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How the Nursing Shortage Affects the ER—And What to Do About It

Gayle Morris, BSN, MSN
by
Updated May 16, 2023
    ER nursing shortages have tangible effects on patient outcomes and retention. ER nurses can help solve this national crisis.
    Credit: Getty Images
    • The ER nursing shortage has a palpable effect on patient outcomes, nurse burnout rates, and staff retention.
    • No longer an “impending crisis,” the nursing shortage in emergency rooms across the nation has reached a breaking point.
    • Nurses’ involvement in advocacy, creative planning, and program development is needed to solve this crisis.

    The nursing shortage continues to have real impacts on nurses and patients. The challenges related to patient care and nursing stress are particularly intense in the emergency room (ER).

    The ER nursing shortage means that some patients wait hours before they are seen, sometimes with dire consequences. Waiting for an expansion of the nursing pipeline to deliver new nurses is not an option. Explore ways that nurses and hospitals can address the ER nursing shortage now.

    ER Nursing Shortage—An Unfolding Crisis

    The nursing shortage is not a new phenomenon. In 2001, the United States Government Accountability Office addressed the nursing shortage and projected future concerns. With an increasing number of nurses leaving the profession since the COVID-19 pandemic, the issue is no longer an “impending” crisis but unfolding with real-world consequences.

    Data from a 2022 survey by the National Council of State Boards of Nursing (NCSBN) revealed that roughly 100,000 registered nurses (RNs) left the profession because of the pandemic, while another 800,000 nurses with more than 10 years of experience plan to leave by 2027.

    In November, medical organizations, including the American Medical Association, warned the White House that the ER nursing shortage is reaching a “breaking point” as nurses and other ER professionals deal with an overflow of patients waiting for a hospital bed due to staffing shortages.

    In a letter to President Biden, leaders from the American Medical Association, the Emergency Nurses Association, the American Psychiatric Association, and others cautioned the White House that the practice of “boarding” patients in the ER while waiting for an inpatient bed has become a crisis triggered by an ER nursing shortage.

    Healthcare leaders noted that, in extreme cases, patients waited in ambulances to be seen in the ER. Provider burnout creates a vicious cycle, with burnout-related departures creating even greater ER nursing shortages.

    The nursing population is aging, which is true for much of the rest of the nation’s healthcare workforce. The median age of nurses is 46, according to a 2022 NCSBN survey. This indicates a dire need for new nurses to offset the number of nurses approaching retirement or leaving the profession.

    ER nurses work in high-pressure environments. They maintain structure in a chaotic environment by quickly recognizing medical conditions and patients requiring immediate care and minimizing pain and trauma.

    Hospitals must provide care to people who arrive in the emergency room. Yet, a lack of funding contributes to a growing ER nursing shortage as some hospitals cut staff to protect profits. No region in the U.S. has been spared the consequences of an acute nursing shortage in the ER.

    As Congress begins taking bipartisan steps to address the issue, nurses and hospitals can also make changes that may significantly impact patient care and nurse retention.

    Fixing the ER Nursing Shortage: A Brainstorm

    It is no secret that fixing the ER nursing shortage will not be easy. It will require collaboration and innovation at all levels of the healthcare delivery system and the local, state, and federal levels of government to:

    • Find ways to train, hire, and retain more nurses
    • Increase professional satisfaction
    • Raise salaries
    • Improve mental health support
    • Pay hospitals and providers adequately for the care delivered

    As Congress works toward developing legislation to address these issues and nursing schools start implementing changes to increase the number of new graduates, hospitals and nurses can consider making local changes and sharing results so other regions can integrate what works and avoid what doesn’t.

    Improve the Patient Experience

    A patient’s ER experience affects their satisfaction, which is tied in many aspects to hospital reimbursement. The federal government uses patient satisfaction scores to help determine Medicare reimbursement for services.

    One potential solution for increasing satisfaction in the ER: patient liaisons. Nurses can advocate for these professionals to be stationed in the ER to help explain to patients how the unit uses resources, how the triage system works, and what factors impact how long it takes to be seen. This frees ER nurses’ time and may improve patient flow.

    While it is not an immediate answer to the ER nurse shortage, improving patient satisfaction — and, down the road, hospital reimbursement — could allow hospitals to hire more ER nurses, invest in better training, and provide appropriate mental health services. These strategies can lower nurse burnout and improve retention.

    Coordinate ERs

    ERs in a region can coordinate care and resources, such as ambulance services. In real time, this coordinated effort can divert patients to different ERs based on the patient’s condition and wait times.

    For example, Level 1 trauma centers can take the most critical patients, while other patients can be diverted to Level 2 or 3 hospitals. This ensures Level 1 trauma centers are not juggling non-life-threatening injuries like bone fractures with heart attacks and open head wounds.

    Under this system, if a patient deteriorates and requires a higher level of care, they can still be transported to another hospital. ER nurses are in a unique position of advocating for a system in their area as they can speak directly to how patient satisfaction and reimbursement are profoundly related to patient flow.

    Expand Labor Sources

    Traditionally, nurses have drawn blood, taken vital signs, transported patients, changed sheets, and just about everything in between. Yet, many of these routine tasks can be delegated to other staff. For example, phlebotomists can draw blood and be trained to start IVs. Certified nursing assistants (CNAs) can transport stable patients, take vital signs, change sheets, and refresh supplies.

    With the help of ER nurses, hospital leaders can determine which tasks can or should be done by CNAs or similar professionals and design and fill new positions accordingly. This can give ER nurses more time for direct patient care, which eases the pressure created by staffing shortages.

    Support New Nurses

    New ER nurses benefit from better mentorship, training, and mental health care. Still, the ER is a fast-paced, challenging place to work. With the ongoing nursing shortage, patients and nurses alike are experiencing low levels of satisfaction.

    Preventing burnout is a key strategy in retaining the qualified nurses already working in the ER and hiring nurses who understand the importance of keeping staff turnover to a minimum.

    ER nurses need meaningful relationships with more experienced colleagues and leadership. Novel training programs also can help.For example, the Emergency Nurse Association Emergency Nurse Residency Program, created by ENA University, was designed to help nurses refine communication, problem-solving, and critical-thinking skills for the ER.

    Nurse residency programs can raise confidence, improve clinical judgment, and help reduce staff turnover. All factors that make an ER position more attractive to new and seasoned nurses alike.

    Local, State, and Federal Advocacy

    Nurses are strong patient advocates. That strength is also effective when nurses advocate for themselves, their colleagues, and their profession.

    Impacting the ER nurse shortage long term requires community and legislative changes. To achieve those changes, nurses must publicly advocate for strategies that impact healthcare.

    For example, many small healthcare providers are on the verge of bankruptcy. In 2022, 46 healthcare organizations filed for bankruptcy.

    Nurses can work with lawmakers and national nursing associations to address working conditions, reimbursement issues, and other areas of importance. Although many nurses feel one voice is not enough to make a difference, one voice can serve as an inspiration to others.

    The ER nurse shortage is a crisis playing out in communities across the nation and the world. But, as with all crises, the work of many hands makes a noticeable and significant difference to the end result. ER nurses can work together to make changes in their workplaces, communities, states, and countries. Nurses can solve this nursing crisis.