Anyone who has worked in rural or remote healthcare knows the phrase. “We’re short-staffed, again.” However, it’s not just frequent staffing challenges, staff shortages, lack of backup during major clinical events, or time constraints that create workload pressure. These factors can create environments where manipulation, whether it’s intentional or not, can be almost invisible, and is often framed as ‘teamwork’.
Most people who pressure a colleague into covering another shift aren’t doing it maliciously. However, the effect on the person being pressured can look identical, whether or not the intent behind it was manipulative.
In under-resourced teams, manipulation can show up as:
- Guilt trips. It may sound something like. “You know we’re already stretched thin. I don’t know what we would do if you don’t come in.”
- Verbal commitments about duties or scope that quietly expand. You may have agreed to informally help with a task “just this once whilst we’re short-staffed” without any discussion about it becoming ongoing. Weeks later, it’s simply now expected of you, perhaps even raised as a performance issue. It becomes the new baseline without any consultation or renegotiating.
- Framing reasonable boundaries as ‘letting the team down’ or even worse, ‘letting the patients down’.
- Comparison with others, such as, “Everyone else has picked up extra shifts this month…”
- Manufactured urgency used to bypass process. For example, “There’s no time to go through the usual channels; we just need your answer now.”
What makes these dynamics so difficult in rural and remote healthcare is that the scarcity is often real. There isn’t relief staff to help support you, and the clinical need is often urgent. This makes it genuinely difficult to distinguish between legitimate requests driven by real constraints and a pattern of behaviour that keeps work disproportionately landing on you.
Demerouti & Bakker’s (2023) Job Demands-Resources theory suggests two separate pathways through which work affects wellbeing: a health-impairment process, where chronic demands without adequate resources erodes energy and leads to exhaustion, and a motivational process, whereby sufficient resources such as support, autonomy and recognition can sustain people, even whilst they’re under pressure.¹ In a short-staffed team, demands such as workload, urgency and emotional labour are high, whilst the ability to say no without consequence is often the first thing to disappear. Manipulation, whether it’s intentional or not, exploits that gap between the organisation’s needs, and prioritising these over your personal needs.
Another model of burnout (Maslach & Leiter, 1999) looks at the job-person fit model, which identifies workload and control as two of the six areas most predictive of burnout when they’re mismatched.² Short-staffed teams are by definition high-workload, low-control environments. This mismatch between workload and control is where manipulation can take hold, as when someone has no real capacity to say no without consequence, “no” stops being a genuine option. Meijman & Mulder’s (1998) effort-recovery theory adds a further layer: recovery isn’t optional, it’s physiological and necessary.³ Every “yes” said under pressure and without adequate recovery time between shifts compounds until it shows up later as exhaustion, irritability, or an urge to leave the profession altogether. Manipulation that trades on goodwill is, in effect, taking away from a colleague’s recovery time.
So, what can you do in this environment? A couple of suggestions are:
Notice the pattern, not just the moment. One extra shift isn’t a crisis. However, a pattern where the same one or two people are always asked and always say yes, has become a structural issue. Rather than absorbing it individually, approach your supervisor and name the behaviour.
Separate the ask from the guilt. It’s possible to simultaneously hold the ideas of ‘the request being reasonable, given the circumstances’ with ‘not feeling obligated to be the one who solves it every time’. Value-based boundaries that are grounded in what matters to you (such as patient care, your own health, and sustainability) hold up better under pressure as they are flexible, unlike rules-based values (for example, you don’t work weekends) which tend to be more rigid.
Use peer consultation as an early warning system. Colleagues often see patterns in each other’s rosters and workloads before the person does. Regular, informal check-ins, such as, “How many extra shifts have you been asked to pick up this month?” can reveal an unsustainable pattern before it becomes embedded.
Practice self-compassion when boundaries don’t hold. Boundaries sometimes fail, especially under pressure. It’s not evidence of any weakness, but a reflection of working inside a system that too often asks individuals to absorb structural gaps. Practice the self-compassion principles of self-kindness over self-judgement, common humanity over isolation, and mindfulness over over-identification (see the Self-Compassion Institute for more on these three principles). Self-compassion is what you need right now.
Short staffing is a systemic problem. An individual within a team shouldn’t be manipulated by managers or other staff into filling roster gaps, whilst the underlying staff scarcity remains unaddressed. Naming the dynamic and separating ‘the system is under-resourced’ from ‘I personally must fix it every time I’m asked’ is the first step toward advocating for the structural changes required to reduce the pressure. You don’t need to simply absorb those pressures yourself.
Be kind,
Dr Nicole Jeffery-Dawes (she/her)
Senior Psychologist, Bush Support Line
- Demerouti, E. & Bakker, A.B. (2023). Job demands-resources theory in times of crisis: New propositions. Organisational Psychology Review, 13(3). Accessed 10 September 2026 at https://journals.sagepub.com/doi/10.1177/20413866221135022
- Leiter, M. & Maslach, C. (1999). Six areas of worklife: A model of the organizational context of burnout. Journal of Health and Human Services Administration, 21(4):472-89. Accessed 10 September 2026 at https://www.researchgate.net/publication/12693291_Six_areas_of_worklife_A_model_of_the_organizational_context_of_burnout
- Meijman, T.F. & Mulder, G. (1998). Psychological Aspects of Workload. In De Wolff, J., Drenth, P.J.D. & Henk, T. A (Eds.) Handbook of Work and Organizational Psychology (Vol.2). Psychology Press.
