Emergency Nurse Staffing and Outcomes for Patients and Nurses: A Scoping Review

Emergency department crowding compromises patient safety and quality of care. Nurse staffing is a key determinant of patient flow, treatment timeliness, and clinical outcomes. This review mapped and synthesized evidence on the relationship between emergency nurse staffing and outcomes for both patients and emergency nurses.

A scoping review was conducted using the Arksey and O'Malley framework and Joanna Briggs Institute methodology, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. MEDLINE, CINAHL, CENTRAL, Scopus, and Igaku Chuo Zasshi were searched from inception to February 25, 2025, without publication-year restriction. Eligible studies reported nurse staffing in emergency departments and patient- or nurse-related outcomes.

The authors retrieved 1965 studies, and 41 met eligibility criteria after full-text screening. Forty-1 studies, primarily observational and conducted in the United States, were included. Nurse-to-patient ratios varied considerably, ranging from 1:1 in resuscitation areas to 1:20 in general emergency departments. Overall, 32 of 41 studies (78%) reported positive associations between higher staffing and favorable outcomes, including shorter length of stay, reduced waiting times, fewer patients leaving without being seen, fewer errors, and lower mortality. Nurse-related outcomes such as burnout and turnover were examined in a few studies, suggesting potential benefits of adequate staffing.

This scoping review found that adequate nurse staffing in emergency departments was consistently associated with improved patient safety and quality of care. However, the predominance of observational designs and heterogeneity in staffing measures limit comparability across studies. Future research should adopt standardized staffing indicators and systematically include nurse-related outcomes to strengthen the evidence base for international policy and practice.