In 1949, the Board of Trustees voted to employ a full-time business manager for the Hospital. This decision shifted all administrative duties from the Superintendent of Nurses to the business manager. The Business Manager also managed many functions of the Trustees. Emma Bass, who married Robert Straw, became Mrs. Straw and resigned in 1951. Stella Austin, who replaced Mrs. Straw, was referred to as Superintendent and more often as Director of Nurses and Nursing Services.
In 1965 the US Government passed the Medicare Act. This increased the ability of elderly citizens to pay for health care. By 1967, Littleton Hospital once again experienced a nursing shortage due to increases in the volume of patient admissions. Mr. Schauer, the Hospital Director at this time, reported that the State Division of Vocational-Technical Education agreed to underwrite a refresher course for inactive registered nurses. The State offered this course to the Hospital at no cost, as long as the Hospital provided space for a classroom. The most difficult task for this endeavor was to find an instructor for this program.
The hospital began construction of an intensive care unit (ICU) that included a cardiac care program in 1971. To meet the staffing needs of this unit, the hospital sent a team of nurses to Boston City Hospital and the Medical Center at the University of Vermont in Burlington, VT to train for the care of patients needing intensive care. Nursing shortages further strained the Hospital when the ICU opened on September 20, 1971. Staffing the ICU left a shortage of nurses on the acute care (Med-Surg) unit. The Hospital recruited more nurses through advertisements in nursing journals, the Manchester Union Leader, utilizing a nurse consultant, and publicizing vacancies at seminars and regional meetings. The hospital reduced the nursing workload by placing ward clerks on the nursing units for two shifts each day. The communication of patient care needs between nursing units was improved and weekly department head meetings addressed patient needs regularly. As the Hospital began expanding its services, administration began to question its role in the community as a "cottage hospital". The Hospital now provided critical as well as acute care and maternal-child care services to the community. These additional services lead to a change in name that included the concept of a "regional hospital".