The Calm in the Chaos: Lived Experiences on Managing Patient Overcrowding Among Nurses in the Emergency Department

This study explores the lived experiences of Emergency Department (ED) nurses in managing patient overcrowding within a public tertiary hospital in the Caraga Region. Utilizing a Husserlian descriptive phenomenological design, the research captures the essence of this phenomenon through in-depth, semi-structured interviews with eight purposively selected registered nurses, with data analyzed using Colaizzi’s systematic method. The findings revealed the following themes and subthemes: Overcrowding at its Finest (comprising Space is Limited, The Unending Arrival, and Prolonged ED Stay); Managing Overcrowding (comprising The Weight of the Shift and The Collective Shield); and Grace Under Pressure (comprising Decision-Making Under Stress and maintaining composure and meaning). Despite facing severe resource constraints and ethical dilemmas in prioritization, nurses demonstrate profound professional resilience by moving beyond mere task performance to establish meaningful human-to-human connections with patients and their families. Regarding the applicability of the study, while adaptive strategies and teamwork allow for functional care delivery, they also mask a hidden vulnerability within the workforce where professional duty often supersedes the nurse's own well-being.

Emergency Department, Patient Overcrowding, Lived Experiences, Nursing Management, Human-to-Human Relationship Model

1. Altun, M., & Kudu, E. (2025). Overcrowding in emergency departments: A scoping literature review. Anatolian Journal of Emergency Medicine, 8(2), 94-100. [Google Scholar] [Crossref]

2. Al Qadire, M., & Abdelrahman, H. (2026). Triage nurses’ decision-making is strained by overcrowding, staffing shortages and growing emotional burden. Evidence-Based Nursing. [Google Scholar] [Crossref]

3. Asare Antwiwaah, E., & Hamal, P. (2025). Triage Competence and Challenges Among Registered Nurses in Emergency Care: A descriptive literature review. [Google Scholar] [Crossref]

4. Berdida, D. J. E., Grande, R. A. N., Alshammari, M. H., & Lopez, V. (2025). Stress, psychological well-being, social support, practice environment, resilience, job satisfaction, and acculturation among Filipino internationally qualified nurses: A structural equation model. Nursing Outlook, 73(3), 102424. [Google Scholar] [Crossref]

5. Berger, R. (2015). Now I see it, now I don’t: Researcher’s position and reflexivity in qualitative research. Qualitative Research, 15(2), 219–234. [Google Scholar] [Crossref]

6. Butun, A., Kafdag, E. E., Gunduz, H., Zincir, V., Batibay, M., Ciftci, K., ... & Yigit, E. (2023). Emergency department overcrowding: causes and solutions. Emergency and Critical Care Medicine, 3(4), 171-176. [Google Scholar] [Crossref]

7. Comia, R. L., Floranda, L. M. M., & Durante, C. A. G. (2023). Decision-Making Competence and Critical Thinking Ability among Triage Nurses in a Selected Hospital in Batangas, Philippines. International Journal of Multidisciplinary: Applied Business and Education Research, 4(8), 2740-2748. [Google Scholar] [Crossref]

8. Cresswell, J. W., & Plano Clark, V. L. (2011). Designing and conducting mixed method research. 2nd edition. Sage. [Google Scholar] [Crossref]

9. Creswell, J. W., & Poth, C. N. (2018). Qualitative inquiry and research design: Choosing among five approaches (4th ed.). Sage. [Google Scholar] [Crossref]

10. Dumrique, J., Enriquez, A., & Liyanage, N. (2024). Challenges Nurses Face when Performing Triage in Accident and Emergency Departments. [Google Scholar] [Crossref]

11. Entrata, P., & Nicomedes, C. J. (2024). Emotional intelligence and perceived social support as predictors of psychological well-being among nurses in hospitals in metro manila: Basis for psychological wellness program. Archives of Psychiatric Nursing, 49, 140-148. [Google Scholar] [Crossref]

12. Finlay, L. (2002). Negotiating the swamp: The opportunity and challenge of reflexivity in research practice. Qualitative Research, 2(2), 209-230. [Google Scholar] [Crossref]

13. Gholipour, M., Dadashzadeh, A., Jabarzadeh, F., & Sarbakhsh, P. (2025). Challenges of clinical decision-making in emergency nursing: an integrative review. The Open Nursing Journal, 19(1). [Google Scholar] [Crossref]

14. Gorick, H., McGee, M., & Smith, T. O. (2025). Assessments under pressure: Interviews with triage nurses in emergency departments: An exploratory descriptive qualitative study. Journal of Advanced Nursing. [Google Scholar] [Crossref]

15. Guerrero, J. G., Alqarni, A. S., Cordero, R. P., Aljarrah, I., & Almahaid, M. A. (2024). Perceived causes and effects of overcrowding among nurses in the emergency departments of tertiary hospitals: a multicenter study. Risk Management and Healthcare Policy, 973-982. [Google Scholar] [Crossref]

16. Ivziku, D., De Maria, M., Ferramosca, F. M. P., Greco, A., Tartaglini, D., & Gualandi, R. (2022). What determines physical, mental and emotional workloads on nurses? A cross‐sectional study. Journal of Nursing Management, 30(8), 4387-4397. [Google Scholar] [Crossref]

17. Labrague, L. J. (2024). Emergency room nurses' caring ability and its relationship with patient safety outcomes: A cross-sectional study. International Emergency Nursing, 72, 101389. [Google Scholar] [Crossref]

18. LeVasseur, J. J. (2003). The problem of bracketing in phenomenology. Qualitative Health Research, 13(3), 408–420. https://doi.org/10.1177/1049732302250337 Northumbria University Research PortalPubMed+1 [Google Scholar] [Crossref]

19. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications. [Google Scholar] [Crossref]

20. Mertens, D. M. (2005). Research and evaluation in education and psychology: Integrating diversity with quantitative, qualitative, and mixed methods (2nd ed.). Sage. flex.flinders.edu.au [Google Scholar] [Crossref]

21. Morrow, R., Rodriguez, A., & King, N. (2015). Colaizzi’s descriptive phenomenological method. The Psychologist, 28(8), 643-644. http://eprints.hud.ac.uk/id/eprint/26984/. [Google Scholar] [Crossref]

22. Nowell, L. S., Norms, J. M., White, D. E., and Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16, 1–13. https://doi.org/10.1177/1609406917733847. [Google Scholar] [Crossref]

23. Olivia (2018). What is trustworthiness in qualitative research? https://www.statisticssolutions.com/what-is-trustworthiness-in-qualitative- research/ [Google Scholar] [Crossref]

24. Patton, M. Q. (1990). Qualitative evaluation and research methods. 2nd edition. Sage. Patton, M. Q. (2002). Qualitative research and evaluation methods. 3rd edition. Sage Publications. [Google Scholar] [Crossref]

25. Parvaresh-Masoud, M., Cheraghi, M. A., & Imanipour, M. (2023). Nurses' perception of emergency department overcrowding: A qualitative study. Journal of Education and Health Promotion, 12(1), 449. [Google Scholar] [Crossref]

26. Pearce, S., Marr, E., Shannon, T., Marchand, T., & Lang, E. (2024). Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes. Internal and Emergency Medicine, 19(2), 483-491. [Google Scholar] [Crossref]

27. Polit, D. F., & Beck, C. T. (2008). Nursing research: Generating and assessing evidence for nursing practice. 8th Edition, Wolters Kluwer Health/Lippincott Williams & Wilkins. [Google Scholar] [Crossref]

28. Pousa, P. C. P., & Lucca, S. R. D. (2021). Psychosocial factors in nursing work and occupational risks: a systematic review. Revista brasileira de enfermagem, 74(suppl 3), e20200198. [Google Scholar] [Crossref]

29. Reyes-Rodriguez, G., Cuellar-Pompa, L., & Rodríguez-Gómez, J. Á. (2024). Psycho-emotional status related to working conditions among nurses: A scoping review. Journal of Nursing Reports in Clinical Practice, 3(1), 58-68. [Google Scholar] [Crossref]

30. Sanchez, A. F. C. (2025). Perceived safety and burnout among provincial hospital nurses (Doctoral dissertation, Central Philippine University). [Google Scholar] [Crossref]

31. Sartini, M., Carbone, A., Demartini, A., Giribone, L., Oliva, M., Spagnolo, A. M., ... & Cristina, M. L. (2022, August). Overcrowding in emergency department: causes, consequences, and solutions—a narrative review. In Healthcare (Vol. 10, No. 9, p. 1625). MDPI. [Google Scholar] [Crossref]

32. Speziale, H. J. S., & Carpenter, D. R. (2007). Qualitative research in nursing: Advancing the humanistic imperative. 4th edition. Lippincott Williams & Wilkins. [Google Scholar] [Crossref]

33. Speziale, H. S., & Carpenter, D. R. (2003). Qualitative research in nursing: Advancing the humanistic imperative. Lippincott Williams & Wilkins. [Google Scholar] [Crossref]

34. Tamayo, R. L. J., Quintin-Gutierrez, M. K. F., Campo, M. B., Lim, M. J. F., & Labuni, P. T. (2022). Rationing of nursing care and its relationship to nurse practice environment in a tertiary public hospital. Acta Medica Philippina, 56(3). [Google Scholar] [Crossref]

35. Villanueva, A. L. B., Villanueva, B. A. D., Villanueva, J. P., Villanueva, L. J. B., Villegas, J. A., & Zamora, E. A. J. (2024). Workload and performance of emergency department nurses in Iloilo City (Doctoral dissertation, Central Philippine University). [Google Scholar] [Crossref]

36. Young, L. (2022). [Secondary source discussing interpretivism, constructivism, and realism; includes references to Cohen & Manion (1994) and Mertens (2005)]. As cited in Young (2022). [Google Scholar] [Crossref]