The U.S. healthcare system – based largely on market forces – is generally regarded as inefficient. As the demand for medical care in the U.S. continues to surge, hospitals are struggling to keep up. People in the U.S. visited the emergency department 139.8 million times in 2024 – 42.7 visits per 100 people.
As a consequence, high demand paired with budget and staffing issues means that many hospitals across the U.S. are struggling. But where is the system struggling the most?
A company called Nursa has recently analysed overcrowding, staffing levels, and how sick the average patient is for every U.S. state to reveal the states with the most overwhelmed hospitals, with data shared with Digital Journal. This reveals that Maryland has the most overwhelmed hospitals in the US, scoring 9.12 out of 10.
As to the headline outcomes:
The states with the most overwhelmed hospitals
| Rank | State | Registered nurse shortage | Nurses per hospital Bed | Medicare patients per nurse | Beds per 10k population | Admissions per hospital bed | Average length of hospital stay (days) | Medicare admissions per hospital | Average patient risk score /10 | Overwhelm Score /10 |
| 1 | Maryland | 12,860 | 4.0 | 2.9 | 17.9 | 15.0 | 6.1 | 3,839 | 8.8 | 9.12 |
| 2 | Virginia | 28,720 | 3.1 | 2.8 | 19.9 | 11.6 | 5.0 | 2,870 | 5.5 | 8.79 |
| 3 | South Carolina | 11,350 | 3.7 | 2.3 | 20.7 | 11.3 | 5.0 | 2,458 | 4.9 | 8.18 |
| 4 | Florida | 10,500 | 3.7 | 2.0 | 24.1 | 10.4 | 5.0 | 3,473 | 9.6 | 8.16 |
| =5 | Pennsylvania | 20,880 | 3.4 | 2.0 | 26.2 | 9.3 | 5.2 | 2,377 | 6.1 | 8.11 |
| =5 | North Carolina | 16,010 | 4.1 | 1.7 | 19.8 | 9.4 | 5.6 | 2,459 | 6.7 | 8.11 |
| 7 | California | 34,380 | 3.9 | 1.6 | 18.8 | 8.5 | 5.5 | 2,257 | 9.8 | 8.09 |
| 8 | New Jersey | -420 | 3.8 | 1.9 | 22.9 | 10.4 | 5.8 | 3,609 | 9.4 | 8.01 |
| 9 | New Hampshire | 1,820 | 4.1 | 2.3 | 20.4 | 12.6 | 5.6 | 2,772 | 2.4 | 7.90 |
| 10 | Missouri | 8,920 | 3.1 | 2.0 | 28.3 | 8.5 | 5.3 | 2,286 | 7.7 | 7.81 |
| 11 | Delaware | -1,460 | 4.7 | 1.9 | 24.1 | 12.7 | 6.1 | 5,354 | 8.2 | 7.75 |
| 12 | Washington | 7,210 | 5.0 | 1.5 | 15.5 | 9.8 | 6.0 | 2,571 | 4.3 | 7.73 |
| 13 | Michigan | 13,440 | 3.7 | 1.6 | 23.8 | 8.3 | 5.2 | 2,222 | 8.4 | 7.68 |
| 14 | Arizona | 13,530 | 3.6 | 2.0 | 19.7 | 9.0 | 4.7 | 2,104 | 3.1 | 7.66 |
| 15 | West Virginia | 4,940 | 2.5 | 2.4 | 35.7 | 8.4 | 5.3 | 2,117 | 4.5 | 7.65 |
As indicated from the table, hospitals in Maryland are struggling the most. 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 U.S. 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.
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.
In contrast, the least populated state in the U.S. 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 U.S.
