of South à£à£Ö±²¥Ðã is considered short of primary medical care staff, per the South à£à£Ö±²¥Ðã Department of Health. By 2030, South à£à£Ö±²¥Ðã is projected to have one of the highest nursing shortages in the entire country. 

Theresa Garren-Grubbs is a clinical assistant professor in South à£à£Ö±²¥Ðã State University's College of Nursing. She was hired by SDSU in 2016 and soon learned the many challenges the state's rural nursing workforce faced. She has made it her mission to solve this problem and improve rural health and well-being through research and education. 

"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 à£à£Ö±²¥Ðã is considered rural or frontier, this research has significant implications for our state."

One of Garren-Grubbs’ major initiatives has been "PREPARE-RNs: Partnering to Address the Critical Nursing Shortage in South à£à£Ö±²¥Ðã," a project aimed at addressing health care workforce capacity. What began in 2022 with $1 million in funding from the Health Resources and Services Administration has blossomed into an academic-clinical partnership with Avera Health that provides undergraduate nursing students with the opportunity to complete over 200 clinical hours in rural acute care settings in South à£à£Ö±²¥Ðã.

"Since these clinical hours occur during the final year of the nursing program, the students can appreciate the flexibility and skill required by nurses in these settings," Garren-Grubbs explained. "Exposure to rural nursing has motivated many participants in the program to seek employment in rural settings."

The results of this work have been encouraging. According to Garren-Grubbs, over half of the nursing students who participated in the PREPARE-RNs project have accepted their first nursing position in a rural health care facility within South à£à£Ö±²¥Ðã.

"By understanding the experiences of rural nurses, we can make informed recommendations for health care facilities regarding recruitment and retention," Garren-Grubbs said. "Practicing in a rural setting can be daunting for many new nurses, but we are learning more about what they seek in their first nursing job, which often includes a supportive, nurturing environment to learn. This can be used to develop programs, especially in rural settings, to support new nurses."

For her work, Garren-Grubbs was named the College of Nursing's Outstanding Researcher at SDSU's 2025 Celebration of Faculty Excellence.

"I am passionate about the land-grant mission of South à£à£Ö±²¥Ðã State University and believe it is important to conduct research that benefits our local communities and beyond," Garren-Grubbs said. "University-level research can play a pivotal role in addressing the nursing shortage in South à£à£Ö±²¥Ðã and our region. By collaborating closely with our clinical partners, we can identify the needs of current nurses in rural practice and understand what attracts nurses to these settings."

There is still much work to be done in addressing the rural nursing shortage, however. According to Garren-Grubbs, the reasons why nurses do not choose rural practice settings are still not widely understood.

"Despite our extensive knowledge of health care and nursing in rural settings, many unknowns remain," Garren-Grubbs said. "My research aims to explore the differences between health care and nursing in rural versus urban settings and to identify strategies to promote rural practice among nurses."

She also plans to further investigate the rural nursing shortage and enhance the rural training programs available to SDSU's undergraduate nursing students to foster their interest in rural nursing settings.

"With a better understanding of what nurses are looking for in their clinical practice, we can develop more effective programs and supports for those interested in rural practice," Garren-Grubbs added.