In Casper, Wyo., the nursing workforce is small and close-knit. Casper Surgical Center treats that as a recruiting asset.
“Most of the people who work in nursing in this town know each other,” Kevin Youmans, administrator and CEO of the center, told Becker’s.
Nurses have long ranked among the hardest roles to fill. A June 2022 MGMA report on staff compensation put nurses and medical assistants among the toughest hires and listed staff referral bonuses as one way practices were responding. Smaller markets face their own pressure. In 2022, Deb Meyer, RN, administrator of Skyline Surgery Center in Pocatello, Idaho, told Becker’s that healthcare workers “can get paid nearly quadruple to work as a traveler within their own communities.”
Hospitals add to the strain. Sarah Malaniak, administrator of New York City-based Peakpoint Flatiron Surgery Center, told Becker’s in December 2025 that hospitals frequently outbid surgery centers for staff, which drives up turnover and recruiting costs. She said keeping pace takes higher pay, signing bonuses and richer benefits, which many centers, especially smaller ones, can’t afford for long.
“The most significant financial challenge is keeping up with the labor market,” Michael Cournyea, CEO of University at Buffalo (N.Y.) Neurosurgery, told Becker’s. “Most ASCs are competing with hospitals and health systems for RNs and surgical techs, and this is driving up the costs for these positions.”
Casper Surgical Center’s hiring approach has three parts:
1. Paid social that leads straight to the application. The center has a fixed marketing budget for promoting its services and sometimes shifts part of it to recruitment. Job ads run on Facebook and link directly to the careers page on the center’s website, where candidates can apply online.
2. Staff as recruiters. The center asks employees to think about whom they would want as co-workers and to tell those people about open roles. It pays a [$X] referral bonus when a staff referral leads to a hire.
“It’s who do you know in town that you would love to work with in this place?” Mr. Youmans said.
Some surgery centers still advertise large sign-on bonuses instead. As of Oct. 21, Becker’s found ASC nurse postings with sign-on bonuses of up to $10,000, including at Vail Valley Surgery Center in Vail, Colo., which also offers relocation and housing assistance. Center ONE Surgery Center in Jacksonville, Fla., is offering $5,000 for an operating room circulator and $2,500 for a preoperative and post-anesthesia care unit nurse.
3. Benefits as a selling point. Mr. Youmans has worked at several healthcare organizations, and he said the center’s benefits stand out.
“I think our benefit structure is as good as I’ve seen in the country,” he said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
