"We are a 57 bed ER and all too often have up to 20-25 patients boarding in our ER, waiting for a hospital bed upstairs. This makes it very difficult for us to open up beds to those patients in the waiting room—sometimes for up to 18 hours—to be seen and evaluated. During these very long waits, patients can decompensate, and what started as a problem that could have been treated and stabilized becomes a potentially life-threatening issue. We have had some patients in our ER for greater than 40 hours—an entire work week—before getting a hospital bed upstairs. Given our current nursing shortages, staff burn-out, and the coming flu season, these conditions are untenable."