How the Nursing Shortage Affects the ER, and What to Do About It

The nursing shortage hits the emergency room harder than almost anywhere else. Patients wait hours to be seen, sometimes with dire consequences, while burnout pushes more nurses out the door. Waiting for the pipeline to deliver new graduates is not a plan. Here is how the shortage plays out in the ER and what nurses and hospitals can do about it now.

An Unfolding Crisis, Not an Impending One

The shortage is not new. The U.S. Government Accountability Office flagged it and projected future strain back in 2001. What changed is scale. The NCSBN 2024 National Nursing Workforce Survey found that roughly 138,000 nurses have left the workforce since 2022, and nearly 40% of RNs say they intend to leave or retire within five years. The workforce is also aging: the median RN age rose to 50 in 2024, up from 46 in 2022. That combination signals a sustained gap, not a temporary dip.

The strain is most visible in patient boarding. In a 2022 letter to the White House, leaders from the American Medical Association, the Emergency Nurses Association, the American Psychiatric Association, and others warned that boarding patients in the ER while they wait for an inpatient bed had become a crisis driven by staffing shortages. In extreme cases, patients waited in ambulances to be seen. Provider burnout feeds the cycle: each departure widens the gap and raises the load on everyone left.

ER nurses work in high-pressure environments, holding structure in chaos by rapidly identifying who needs immediate care and minimizing pain and trauma. Hospitals must treat everyone who walks in, yet underfunding drives further cuts as some systems trim staff to protect margins. No region has been spared.

Fixing the ER Nursing Shortage

There is no easy fix. It takes collaboration across the whole delivery system and every level of government to train, hire, and retain more nurses, raise satisfaction and salaries, improve mental health support, and pay providers adequately for the care they deliver. While legislators and nursing schools work the long-term levers, hospitals and nurses can make local changes now and share what works.

Improve the patient experience

ER satisfaction scores feed into Medicare reimbursement. One lever: patient liaisons stationed in the ER to explain how triage works, how resources get used, and what drives wait times. That frees nurse time and can improve patient flow. Better satisfaction supports better reimbursement, which over time funds more hires, better training, and mental health services that lower burnout and improve retention.

Coordinate ERs across a region

ERs in a region can coordinate care and resources like ambulance services, diverting patients in real time based on condition and wait times. Level 1 trauma centers take the most critical cases while fractures and minor injuries route to Level 2 or 3 hospitals. If a patient deteriorates, they can still be transferred up. ER nurses are well positioned to advocate for this kind of system, since they see directly how patient flow ties to satisfaction and reimbursement.

Expand and redistribute labor

Nurses have traditionally done everything: drawing blood, taking vitals, transporting patients, changing sheets. Much of that can be delegated. Phlebotomists can draw blood and be trained to start IVs. Certified nursing assistants can transport stable patients, take vitals, change linens, and restock supplies. With nurse input, leaders can decide which tasks shift and staff accordingly, giving ER nurses more time for direct patient care.

Support new nurses

New ER nurses do better with strong mentorship, training, and mental health support. The ER is still a fast-paced, demanding place, and preventing burnout is the key to keeping the nurses you already have. New hires need real relationships with experienced colleagues and leadership. Residency programs help too: the Emergency Nurses Association residency program, built through ENA University, sharpens communication, problem-solving, and critical-thinking skills for the ER. Residencies build confidence and clinical judgment and reduce turnover, which makes the unit more attractive to new and seasoned nurses alike.

Advocate at every level

Nurses are strong advocates for patients, and that strength works just as well for the profession. Long-term change in the ER requires community and legislative action, which means nurses have to speak up publicly. Many small providers are financially fragile; in 2022 alone, 46 healthcare organizations filed for bankruptcy. Working with lawmakers and national nursing associations on working conditions, reimbursement, and related issues is how that changes. One voice may feel like too little, but one voice inspires others. The ER shortage is a crisis playing out in communities across the country, and the work of many hands is what moves it.