News & 

Advice, insights, and news from our team.

In Depth: The Emergency Department Registered Nurse Shortage Crisis

We are fully aware that the nursing shortage in the US  extends beyond the Emergency Department (ED), but choose to focus on that particular venue in this addition to the In Depth series.

This paper was promoted by a press release from the American College of Emergency Physicians (ACEP), entitled Nursing Shortages Compound Capacity Concerns, Strain Emergency Departments Amid COVID Surge, which reads, in part:

As COVID cases surge, the American College of Emergency Physicians (ACEP) is very concerned that nursing shortages in emergency departments can complicate patient access to care and add to incredible levels of stress already on physician-led care teams.  

“Emergency physicians are being tested yet again by hospital capacity concerns and staff shortages,” said Gillian Schmitz, MD, FACEP, president of ACEP. “In many communities the strain on the frontlines is more severe today than at any other point during this pandemic.”

An emergency nurse has an indispensable role on a physician-led care team. But with fewer nurses available, each member of the team will clock extra hours, care for more patients, and stretch to take on additional clinical and nonclinical duties. Meanwhile, emergency physicians are leading efforts at the facility, regional and federal levels to address workforce issues that include staffing concerns and resource shortages that cut across job roles.

“Everyone available is filling gaps as best they can, but the current path for many frontline workers is not sustainable,” said Dr. Schmitz.

We’ll return to that release shortly, but the obvious question, if you accept the premise that a shortage exists (we do, and won’t dwell on that matter further), is “Why is there a nursing shortage?” Not surprisingly, researchers have investigated, and have an opinion.

SNHU posted, Nursing Shortage: Why There’s a Continued Demand for Nurses, which includes this summary

There are four main contributors to the nursing shortage:

  • Retiring nurses or those choosing to leave the profession.
  • The aging population necessitates increasing the level of care patients require.
  • A nursing faculty shortage capping prelicensure admission capacity.
  • Nursing burnout.

I think that is part of the story, but two other factors, the pandemic and the rise of travel (agency) nurse staffing, also play a significant role in the crisis and its current trajectory,


“Right now, with the pandemic, many nurses are being faced with an incredible amount of trauma due to the number of deaths that they are seeing with COVID on a regular basis and just with incredible sick people,” Dimsy-Reed said.

Younger nurses are being trained to take their place, but there just are not enough to fill vacancies.

West Virginia Hospital Association President and CEO Jim Kaufman said, “Nursing is getting a lot of attention because there is more than 180 thousand vacant nursing positions nationwide. Hospitals are trying to be creative. Ho do we use the health care professionals we have to their fullest capabilities?”

… and this passage:

There is a big dollar big draw to travel nursing. The website Zip Recruiter lists West Virginia in the top four in the country for yearly wages for travel nurses offering $102,000 a year, more than $49 an hour. While the same website lists West Virginia local or non-travel nurse pay at $62,000 a year, or $31 an hour.

“You are seeing those hourly rates for temporary nursing skyrocket,” says Jim Kaufman., West Virginia Hospital Association President and CEO. “We’re competing with 49 other states for the limited number of health care professionals that are out there.”

Avant healthcare provides an interesting infographic on the topic that we will not reproduce here but is worthy of a click.

What is to be done?

AAMC posted Hospitals innovate amid dire nursing shortageswhich includes this excerpt explaining the problem:

Also never seen before are the staffing shortages that are plaguing hospitals in the latest COVID-19 hot spots, forcing them to offer eye-popping employment bonuses and draft everyone — from students to administrators to physicians — to fill in the gaps as best they can. While shortages abound across front-line jobs, nowhere is the need greater than in nursing, as hospitals hit by the current surge report unprecedented vacancies in nursing slots: 470 out of 3,800 positions at Parkland; 240 out of 1,400 at UAMS; and 760 out of 4,000 at UAB.

“It’s a dire situation,” explains LouAnn Woodward, MD, vice chancellor at the University of Mississippi Medical Center (UMMC).

The situation keeps growing more dire throughout the pandemic, which exacerbated conditions — including widespread staff burnout and an aging workforce — behind a looming nationwide nursing shortage. The current surge of the delta variant has found front-line caregivers particularly vulnerable, both physically and emotionally, because they had been moving ahead in confidence that the worst of COVID-19 was behind them.

and this excerpt explaining the solutions:

Hospitals are employing several strategies to fill the gaps in nursing for the short term.

  • Tapping staff doing nonclinical work: Employees whose jobs do not involve clinical care are stepping in to serve patients or take on other tasks to ease the burden on clinical staff.
  • Tapping educators and students: In hot spots around the country, medical, nursing, and pharmacy students are in hospitals doing everything from helping to transport patients and ferrying lab specimens to delivering meal trays and emptying trash cans.
  • Recruiting: Many hospitals are offering signing bonuses for nurses to work in specific high-need areas. UAMS, for example, offers a $25,000 bonus for experienced acute care nurses (paid over three years). In addition to signing bonuses, UMass Memorial Health offers its current nurses up to $5,000 for referring nurses who take critical jobs there and stay for certain lengths of time, Precourt explains.
  • Retaining: Some hospitals are raising salaries and offering bonuses to keep their existing nursing staff. UAMS recently announced $10,000 retention bonuses for nurses who have been at the organization for at least three years and work in certain high-need units. Parkland offers some of its nurses temporary contracts that pay close to what they might receive through a traveling nurse company; when the contracts expire, they can resume their regular employment.“The benefit is they can stay in their home hospital, the hospital is able to retain them, and we will float them to the area of the hospital in greatest need,” says Roberto de la Cruz, MD, Parkland’s executive vice president and chief clinical officer.
Back to the ACEP press release

“Emergency department leaders are doing their best to meet today’s challenges under severe resource constraints,” said Dr. Schmitz. “Emergency physicians will continue to do everything necessary to treat patients, but it will take a collaborative effort with legislators, policymakers and health system leaders to strengthen care teams, improve access and address capacity concerns with solutions that can save lives right now and in the months ahead.”

Recognition of the essential role ED RN’s play in the safe and effective operation of the department and their effect on patient care and outcomes is only the start. Support of and recognition for that contribution, along with programs that address stressors and safety, will help ensure recruitment and retention.


This is 15 1 1 1 1 1 1 1
Paul Hudson, FACHE
Chief Operating Officer