About five years after hospitals were hit hard by the COVID-19 pandemic, workforce trends appear to be stabilizing.
In 2021, overall vacancy rates for hospital positions in Missouri were at 17%, but this rate declined to 10.1% in 2025, according to the Missouri Hospital Association’s 2026 Workforce Report. Despite a lower number of open positions, the number of employee separations remained high, and the employee turnover rate saw an uptick from 22.2% in 2024 to 23.7% in 2025.
Jill Williams, MHA’s vice president of workforce development, said these findings indicate that hiring has improved, but hospitals are still struggling to retain staff.
“Workforce challenges are no longer temporary,” Williams said. “They’re no longer a temporary disruption, but more a larger strategic issue that requires long-term investment and collaborative solutions.”
Turnover rates stay high for entry-level roles
Most of the hospital jobs that saw high turnover were not the same as those with high vacancy rates, though nurse assistants and licensed practical nurses reached the top 10 in both categories.
Specialized clinical roles like employed physicians, imaging specialists and nursing roles saw the highest number of vacancies. These roles, which include MRI and CT technologists, licensed practical nurses, nurse assistants, registered nurses and surgical technicians, require significant training and professional licenses, making qualified candidates more difficult to find.
Conversely, the turnover rate is elevated in roles that serve as entry points into higher level healthcare jobs or support roles. These positions include nurse assistants, environmental services workers, phlebotomists and food service workers. The relatively low vacancy rates for these positions combined with their high turnover rates points to a lower number of jobs being open at a time but a lack of long-term hires.
However, high turnover for entry-level roles is not a new phenomenon, and Williams said that much of the turnover comes from expected career advancements or changes in path.
“As far as turnover, you know, we typically see those entry-level roles: nurse assistant, environmental services, phlebotomist — those typically always hit those top few turnover positions,” Williams said. “Those positions are constantly experiencing wage competition, and they’re kind of like a stepping stone for career advancement, you know, people are getting their foot in the door, they're maybe realizing healthcare isn't for them, or they are, and then they are advancing their career, maybe going back to school or getting on-the-job training, and then advancing up through the healthcare system.”
Environmental services workers, also referred to as housekeeping or janitorial services, are the staff responsible for cleaning and disinfecting healthcare facilities, including medical equipment and patient rooms. In 2025, environmental services workers saw a 42.5% turnover rate in Missouri hospitals, which may be due to safety or pay factors.
These workers face the risk of infectious disease and hazardous chemicals that cleaners in other sectors might not face, according to the Occupational Safety and Health Administration.
A healthcare workplace safety report from Press Ganey found that safety plays a role in workforce retention. The State of Healthcare Safety 2026 report found that workers with unfavorable views of workplace safety are 1.74 times more likely to leave and that 46.6% of respondents rated their workplaces low on overall safety culture.
In 2024, janitors and cleaners in the healthcare and social assistance industry had a median wage of $18.35 per hour or $38,160 annually, according to data from the U.S. Bureau of Labor Statistics. Janitors and cleaners in eight other industries had higher median wages in the U.S., including transportation, educational services and government sectors.
Rural healthcare programs invest in building pipelines
Regional differences have pointed to a variety of problems across the state, from rural areas facing shortages while the urban centers of St. Louis and Kansas City struggle with high turnover rates in various roles.
The south central region of the state, which includes Poplar Bluff and West Plains, has seen a large decrease in the nursing turnover rate. For the past five years, the region has led the state in turnover rate, seeing rates as high as 40.9% in 2021. In 2025, that number fell to 17.1%, which was lower than the state average. This change signals fewer nurses are leaving their positions in the region.
Williams said that Poplar Bluff Medical Center’s Nurse Extern Program, which launched in 2024, might have something to do with the improved retention. The program allows nursing students in southeast Missouri to get experience in different nursing specialities along with one-on-one mentorship.
“Our Nurse Extern Program is more than just an educational opportunity — it’s about building a culture that values, mentors, and supports future nurses,” said Carla Rider, Poplar Bluff Regional Medical Center chief nursing officer, in a 2024 news release. “With this program, we aim to increase nurse retention at PBRMC, ensuring continuity of care and stability within our hospital and community.”
Williams said in the report that rural healthcare programs’ investments in pipeline-capacity building systems could increase the number of rural healthcare workers. These investments come as Missouri struggles with a shortage of physicians and an aging population that will require more care. The report found that Missouri has demand for approximately 1,000 physicians, including 600 primary care physicians and 160 psychiatrists.
Many of these shortages fall in rural areas. Of the 40 geographic areas in Missouri that have a designated Health Professional Shortage Area, only six are classified as nonrural, according to data from the Health Resources and Services Administration.
As workforce shortages persist, Williams said hospitals are beginning to redesign care teams. These restructured workforces can include EMTs and paramedics working in emergency departments and medical assistants taking on more clinical responsibility. These changes go beyond the hospital as some hospitals are using community health workers to help patients navigate social factors contributing to their health and care coordinators to manage transitions of care.
Artificial intelligence, technology use grows in hospitals
Technology also plays a role as hospitals work to accommodate ongoing shortages and try to reduce their employee separations. Virtual nurses play a support role to bedside teams and AI-enabled documentation tools, scheduling systems and telehealth are playing growing roles in hospitals, according to Williams.
“As this AI and technology continues to come out, I feel like that's going to be really an emerging component of long-term sustainability, and to upskill the workforce in these new skills that technology will demand, and kind of using technology as a way to increase efficiencies,” Williams said. “Maybe employees working in new and different roles, or care teams, or care models working in different ways than they have in the past.”
A report from the Office of the National Coordinator for Health Information Technology found that in 2024, 71% of hospitals integrated predictive AI into their electronic health records, which are digital versions of patient paper charts. Predictive AI is defined as “using statistical analysis and machine learning to classify or produce a risk score for individuals,” according to the AI hospital trends report.
The use of predictive AI to simplify billing, facilitate scheduling and identify high risk outpatients to inform care increased by a wide margin from 2023 to 2024. Of hospitals that used predictive AI in 2024, 92% used it to predict health trajectories or risks for inpatients, the same percentage as the year before.
“I think Missouri's healthcare workforce continues to experience significant pressures, but there are clear signs of transformation and progress,” Williams said. “I think hospitals are increasingly trying to find ways to address workforce challenges through a more comprehensive strategy, so something that recognizes kind of that interconnected nature of workforce pipelines through employee experience, leadership development, creating a safe workplace, and then those operational innovations through AI and technology.”
