I’ve worked with healthcare organizations for over 20 years and helped many more to review their workforce management systems. In this time, I have come across the same question in almost every organization: how do we deliver quality care while maximizing our current workforce?
When we talk about the nursing shortage, the conversation often starts—and unfortunately ends—with staffing numbers. Yes, we're facing a numerical shortage of nurses, but that only scratches the surface of a much deeper, more complex issue. To truly address the crisis, we have to look beyond the headcount and start thinking about the systems, strategies, and structures that support our healthcare workforce.
The truth is, we don't just have a nursing shortage—we have a workforce ecosystem problem.
A few years ago, we experienced a mass exodus from the nursing profession—particularly during COVID—and while some of that has rebounded, the impacts are lasting. One of the largest problems today is that we have one of the youngest nursing workforces in decades. That shift is creating downstream effects, not just in terms of clinical experience but also in leadership readiness.
Nurse managers today are earlier in their careers and may lack the institutional knowledge or managerial acumen that's built over decades. That affects everything from staff development to operational decision-making, ultimately impacting patient satisfaction and clinical outcomes.
Compounding the issue is the educational bottleneck. We simply don't have enough faculty to train the next generation of nurses—or respiratory therapists, or imaging techs. Across the board, healthcare education is under strain, and it's one of the biggest long-term threats to our ability to meet future demand.
At the same time, we're facing persistent burnout, poor work-life balance, and unsustainable staffing ratios. But the greatest missed opportunity is in how we deploy the staff we do have. Healthcare is years—sometimes decades—behind other industries in applying sound workforce management practices.
Take call centers, for example. Their entire business model is built around forecasting call volumes and scheduling accordingly. They use data to predict demand and ensure there's someone ready to answer your call when you need them. In healthcare, we still operate in a reactive mode:
Many of the workforce management strategies healthcare relies on today are outdated or borrowed wholesale from industries that moved on long ago. We're stuck with rigid scheduling models, inconsistent staffing processes, and a lack of alignment across departments.
Look at how retail manages staffing. On Saturday mornings, grocery stores have more cashiers than they do on Tuesday afternoons. It's not guesswork—it's forecasting. Yet in healthcare, we often staff units based on fixed budgets or the assumption of maximum capacity, rather than aligning staffing with actual patient flow. That mismatch creates chronic overstaffing on some days and under-resourcing on others.
This is especially problematic when you consider how siloed healthcare organizations tend to be:
Rarely are all of these groups aligned around a common workforce strategy. We can't keep operating this way. Our workforce challenges are interconnected—and solving them requires a truly interdisciplinary approach.
So, what does a sustainable workforce ecosystem look like in healthcare?
First, it starts with aligning three key outcomes: quality patient care, engaged employees, and responsible financial performance. You can't focus on one without considering the others. A successful ecosystem ensures that the right people are in the right place at the right time—and that they're supported, continuously upskilled, and retained.
It also requires breaking down the silos between departments. Workforce management is not just an HR problem, or a clinical problem, or a technology problem. It's a shared responsibility that requires cross-functional governance. We need collaborative teams that bring together stakeholders from HR, clinical operations, finance, and IT to build holistic, strategic workforce management programs.
But governance alone isn't enough. We need accountability at every level. Leadership must drive change and set clear expectations. Change management is critical—and not just in the abstract. We have to help frontline staff and managers understand what's in it for them and support them through the transition.
Policies, processes, and technology all need to align. New technology won't solve old problems if we don't also change how we work. I've seen too many organizations invest in cutting-edge tools without adapting their workflows.
One of the most important shifts we can make is moving from reactive to proactive scheduling.
Healthcare often leans on two flawed approaches: scheduling to maximum capacity or scheduling based on budgeted full-time equivalents (FTEs). Neither accounts for the natural ebb and flow of patient demand. We need to start with balanced schedules—ones that align staffing levels with actual, evidence-based demand patterns.
That means analyzing trends, identifying patterns of over- and under-staffing, and adjusting accordingly. If your staff's annual PTO utilization is around 20% but you've only built 10% into your FTE resource planning, you're already facing a significant gap before you even start creating schedules. Without a defined strategy for addressing this additional 10% absence rate, you'll likely resort to premium pay solutions, driving up costs unnecessarily.
Too often, we throw incentives or agency staff at the problem without a real strategy. That's not sustainable. Instead, we need evidence-based plans that identify which levers to pull—float pools, PRNs, part-time staff—based on predictable gaps. These are things we can forecast. And with the right tools like automated scheduling solutions, we can do it well before the schedule is even created.
AI and automation are critical tools for enabling this shift. They aren't about replacing people—they're about enhancing decision-making.
In healthcare, clinical leaders are promoted for their clinical expertise. That's exactly how it should be. But we can't expect them to become workforce management experts overnight. Their focus should be on patient care, not data analysis.
Smart scheduling automation helps bridge that gap. It processes the data, identifies patterns, and provides actionable recommendations so clinical leaders can make smarter staffing decisions without needing a PhD in operations. Solutions that automate shift-filling and staff deployment can save managers hours each week while ensuring fair distribution of work.
We also have to talk about standardization. Every unit doesn't need to reinvent the wheel. About 80% of best practices can be consistent across service lines. The other 20% can be customized to account for specific needs. But unless we create consistent workflows and expectations, we'll never fully leverage the tools we have—or realize the efficiencies we need.
If there's one thing I urge healthcare leaders to do, it's this: take a step back and reflect.
Ask yourself:
If your workforce strategies haven't changed in the last 5 to 10 years, that's a serious disconnect.
The world around us is evolving—our workforce is evolving—and we can't afford to stand still. Now is the time to build the sustainable systems we need to support our clinicians, deliver better patient care, and ensure the long-term viability of our healthcare institutions.
Next Steps:
This work isn't easy. It requires strategic thinking, cross-functional collaboration, and a willingness to challenge the status quo. But the payoff is worth it—not just for your bottom line, but for the people who rely on you every day: your staff and your patients.