Contracts were heavily affected by cuts in federal programs that are critical to some rural regions, and uncertainty caused by inconsistent messaging about the future of such programs. Some areas are very dependent facilities that can only survive with public funding.

For example in nursing categories, CNOs (Chief Nursing Officers) would be requesting more staff, but CFOs would block those requests due to changing budget forecasts. The unpredictability of the fed is causing chaos downstream.

There is also a continuing trend to "realign" staff levels post-COVID, but that now is much easier to forecast for compared to the political chaos. In 2026 healthcare, that would not be a reason for attrition at these levels.