Emergency department crowding is, in large part, a nurse staffing problem. That is the conclusion of a study of 410 hospitals published in the journal Medical Care, which linked survey responses from 11,705 hospital nurses with federal crowding measures and found that where more ED nurses reported inadequate staffing, patients waited longer and more left without being seen.
The shortages nurses described were widespread. On average, 61 per cent of emergency nurses and 58 per cent of inpatient nurses said their hospital did not have enough staff to get the work done, and at the average hospital 68 per cent of ED nurses said their department boarded patients daily — holding admitted patients in the ED because no inpatient bed was available. The nurses were surveyed between December 2023 and March 2024 across California, Florida, Illinois, Louisiana, New Jersey, New Mexico, New York, Oregon, Pennsylvania and Washington.
The effects scaled with the shortfall. Each standard-deviation rise in the share of ED nurses reporting inadequate staffing was associated with ED stays about 8.5 minutes longer for patients without psychiatric concerns, and about 18.4 minutes longer for patients with mental health concerns, after adjusting for hospital characteristics.
The research team, led by K. Jane Muir at Penn Nursing's Center for Health Outcomes and Policy Research, also modelled the upside: funding more bedside nurse positions across the study hospitals was associated with more than 5,000 additional patients treated through shorter ED stays, and more than 250 patients retained in care who would otherwise have left the waiting room unseen. Their prescription is direct — hospitals can create more funded positions for bedside nurses to relieve chronic understaffing and the long waits that come with it.
