Crowding in emergency departments is threatening the quality and safety of care. Use of nurse practitioners and physician assistants in this setting may be a cost-effective model, but there is little data on how to effectively utilize these providers. The purpose of this research was to determine utilization and current staffing patterns of nurse practitioners and physician assistants in emergency departments. Managers in Washington and Oregon emergency departments were surveyed in March 2009. There was a 59% response rate, with 58% of respondents indicating that they employed this workforce. Larger, urban hospitals employed these providers' more than smaller, rural hospitals. A significant majority reported that current utilization of these providers had a positive impact on timeliness of care by decreasing wait times and lengths of stay. With further clarification and understanding, the potential to use nurse practitioners and physician assistants in a more consistent and effective manner will be enhanced.