Nurses have given plans for an overhaul of emergency care to the Welsh health minister, telling him workloads are "unsustainably high".
Nurses told the RCN their workloads are 'unsustainably high'
The Royal College of Nursing (RCN) has sent 28 recommendations to Dr Brian Gibbons, including guidelines on staffing and extra funding.
They also want the public educated to stop accident and emergency misuse, and a four-hour target for seeing patients.
The report said staff felt workplace stress was reaching a dangerous level.
It added that many nurses and health workers believed that patient care had been "significantly compromised" by stress.
The report follows problems in early 2005 at most of Wales' accident and emergency departments, which saw ambulances queueing at hospitals and some health chiefs warning the system was at breaking point.
The RCN said, in its report onTuesday, that structural and organisational constraints "had led to a situation in which nurses and other professionals were often prevented from providing a basic level of care and treatment they have been trained to give".
The RCN has highlighted giving nurses more power as a way of solving emergency care problems.
AMONG THE RECOMMENDATIONS
95% of A&E patients dealt with in four hours
Increased funding and monitoring
Implementing RCN staffing guidelines
Better training for nurses
Educating patients to stop misuse
Walk-in care centres
The report concluded: "The pressures that are experienced in emergency care services in Wales are part of a whole system dysfunction.
"The solution to the prolonged emergency crisis does not lie in changing one aspect of the service.
Along with the recommendations, the RCN has listed the authorities and organisations it wants to implement them - including the Welsh assembly, local health board and NHS trusts, NHS Direct, education authorities and home care providers.
The RCN has also suggested timescales within which these changes should be implemented.
Fiona Salter, an RCN representative at Cardiff and Vale NHS Trust, told BBC Radio Wales the situation had reached crisis point.
"I think the situation is very serious at the moment," she said. "Things couldn't be very much worse across Wales. Departments are crowded and under-staffed.
"What is required is an overall review of A & E services - not just A & E departments, but with the whole emergency service care provision."
Ms Salter said that, if things did not improve, nurses would "vote with their feet", but they would probably leave the NHS rather than take strike action.
"There are not many nurses that would take strike action, because that would affect patients, and that's not what they want," she said.
A spokesman for Welsh Labour, which controls the Welsh Assembly Government, said: "We will look closely at the RCN proposals. They are on the frontline and we work closely with them.
"There have already been real improvements in A&E services since 1997 and today nine out of 10 patients are either discharged or admitted to hospital within four hours."
Plaid Cymru's Hywel Williams said: "The recommendations put forward by RCN Wales further demonstrates that there has been no improvement in the (Welsh Assembly) Government's handling of the provision of accident & emergency services.
"I welcome this plan put forward by RCN Wales and hope that the Labour Government will take its recommendations very seriously."
A Conservative spokesman said health care staff were being "let down" by the current system and it would increase funding in Wales.
"We believe in reducing bureaucracy and empowering local professionals to operate local services and give greater choice to patients," he added.
Kirsty Williams of the Liberal Democrats said: "We have long campaigned for a better use of existing capacities and skills as highlighted by the Royal College of Nursing plan.
"The way forward for the NHS is through better use of resources and re-direction to appropriate services."