The Nursing Shortage Is Not a Recruiting Problem

When healthcare leaders talk about workforce challenges, the conversation often starts with recruiting.

How do we attract more nurses?
How do we fill open positions faster?
How do we compete for talent?

After more than two decades in healthcare, I’ve come to believe—though important—these questions are often asked too late.

One of the biggest misconceptions I encounter is the belief that workforce shortages begin when positions become difficult to fill. In reality, the vacancies organizations are trying to fill today are often the result of decisions, constraints, and workforce trends that have been developing for years. By the time recruiting becomes the primary focus, the problem has usually been building much longer than anyone realizes.

That’s why I tend to view workforce challenges through a different lens. Recruiting is important, but it’s only one piece of a much larger workforce conversation. The harder work is understanding what’s shaping your workforce long before a vacancy appears.

We may be solving the wrong problem

Many organizations approach staffing shortages as a hiring issue when they’re actually dealing with a workforce strategy issue.

And I understand why. Earlier in my career, when I was a nurse manager, I didn’t fully understand the entire workforce picture either. I understood my lane. I understood my unit, my staffing challenges, and the immediate pressures facing my team. What I didn’t see were all of the factors influencing the nursing pipeline long before those challenges showed up on my unit.

That’s often the challenge for healthcare leaders today. The staffing shortage they are dealing with feels urgent because it is urgent. Patient care still needs to happen, and schedules still need coverage, so leaders don’t have the luxury of ignoring today’s vacancies. At the same time, workforce challenges rarely develop overnight. They are influenced by educational capacity, pipeline development, retention trends, changing career preferences, operational pressures, and long-term planning decisions happening across the healthcare ecosystem.

When I was a nurse manager, I would have focused on the vacancy because that’s what I was dealing with every day. Looking back, I realize the vacancy was only the visible part of the problem. The factors contributing to it were already in motion long before that position became difficult to fill.

The nursing pipeline is more complex than most leaders realize

One of the reasons workforce planning is so difficult is because the nursing pipeline is influenced by several factors that most organizations cannot immediately control.

Many healthcare leaders understandably focus on recruiting because that’s where they have the greatest visibility. What they’re often dealing with, however, is a pipeline challenge that began years earlier. If fewer nurses are entering the profession, recruiting teams eventually find themselves competing for a smaller pool of candidates. At that point, recruiting effort alone cannot fully solve the problem.

One factor that receives less attention is educational capacity. Nursing programs cannot expand indefinitely without qualified educators. The challenge is that nursing education depends on experienced nurses who are prepared to teach the next generation.

As educational programs face faculty constraints, their ability to increase enrollment becomes more limited, affecting the supply of future nurses entering the workforce years later.

Healthcare leaders should also account for the reality that not every nurse intends to spend their entire career at the bedside. Some nurses pursue advanced practice roles. Others move into leadership, education, healthcare technology, consulting, or industry positions. None of those choices are negative.

In fact, healthcare needs talented professionals in all of those areas. Workforce planning becomes more effective when organizations recognize that career mobility is normal and plan accordingly rather than assuming every bedside nurse will remain there indefinitely.

The shortage of bedside nurses

One of the distinctions I find myself discussing most often is the difference between a nursing shortage and a bedside nursing shortage.

There are nurses throughout healthcare. The challenge many hospitals are experiencing is whether enough nurses are choosing inpatient and bedside roles and, equally important, how long they remain there. This is a very different conversation than simply looking at the total number of licensed nurses in the workforce.

When organizations focus on retention, I think it’s important to spend time understanding what daily work actually looks like for bedside nurses. Turnover data can tell leaders what happened, but it doesn’t always explain why it happened.

In my experience, fatigue is often driven by much more than patient care. Nurses are managing interruptions throughout the day—they’re answering call lights, completing administrative work, coordinating communication.

Sometimes they’re handling responsibilities that don’t require nursing judgment at all. I’ve seen nurses spending time mopping floors, changing trash, and performing tasks that gradually became part of the nursing workload simply because nobody else was available to do them.

Those responsibilities may seem small individually, but together they can create significant strain. If organizations want to improve retention, they first need to understand what is creating pressure for bedside nurses today. Otherwise, we risk treating the symptoms of turnover without fully understanding what’s driving it.

Making time for the future

One of the hardest realities in healthcare leadership is that urgent problems almost always demand the most attention.

When a leader says, “I need nurses today,” they’re absolutely right.

The challenge is that today’s staffing needs and tomorrow’s workforce strategy are not the same conversation.

Healthcare organizations have to operate on multiple timelines simultaneously. They need solutions for immediate staffing shortages, but they also need a strategy for the workforce they’ll need two, five, and ten years from now. The organizations I see having the most productive workforce conversations are usually the ones willing to make time for both discussions.

Long-term workforce planning means looking beyond the next quarter. It means understanding pipeline trends, educational constraints, anticipated retirements, turnover patterns, workforce mobility, and future care delivery demands. It also means recognizing that some workforce solutions require years before organizations experience the full benefit.

That’s why I often encourage leaders to think beyond today’s staffing pressure and ask what they want their workforce to look like in five years. If that conversation only starts after a staffing crisis arrives, they’re already behind.

There isn’t a single solution

Healthcare has a tendency to look for a single solution to complex problems, but workforce challenges rarely work that way.

Over the years, I’ve watched healthcare revisit many of the same workforce ideas. Every few years, a familiar strategy returns in a different form. Sometimes it works, sometimes it doesn’t. But if we don’t understand why previous approaches fell short, we often find ourselves having the same conversations again a few years later.

That’s why I don’t believe workforce resilience comes from one initiative. Recruiting, retention, leadership development, operational redesign, workforce planning, international nursing, they all matter. The challenge for healthcare leaders is determining which combination makes sense for their organization and whether those decisions support where they want their workforce to be in five years.

A Different Question for Leaders

Healthcare leaders rarely have the luxury of focusing only on the future. They’re balancing staffing needs, operational pressures, and patient care responsibilities every day.

That’s exactly why I think this question matters.

If nothing changed, what would our nursing workforce look like five years from now?

The answer may not be comfortable. It may reveal gaps in the pipeline, challenges with retention, or assumptions that no longer match reality. But those are conversations worth having because workforce shortages rarely appear without warning. More often, they develop gradually until they reach a point where they can no longer be ignored. The earlier leaders recognize that, the more options they have to address it.

If you’re looking to revisit your workforce planning strategy, my team and I spend a lot of time helping healthcare organizations work through these challenges. Reach out to the Insight Global Health team, or connect with me directly. I’d be happy to continue the conversation!

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