As the demand for medical care in the US continues to surge, nationwide hospitals are struggling to keep up. Americans visited the emergency department 139.8 million times in 2024 - 42.7 visits per 100 people. High demand paired with budget and staffing issues means that many hospitals across the US are working to keep their heads above water. But where is struggling the most?
Interested to find out, the experts at healthcare workforce management platform Nursa analysed overcrowding, staffing levels, and how sick the average patient is for every US state to reveal the states with the most overwhelmed hospitals.
Table: States with the most overwhelmed hospitals
Maryland hospitals are the most overwhelmed in the US
Hospitals in Maryland appear to be struggling the most, scoring a 9.12 out of 10 overwhelm score.
Patients outnumber registered staff in Maryland more than any other state, with 2.9 patients per nurse, compared to Wyoming, which has more nurses per patient with less than 1 patient per nurse (0.7). Maryland also has the 5th fewest beds per 10k population in the US, with just 17.9 beds. In the state, the average patient stays for 6.1 days in the hospital, with patients scoring 8.8 out of 10 for risk score, which estimates how sick patients are based on their medical conditions and history, the sixth most severe health risk in the US.
This ranking comes alongside the report from September 2025 that Maryland hospitals have seen a rise in medical errors for the fourth consecutive year, potentially attributed to a variety of causes, including workforce shortages, increased patient acuity, and residual impacts from the COVID-19 pandemic.
Maryland also has the longest ER waits, with Maryland residents spending, on average, 4h 11m in the ER before leaving - 62% longer than the national average of 2h 35m despite having one of the fewest ER visits per 1k people per year, with 303.
Virginia is also at risk with a high overwhelm level
Following in second place, Virginia hospitals garner an overwhelm score of 8.79 out of 10. Virginia has the second most patients per registered nurse, with 2.8 patients outnumbering staff. The state has the fifth-highest number of admissions per hospital beds, with 11.6 patients per bed, and only 19.9 beds per 10k population, with an average five-day stay, risking corridor care with patients unable to receive appropriate care.
It is estimated that Virginia hospitals are expected to lose out on $26 billion over 14 years under changes to the Medicaid program. This naturally is expected to hit workforces as state facilities grapple with funding losses and resort to downsizing workforces, which is expected to cause an increase in overwhelmed hospitals and staff.
In third place, South Carolina’s overwhelm score is 8.18 out of 10. In the state, there are 2.3 patients per registered nurse, the sixth most in the US. The state also lands in sixth place for the most admissions per hospital bed, with 11.3 patients per bed, with the average stay being 5 days per patient.
Wyoming hospitals are the least overwhelmed in the US
The least populated state in the US lands in last place with an overwhelm score of just 2.34 out of 10. Wyoming places 46th for nursing shortage, with -6,160,one of only 18 states with a surplus of nurses compared to the demand. Wyoming residents also stay in the hospital the second-shortest, with average admissions lasting 4.5 days compared to Alaska’s 7-day average. Wyomingites' health risks also only score 0.2, the lowest in the US.
Methodology
Nursa set out to determine which states have the most overwhelmed hospitals in the US. To do this, we ranked each state on eight factors. All data is correct as of 1/13/2026. Explore the full dataset.
- Registered Nurse shortage (demand-supply) was sourced from HRSA (2024)
- Registered Nurses per hospital bed data was sourced from KFF (2023) and compared to nurse staffing levels sourced from HRSA (2024)
- Patients per Registered Nurse was sourced from Medicare Inpatient Hospital Data 2023 and compared to nurse staffing levels sourced from HRSA (2024)
- Hospital beds per 10k population data was sourced from KFF (2023)
- Admissions per hospital bed data were sourced from Medicare Inpatient Hospital Data 2023, as was average length of hospital stay in days and Medicare admissions per hospital
- Average patient risk score out of 10 was also sourced from Medicare Inpatient Hospital Data 2023, using the average HCC (Hierarchical Condition Category) risk score, which estimates how sick a patient is based on their medical conditions in order to predict healthcare costs; this rating was percentranked to generate a score of 10
- To calculate the final score, the percentrank method was used
Note that Medicare inpatient data does not capture the full range of patient populations and may overrepresent certain patient groups and care types. Additionally, state-level aggregation may mask variation in hospital pressure across regions and individual facilities within states.
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