Nursa Data Reveals America's 10 Most Overwhelmed Hospital States

According to data via Nursa, many hospitals across the United States are struggling to keep up with increasing demand. High levels of patient visits paired with budget constraints, staff fluctuations, and nursing shortages mean some hospitals are at risk for being overwhelmed.

Nursa, a platform that connects nurses to open shifts and per diem roles in partnering facilities, analyzed data points on overcrowding, staffing levels, and patient acuity to reveal the states with the most overwhelmed hospitals. 

How Nursa Ranked Overwhelmed States for Hospitals

To come up with their rankings of the most overwhelmed hospitals by state in the country, Nursa analyzed hospital strain across all 50 states using eight critical metrics: 

• Registered nurse shortages
• Nurses per hospital bed
• Patient-to-nurse ratios
• Bed availability
• Admission rates
• Length of stay
• Medicare admission volumes
• Patient acuity scores

Based on the available data, here's what they found and shared with Nurse.org.

Maryland Leads as the Most Overwhelmed State for Hospitals

Maryland hospitals are facing unprecedented challenges, scoring 9.12 out of 10 on Nursa's hospital overwhelm scale—the highest in the nation. 

This troubling ranking reflects a healthcare system under extreme pressure, with nurses caring for 2.9 Medicare patients each, the highest Medicare patient‑to‑nurse workload in the country. On top of that, the state has just 17.9 hospital beds per 10,000 residents, making it difficult to accommodate patients. (That ratio is also one of the worst in the entire country.)

Emergency departments in Maryland are also feeling the heat, with average wait times of 4 hours and 11 minutes, compared to the national average of 2 hours and 35 minutes. That's 62% longer than the national average!

Once patients are admitted, they’re not exactly breezing in and out, either. The average hospital stay in Maryland is 6.1 days, and patient risk scores, which measure how sick or complex a patient’s condition is, average a hefty 8.8 out of 10.

Translation: patients in Maryland need a lot of care, and there aren’t enough nurses to go around.

Top 10 Most Overwhelmed States for Hospitals

According to the data, the top 10 most overwhelmed states for hospitals are:

1. Maryland (9.12/10)
2. Virginia (8.79/10): Confronts a severe nurse shortage of 28,720 registered nurses, one of the largest in the country 
3. South Carolina (8.18/10): Manages 2.3 Medicare patients per nurse with limited bed capacity
4. Florida (8.16/10): Highest patient risk scores at 9.6/10 despite better staffing ratios
5. Pennsylvania (tie with NC: 8.11/10):  struggles with RN shortages (16,000+ unfilled roles).
6. North Carolina (tie with PA: 8.11/10): also struggles with RN shortages
7. California (8.09/10)
8. New Jersey (8.01/10)
9. New Hampshire (7.90/10)
10. Missouri (7.81/10)

Source: Nursa

Other Data Findings

• Wyoming claimed the title of the state with the 'least overwhelmed' hospitals in America, scoring just 2.34 out of 10 and boasting a rare surplus of nurses, plus one of the shortest average hospital stays of 4.5 days. 
• Washington has the fewest hospital beds per potential patient, coming in at 15.5 beds per 10,000 people in the population
• Alaskans spend the longest in the hospital, averaging 7 days 
• Virginia scored 8.79/10 and is short 28,720 nurses
• California has the largest absolute nursing shortage in all the states, with 34,380 unfilled positions.

In short, every state has its own struggles, and no place is immune to the challenges of modern nursing.

What Does the Data Mean for Nurses?

The data analysis can be a good starting point for nurses who may be starting their careers or looking to travel.

For instance, nurses considering travel assignments may want to avoid traveling to Maryland for assignments unless they know that they thrive in high-pressure environments. Or, on the other hand, Wyoming may offer less strain but less need for nurses. 

For nursing leaders, the findings can also highlight the areas and need to advocate for better staffing ratios and resource allocation. For instance, Virginia is the second most overwhelmed state for hospitals, and is also predicted to lose up to $26 billion over the next 14 years with changes to the Medicaid program, which could make the outlook for patients and nurses even more challenging. 

The data could also be an opportunity to more closely examine some of the multiple converging factors affecting nursing practice in these states, such as:

• Population growth reducing nonprofit hospital bed availability by 7.5% per 1% migration increase in certain regions, estimates suggest 
• A severe 2026 flu season overwhelming emergency departments
• Ongoing workforce pressures from evolving nurse staffing regulations
• Rural and nonprofit hospitals facing heightened operational risks

This data underscores the urgent need for strategic workforce planning and resource allocation in nursing. States with high overwhelm scores require immediate attention to nurse recruitment, retention strategies, and workload management to ensure safe patient care and prevent further workforce burnout.

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