Why Do Clinical Leaders Still Feel Understaffed After Two Years of Progress?

Two years of recruitment investment, retention programs, and culture work were supposed to close the gap in healthcare staffing. Instead, most clinical leaders are still describing their organization as understaffed, even while reporting real progress underneath it. Inovalon surveyed more than 230 clinical leaders across hospitals and post-acute facilities to find out what’s moving, what’s still stuck, and what that gap is costing them in turnover, call-outs, and lost capacity. Here’s what they told us, question by question. 

Why do 75% of clinical leaders still feel understaffed, even after real progress?

Because staffing in healthcare rarely gets solved. It gets maintained, and maintenance never feels finished. In a survey of more than 230 clinical leaders across hospitals and post-acute facilities, 59% reported that staffing levels have genuinely improved over the past two years, driven by recruitment investment, retention programs, and culture work. Yet 75% of those same leaders still describe their organization as understaffed today. Progress and relief turned out to be two different things: leaders fixed real problems and the gap barely closed, because turnover, call-outs, and rising patient acuity kept adding pressure from the other side. 

What’s causing ongoing staffing shortages?

Unplanned call-outs are the single most common driver, cited by 73% of clinical leaders as a top issue tied to understaffing. This is more than retention (55%), insufficient training (30%), or agency overuse (29%). A call-out isn’t a one-time problem; it’s a recurring tax on the schedule. Each one forces a scramble to find coverage, and that scramble compounds: leaders responsible for scheduling reported spending a high proportion of their working hours just managing changes to shifts that were already set. 

Why does unplanned absence hit post-acute facilities harder than hospitals?

Because post-acute organizations are running with thinner staffing margins to begin with. Call-outs were cited as a significant issue by 63% of hospital leaders and by 88% of post-acute leaders. Post-acute facilities also reported markedly higher annual turnover than hospitals (64% report turnover of 20% or more, versus 34% of hospitals), which means there’s less bench strength to absorb a single absence without disrupting the shift. 

What does understaffing do to employee turnover?

It becomes self-reinforcing. 96% of clinical leaders said understaffing makes employees more likely to leave their jobs permanently, and 50% said “much more likely.” That creates a compounding cycle: short-staffed teams push remaining staff harder, harder work drives more departures, and each departure deepens the next shortage. The financial version of this same cycle is well documented. NSI Nursing Solutions puts the average cost to replace one RN at $60,090, with each one-point shift in turnover costing a hospital roughly $295,000 a year. 

Will staffing improve on its own over the next two years?

Leaders don’t think so. Only 12% expect significant improvement over the next two years, down sharply from the pace of the past two years, and 41% expect staffing to simply stay where it is. Leaders are recognizing diminishing returns from the playbook that got them this far. Recruitment campaigns, pay adjustments, and culture initiatives each moved the needle once; squeezing more from the same tools a second time is a different problem, and most leaders know it. 

What scheduling capabilities do clinical leaders say would help?

Visibility and control, more than any single new hire. Two-thirds of leaders valued mobile self-scheduling and shift-swap capabilities as significantly valuable to their teams. Staff who can see and manage their own schedule are staff who are more likely to stay. 62% percent valued the ability to see call-out risk before it happens rather than react to it, and 53% valued automated visibility into overtime and coverage gaps. None of these require solving the labor market. They require a scheduling system that surfaces risk early instead of absorbing it as a crisis. 

How does understaffing affect patient safety? 

More than almost any other factor leaders were asked about. When ranked against threats to patient safety, understaffing and employee burnout outweighed gaps in safety culture, training, or access to safety data. The clearest single finding in the research: fully staffed organizations are more than twice as likely to actively match staff experience and credentials to patient acuity as understaffed organizations are (87% versus 42%). That kind of matching isn’t a luxury extended by well-resourced teams; it’s a discipline that gets harder to sustain exactly when the stakes are highest. 

What can healthcare leaders do to break the cycle?

Treat scheduling as a strategic lever. The leaders in this research who’d adopted advanced scheduling automation reported real, measured gains such as improved staff engagement, better retention, and safer patient care. Inovalon’s Schedule Management™ is built around giving leaders visibility into call-out risk, overtime exposure, and staff-to-acuity alignment before those become the next 6 a.m. phone call.

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