Solution 2: Unload the nursing workforce of less complex tasks by allowing related professionals to increase their scope of practice

To reduce crowding, the central issue hospitals need to address is a shortage of nursing labor. Allowing some lower-level tasks performed by nurses to be completed by related professionals would rapidly address the issue. An immediate step would be the federal government working from the top down with local regulatory bodies to adopt new scopes of practice for workers and delegate some, less complex, currently nurse-only, tasks to others. For example, EMS personnel, certified nursing assistants, and medical assistants could reduce the nursing work burden for tasks such as drawing blood, hanging simple fluids, placing IVs, and other tasks. This would involve partnering with groups like the American Nurses Association or the Emergency Nurses Association to develop programs for nurse extenders. ED physicians lead teams of advanced practice clinicians in some hospitals. Similarly, nurses could lead their own teams with these new roles. Some hospitals have already embraced the concept of nursing extenders.8 Additionally, military branches have skilled workers with complementary skills where an existing workforce could be immediately deployed to meet these needs. Navy corpsmen deliver a wide range of nursing-related tasks in U.S. military facilities. Another idea would be to expand the National Health Services Corps to include graduating high school seniors who could serve in these novel roles for two years, gaining skills and loan forgiveness for college or trade school.

Solution 3: Fund EDs and hospitals to address hospital crowding and ED boarding

With direct funding from the federal government, there would be additional resources to address local issues, customized to hospital needs. Such uses of funds could include hiring ancillary staff to offset nursing tasks, which would address the staff shortages that have caused many hospitals to close available, but now empty, beds. These bed closures directly worsen boarding because there are fewer spaces to send ED patients after hospital admission. Those beds need to reopen. Funding could also be directed further downstream to post-acute facilities where decreases in bed availability have caused upstream congestion in hospitals, also leading to ED boarding.

Alternatively, funding could be deployed to provide resources to internal hospital teams to address remediable flow issues. Funds could be used to hire additional physicians or advanced practice clinicians to augment clinical gaps, or to provide leadership. Such funding would create an imperative for hospitals to focus on ED boarding with additional dedicated human resources at a time when hospital budgets are strained.