Design and Framework:  A cross-sectional study was used to collect benchmark data on the characteristics of U.S. emergency departments.  A systems model was used to identify factors influencing nurse staffing and safe patient care.

Sample: A sample of 444 ED managers from various types, sizes, and locations completed the study.

Instrument: The survey consisted of 75 questions of which 29 questions addressed nursing staffing and strategies. Statistical analyses included descriptive, univariate, multivariate, and backward elimination logistic regression analyses along with qualitative data analysis.

Results: The 444 emergency departments had an average of 27,400 annual patient visits; 28.97 budgeted RN FTEs; 10.16% RN turnover rate; 6.98% RN vacancy rate; and 11.9 weeks to fill vacant RN positions. Weeks to fill positions (p=0.024) and the quality of fringe benefits for RNs (p=0.010) were significant predictors of EDs that did and do not have adverse patient events less than 0.15% of the annual visits and provided urgent care in less than 15 minutes and no waiting for emergent patients.  The sensitivity and specificity of the model was high (78.6% and 72.4% respectively) and could correctly classify 73.3% of the EDs. In addition, the managers identified over 1,000 strategies to improve recruitment and retention of nurses.

Conclusion: Emergency departments that retain their nurses, keep turnover and vacancies low, and rapidly recruit nurses to fill vacancies are more likely to provide rapid care for emergent and urgent patients and have fewer adverse patient events. Many emergency departments are implementing innovative strategies to prevent a nursing shortage.