Background and objective. Emergency departments have evolved into the “safety net” for the healthcare system in the United States. There are increasing numbers of patients presenting to fewer and crowded emergency departments. This safety net is at risk unless changes are made.

The use of nurse practitioners and physician assistants in emergency departments to care for the many non-emergent patients may be a cost-effective approach to increasing access to care and to ease overcrowding in emergency departments. The purpose of this research was to ascertain current practice models for staffing and utilizing nurse practitioners and physician assistants in emergency department practice in two northwestern states.

Methods. A descriptive study using a Web-based survey of emergency department managers in 158 emergency departments in Washington and Oregon was conducted in March 2009. Data analyses were completed using SPSS version 17.0 to obtain descriptive and chi-square statistics.

Results. The study generated descriptive statistics on the utilization of nurse practitioners and physician assistants in emergency departments in Washington and Oregon in an effort to understand the frequency and dynamics of the role. The research also gathered data on how characteristics of the hospital and emergency department could affect the employment of nurse practitioners and physician assistants.

There were 93 hospitals that responded to the survey (59 Washington and 34 Oregon), for an overall 59% response rate. Of the hospital that responded, 58% used nurse practitioners and physician assistants. Larger, urban hospitals who reported overcrowding employed these providers more than smaller, rural hospitals in both States.

Conclusions. The findings of this study provided data on how this workforce delivered care in complex emergency department systems and it is hoped that the generated data will have implications for the development of improved models of care in the emergency departments. With further clarification and understanding of the utilization of these providers the potential to use this workforce in a more consistent and effective manner will be enhanced, which may improve flow through emergency departments by decreasing crowding and cost of care.