When an employee calls off, the immediate priority is clear: Find coverage and keep care moving. Whether you lead a hospital unit or a senior care community, the response takes time and attention out of an already busy day.
Once the gap is closed, it’s worth looking at the practices surrounding it. How are time-off requests handled? Who gets asked to pick up extra shifts? What support can a new employee count on?
Illness and personal emergencies will happen, but reviewing everyday operations and procedures can give leaders a way to strengthen employee support and call-off preparedness. Four areas to consider:
1. Leaving time-off requests unsolved
When coverage is tight, a time-off request can sit unanswered while a manager tries to make the schedule work. The employee is left waiting, and the coverage decision remains open.
Consider treating the request and the coverage plan as one process. Make it clear how employees should submit requests, who responds and when they can expect an answer. If a decision takes longer, explain what’s outstanding and set a time to follow up.
Early conversations can also reveal recurring scheduling conflicts, such as caregiving responsibilities, education commitments or other personal needs. Understanding these constraints gives you information to consider while building the schedule.
The U.S. Surgeon General offers a workplace wellbeing framework that recommends predictable schedules and respect for boundaries between work and personal time. For leaders, a way to apply this practically is to review how time off requests are processed.
Ask your scheduling team where requests may stall. Is approval waiting on one person? Are coverage options being considered too late? Start with the recurring obstacle you can address. You don’t have to promise every requested day off to make the process clearer and more responsive.
2. Treating orientation as the end of onboarding
New employees can complete orientation and still be unsure whom to ask for help during busy shifts. Playbooks and written procedures are useful, but employees also need to understand how to put them into practice and where to turn if something is unclear.
Look at what happens after the initial welcome. Is there a designated person available for questions on the shifts the employee actually completes? Are expectations clear? Does anyone check whether the employee has the information and resources they need?
Build in short conversations during the first few weeks, or consider implementing a new hire survey program to track progress through the first 90 days of employment. Ask what feels familiar, what remains confusing and where more guidance would help. A specific question about the last shift is often a more useful starting point than a general “How’s it going?”
The Surgeon General’s framework identifies training, mentoring and a sense of belonging as elements of workplace wellbeing. Those principles offer a useful way to assess your onboarding process.
Consider asking recent hires what they wish someone had explained earlier. Use their answers to improve the onboarding and orientation process and to identify support that should continue beyond orientation. Keep the feedback loop open as employees settle into their roles.
3. Making the same employees your default coverage plan
Every team has employees who are willing to help when a gap opens. Calling someone who has said yes before is an understandable response when time is short. Over time, though, those individual requests can add up.
Before asking for another pickup, look at the employee’s recent schedule. How many additional shifts have they accepted? How much time will they have between shifts? Are you approaching them because they’re the best available option, or because they’re the first person who comes to mind?
Research provides a reason to pay attention to recovery time. A 2025 randomized trial involving 66 hospital units in Norway tested schedules with fewer intervals of less than 11 hours between shifts. The intervention group experienced a smaller increase in sickness-related absence than the group following usual schedules.
The study focused on sickness absence in a hospital setting. Its practical relevance here is the importance of examining recovery time when making coverage decisions.
Besides illness, repeatedly asking the same employees to cover gaps adds to their workload and, with less time for recovery, potentially contributes to burnout. The ShiftKey burnout hub offers resources healthcare leaders can explore on understanding and reducing burnout.
Review who receives additional-shift opportunities and how those opportunities are communicated. Consider availability, role requirements and recent schedules when approaching eligible employees. Keep track of who repeatedly takes on extra coverage.
Thank people who step in, but give them room to decline. A broad coverage plan gives leaders additional options when their usual volunteers need time away.
4. Letting recognition depend on who picks up extra shifts
Picking up extra coverage is visible and easy to appreciate. Other contributions can receive less attention: helping a new colleague find their footing, sharing useful information during a handoff or taking time to reassure a resident or patient.
Consider widening the lens beyond obvious contributions. Ask managers to notice specific examples of collaboration and good work across shifts and departments. A thoughtful thank-you should make clear what the person did and why it mattered.
Recognition and connection are both part of the Surgeon General’s workplace wellbeing framework. You can apply those ideas through everyday interactions as well as planned activities.
A team meal or activity day can create an opportunity to spend time together. But these activities should be held alongside – not as a replacement for – ongoing attention to scheduling concerns, questions and requests for help.
Review what your recognition practices encourage. Highlight mentoring, teamwork and contributions to care. Avoid making perfect attendance the measure of commitment; employees should be able to take time off without feeling that they’ve let the team down.
Build a broader plan for call-off preparedness
These practices give you specific places to examine how employees experience support day to day. Choose one to review with your team. You might start with unanswered time-off requests, recent hires’ questions or the distribution of additional shifts.
Alongside those improvements, review the options available when an employee does call off. Who coordinates the response? Which internal coverage options can you consider? How can you access additional support when those options aren’t enough?
ShiftKey gives facilities access to a network of independent professionals to help address coverage gaps. Including that option in your planning gives you another avenue to consider when employee availability changes.
For senior care leaders ready to take the next step, the ShiftKey call-off preparedness eBook offers practical guidance and tools for planning ahead and responding when gaps arise.
Sources
“The U.S. Surgeon General’s Framework for Workplace Mental Health & Well-Being,” (U.S. Department of Health and Human Services, 2022).
“Shift Schedule With Fewer Short Daily Rest Periods and Sickness Absence Among Health Care Workers: A Cluster Randomized Clinical Trial,” (JAMA Network Open, 2025).
