Nurse Staffing and Emergency Department Crowding: A 10-State Study

The purpose of this study was to determine the relationship between nurse staffing inadequacy in the emergency department (ED) and inpatient units on objective ED crowding measures.

Three datasets from 2024 were linked: the Penn Nurses4All survey, CMS Hospital Compare, and the AHA Annual Hospital Survey. Nurses4All provided measures of nurse staffing inadequacy. The proportion of nurses reporting staffing inadequacy was the main exposure variable. Crowding measures included the percentage of patients who left the ED without being seen and patient length of stay (in minutes) for patients with and without psychiatric/mental health presentations. The analysis included hospital-level regression models adjusted for hospital characteristics.

The sample included 410 hospitals in 10 states. A 1 SD increase in ED nurses reporting staffing inadequacy was associated with higher hospital left without being seen rates (β=0.4, 95% CI: 0.2-0.6, P<0.001), longer lengths of stay for ED patients (β=8.5, 95% CI: 3.5-13.6, P<0.001), and patients with psychiatric/mental health concerns in the ED (β=18.4, 95% CI: 3.6-33.1, P<0.05). A 1 SD increase in inpatient nurses reporting staffing inadequacy was associated with longer ED lengths of stay for patients with psychiatric/mental health concerns (β=18.0, 95% CI: 5.8-30.3, P<0.01).

Staffing a sufficient number of nurses in both the ED and inpatient units is a promising strategy to alleviate ED crowding.