Michelle Gohanna, BSN, RN, PMP
Founder, Gohanna Staffing Solutions, LLC
Before I began running a healthcare staffing agency, I worked as a project manager.
One of the first lessons you learn in project management is that projects do not always fail because the plan looked bad on paper. They often fail because a decision did not fully account for the people responsible for carrying it out or the people affected by the outcome.
Identifying stakeholders and understanding what each one needs is not simply a planning formality. It can be the difference between a plan that works and one that quietly falls apart.
Now that I run a healthcare staffing agency, I see that same pattern play out in staffing decisions. It may not always be called stakeholder management, but the principle is the same.
Most healthcare staffing decisions affect at least three key groups:
- Facility administrators and operational leaders
- The staff working within the facility
- Staffing agencies helping meet coverage needs
Each group experiences the same staffing decision differently. A plan may look reasonable from one perspective while creating new problems for the other two.
When those perspectives are not considered together, the result can be missed coverage, frustrated staff, increased workload pressure, poor placement experiences, and last-minute scrambling.
Why Stakeholders Do Not Automatically See Staffing the Same Way
Facility administrators are often focused on the broader operational and financial picture.
They may be asking:
- Is coverage adequate?
- Is the staffing budget being managed responsibly?
- Is the organization meeting its care, safety, and compliance obligations?
- Are staffing decisions supporting operational goals?
Their view of success is often shaped by organizational outcomes, financial limitations, compliance requirements, and performance measures.
Staff are focused on the day-to-day reality of the work.
They may be asking:
- Are workloads manageable?
- Are schedules predictable?
- Is there enough coverage to provide care safely?
- Will permanent staff be expected to absorb additional responsibilities when coverage falls short?
Their view of success is shaped by what it actually feels like to work the shift. That is a perspective I try to remain connected to, even while leading from the agency side.
Staffing agencies are focused on matching qualified professionals with the right assignments, maintaining an available workforce, meeting credentialing requirements, and responding effectively when a facility has a staffing need.
They may be asking:
- Do we have enough information to identify the right professional?
- Are the assignment expectations clear?
- Is there enough time to prepare someone properly?
- Are the facility’s needs realistic given the available workforce?
- Can the assignment be filled reliably?
An agency’s view of success is often shaped by appropriate placement, responsiveness, reliability, and the ability to meet the facility’s needs.
None of these perspectives is wrong.
They are different lenses on the same staffing decision. Problems arise when a plan is built around only one of them.
What Happens When Stakeholder Impact Is Overlooked
Several patterns tend to repeat when staffing decisions are made without considering how they will affect everyone involved.
An administrator may make a budget decision that appears responsible financially but increases the workload placed on existing staff.
A facility may change a schedule without considering how that change affects the professional assigned, the agency coordinating coverage, or the staff expecting relief.
Staff may repeatedly report that coverage is inadequate, but there may be no reliable process for that information to reach the people making staffing decisions.
An agency may fill a shift without receiving enough information about the facility’s expectations, leaving the assigned professional underprepared and permanent staff frustrated.
A staffing plan may appear complete because every shift is technically covered, while the people carrying out the plan are struggling with unrealistic workloads, unclear responsibilities, or insufficient support.
Individually, these situations may look like scheduling mistakes, communication failures, or isolated staffing problems.
From where I sit, they are often signs that the decision did not fully account for the people affected by it.
Applying Stakeholder Management to Healthcare Staffing
Stakeholder management is not a one-time exercise.
It is an ongoing practice of identifying who will be affected by a decision, understanding their priorities, communicating expectations, and revisiting the plan as circumstances change.
The goal is not to make every stakeholder equally happy with every decision. That is not always possible.
The goal is to avoid making decisions in isolation and assuming that a plan will work simply because it appears workable from one point of view.
Identify the Stakeholders Explicitly
It sounds basic, but naming everyone affected by a staffing decision makes it easier to determine whether the plan reflects their reality.
Depending on the situation, stakeholders may include:
- Administrators
- Department leaders
- Schedulers
- Permanent staff
- Human resources and compliance teams
- Staffing agency partners
- The professionals being assigned
- Patients, students, residents, or others receiving services
This is a habit I brought with me from project management, and it continues to shape how I evaluate staffing decisions.
Before moving forward, it is helpful to ask:
Who will be affected by this decision, and has the plan accounted for their experience?
That question can reveal issues that may not be visible in a staffing schedule, budget, or coverage report.
Understand the Need Behind Each Perspective
Stakeholders do not always describe their needs in the same language.
An administrator may ask for lower staffing costs, but the underlying need may be dependable coverage within a sustainable budget.
Staff may ask for more people on a shift, but the underlying concern may be workload, safety, burnout, or the ability to provide appropriate care.
An agency may ask for more notice, but the underlying need may be enough time and information to identify, credential, and prepare the right professional.
A facility may ask for immediate coverage, but the underlying priority may be preventing existing staff from becoming overwhelmed.
Looking beyond the initial request helps decision-makers understand what is actually at stake for each group.
It also makes it easier to identify solutions that address the real problem instead of reacting only to the most visible symptom.
Recognize That Urgent Decisions Still Affect Stakeholders
Healthcare staffing needs cannot always be predicted.
Unexpected callouts, leaves of absence, vacancies, and changes in demand can create immediate coverage needs. Urgent and last-minute requests are a normal part of healthcare staffing.
The stakeholder-management lesson still applies when decisions must be made quickly.
Even in an urgent situation, it is important to consider how the response will affect facility leaders, permanent staff, the staffing agency, and the professional entering the assignment.
Advance notice may create more options, but the goal is not to eliminate urgent requests or suggest they cannot be handled.
The goal is to communicate clearly, identify the people affected, and avoid solving the immediate coverage problem in a way that creates unnecessary strain elsewhere.
For example, quickly filling an open shift may solve the schedule on paper. However, the plan may still fall short if the assigned professional does not receive essential information, permanent staff are expected to provide extensive guidance without warning, or expectations differ among the facility, agency, and professional.
Urgency may change how quickly stakeholder alignment happens, but it does not remove the need for it.
Create a Meaningful Feedback Channel for Staff
Staff experience the consequences of staffing decisions directly.
They are often the first to see when a plan that appears workable on paper is creating unsustainable workloads, recurring gaps, workflow problems, or safety concerns.
If there is no reliable way for that information to reach decision-makers, the staffing plan may continue long after its weaknesses have become apparent to the people carrying it out.
A meaningful feedback channel does not mean every concern can be resolved exactly as requested.
It means employee feedback is treated as important operational information rather than as an afterthought.
Organizations should know:
- How staff can raise recurring coverage concerns
- Who is responsible for reviewing those concerns
- How patterns will be identified
- When staffing decisions will be reevaluated
The people closest to the work often hold information that cannot be seen in a staffing report alone.
Prepare People to Carry Out the Plan
A staffing decision does not end when a person is assigned to a shift.
The professional entering the assignment must understand what is expected. Permanent staff must know what support is arriving and what responsibilities remain with them. Facility leaders and agency partners must share the same understanding of the role.
A well-qualified professional can still struggle when expectations are unclear or essential facility information is missing.
Permanent staff can become frustrated when they expect immediate relief but instead must spend significant time explaining processes that could have been communicated beforehand.
This does not mean every placement requires an elaborate onboarding process.
It means the people responsible for making the staffing plan work should receive enough information and support to carry it out successfully.
The plan is not complete until the people involved are prepared to execute it.
Clarify Roles and Expectations
Many staffing problems begin with assumptions.
The facility may assume the agency communicated a schedule change.
The agency may assume the facility will provide orientation.
The assigned professional may assume a certain responsibility falls to permanent staff.
Permanent staff may assume the agency professional will be able to function independently from the moment the shift begins.
When roles are unclear, each group may believe it has fulfilled its responsibility while the plan still breaks down.
Basic questions should be answered whenever possible:
- Who confirms the schedule?
- Who communicates changes?
- Who provides facility-specific instructions?
- Who addresses performance or attendance concerns?
- Who should the assigned professional contact when an issue arises?
- Who is responsible for informing the other stakeholders when expectations change?
Clarity helps prevent a staffing decision from failing because each group was operating from a different understanding.
Revisit the Plan as Conditions Change
Stakeholder needs do not remain static.
A staffing plan that worked six months ago may no longer reflect current workloads, employee availability, turnover, demand, budget conditions, or organizational priorities.
A decision may have been appropriate when it was made and still become ineffective over time.
That is why stakeholder management requires regular reassessment.
Periodic check-ins can help determine:
- Whether the plan is still meeting the facility’s needs
- Whether staff are experiencing recurring strain
- Whether agency partners have the information needed to respond effectively
- Whether assigned professionals are receiving adequate support
- Whether changes in demand require a different approach
These conversations do not always require formal meetings.
Sometimes a brief, intentional check-in is enough to uncover a problem before it becomes a crisis.
The Bigger Takeaway
Staffing problems are often treated as scheduling problems.
Many of them are actually stakeholder-management problems.
Facility administrators, staff, and staffing agencies each hold a different part of the picture. A decision that looks effective from one perspective may create frustration, workload pressure, or operational problems for the others.
I have learned, first as a project manager and now as the owner of a healthcare staffing agency, that a plan is not truly successful simply because it looks complete on paper.
It must also work for the people responsible for carrying it out and the people affected by the outcome.
Bringing stakeholder-management principles into healthcare staffing is not about adding unnecessary meetings or making every decision more complicated.
It is about pausing long enough to ask:
- Who will be affected?
- What does each group need?
- What assumptions are being made?
- Do the people carrying out the plan have the information and support they need?
- Could solving one group’s problem create a new problem for another?
The strongest staffing solutions are not simply created for stakeholders.
They are created with them.
If your facility is looking to build a staffing approach that keeps administrators, staff, and agency partners aligned, I’d welcome the conversation.