PHILADELPHIA (October 13, 2026) – A new study led by researchers from Penn Nursing's Center for Health Outcomes and Policy Research (CHOPR) finds that improving hospital nurse workloads could alleviate delays in care contributing to emergency department crowding.
The findings, published in Medical Care , highlight a promising solution to emergency department (ED) crowding, a national crisis that occurs when the number of patients entering hospitals exceeds the number of available inpatient beds, causing bottlenecks in the emergency department.
In emergency departments where nurses reported staffing inadequacies, researchers identified significantly worse patient crowding. A 1 standard deviation increase in emergency department nurse staffing inadequacy was associated with a
- 18-minute increase in ED length of stay for patients being observed for behavioral health
- 9-minute increase in overall patient ED length of stay
- 0.4 percentage point increase in patients leaving the ED before being seen by a provider.
The study also found that staffing inadequacy as reported by nurses working inpatient was associated with an 18-minute increase in ED length of stay for patients presenting with behavioral health conditions. Over 60 percent of emergency department nurses and 58% of inpatient nurses in the study reported that there were not enough staff to get work done in their hospital.
"Nurses are caring for more patients than they can safely manage, and our findings suggest that high nurse workloads are contributing to excessive delays in emergency department care," said first author Jane Muir, PhD, MSHP, RN , Assistant Professor in the Department of Family and Community Health and CHOPR core faculty.
"Crowding occurs when hospitals don't have enough resources to admit patients into a bed, whether in the ED or inpatient units," Muir added. "We find that having enough nursing positions to appropriately staff high-stakes hospital care is one of the most important resources for ensuring the public experiences safe, timely care. A hospital bed without a nurse to staff it is not an available bed."
The average study hospital was performing worse than the Joint Commission recommendations for ED care (recommendation: less than 2% of patients leave the ED without being seen and less than 4 hours length of stay for patients with behavioral health conditions). In this study, the average ED had 2.8% of patients leave without being seen and 5.5 hours length of stay for behavioral health patients.
Improving nurse staffing adequacy could result in more accessible ED care. In this study, researchers projected that funding more positions for bedside nurses in the 410 study hospitals would be associated with over 5,000 more patients treated due to shorter ED lengths of stay, and over 250 patients retained in care due to fewer people leaving waiting rooms before being seen.
"Hospitals can create more funded positions for bedside nurses to alleviate chronic understaffing conditions and solve long wait times in emergency departments," Muir stated. "Our study emphasizes that safe nurse staffing matters to move the needle on safer, timelier care for the public."
Co-authors for this study include Linda H. Aiken, PhD, RN; Daniela Golinelli, PhD; Karen B. Lasater, PhD, RN; and Matthew D. McHugh, PhD, JD, MPH, RN, all from Penn Nursing's Center for Health Outcomes and Policy Research. It was supported by the National Institute of Nursing Research (NINR) of the National Institutes of Health (NIH) under award numbers R01NR014855, T32NR007104, and R01NR021707.
