Hawai'i to face shortage of nurses

By Walter Wright
Advertiser Staff Writer

Half of Hawai'i's nurses will retire within the next 15 years, and the healthcare community is in an uphill battle to find new recruits to replace them.

Val Falle is a nurse executive at Kaiser's Moanalua Medical Center. Healthcare providers are recruiting to replace retiring nurses. Bruce Asato • The Honolulu Advertiser

Nationwide, at least 126,000 nurses are needed right now to catch up with an 11 percent vacancy rate for registered nurses in hospitals, according to the American Hospital Association.

About 400 nurses retire each year in Hawai'i, but the state is graduating only 280 nursing students a year.

Adding to the shortfall is the number of new job positions being created.

For decades, nursing was a field traditionally dominated by women. But young women today have recognized there's more opportunity in other professions than there used to be, said Judy Swanson, a nurse who works as a recruiter at Kaiser Moanalua.

"Nursing used to be one of the few options opened to women," she said. "Now, you can make just as much doing something else and not get as dirty."

The need for nurses will soar as the the population ages and lives longer, with the number of people older than 65 doubling by 2030.

When the shortage hits home in the coming years, "You may have paraprofessionals instead of nurses taking care of our parents and grandparents," said Chris Keliipio, executive director of the Hawai'i Nurses Association, which represents about a third of the registered nurses in Hawai'i.

"For example, Medicare has approved hiring of 'feeding assistants' to work in long-term care," she said. "My greatest concern is our healthcare system in Hawai'i is already in trouble economically, and not doing enough in terms of pay and working conditions to keep nurses working in the hospitals."

Precise numbers are hard to come by, but the American Healthcare Association says its surveys show 21 percent of nursing facility positions in Hawai'i are vacant, the same as the national average.

As of March 11, there were 12,223 licenses issued in Hawai'i for registered nurses, 2,546 for licensed public nurses, and 444 for advanced practice registered nurses, according to Kathy Yokouchi, executive officer of the state nursing board.

That's up noticeably from the 10,514 RN licenses, and 2,357 LPN and 308 APRN licenses in effect in 1998, but employers say the increase is not enough to fill the widening gap.

"In the past, the number of nurses was growing much more rapidly, because there were more new graduates and people taking the exam," Yokouchi said. "It's not just that baby boomer nurses will be retiring in the next 10 years. So will the educators who train new nurses. It's sort of a double whammy."

Hawai'i hasn't felt the worst yet, but Keliipio says nurses are leaving Hawai'i for California, and Las Vegas and other Mainland cities, "mostly because of the economics of living in Hawai'i and also because it seems easier for new graduates to get jobs on the Mainland."

Nora Nomura, head of field services for HGEA Unit 9, representing more than 1,300 registered nurses in state hospitals, institutions and healthcare programs, says the shortages are especially acute in rural settings or "the more difficult work environments like the state (mental) hospital or the prisons."

The union has just entered an agreement at Hawai'i State Hospital to allow graduate nurses straight out of nursing school, not yet licensed, to work there, with RNs as their mentors, she said.

"I called for vacancy factors, and the state hospital has around 20 positions vacant out of about 100," she said. "That's even after federal court decrees increasing the salaries there."

Pay is a factor, the union agent said. The pay scale for registered nurses in Hawai'i ranges from about $35,000 to $64,500 a year without differentials. Licensed practical nurses make from $31,000 to $35,000 a year. That is compared to between $37,000 and $44,000 in such cities as Los Angeles, San Diego, San Jose and Long Beach in California; Anchorage, Alaska; Seattle and Portland, Ore.

The state Labor Department predicts the number of registered nursing jobs in Hawai'i will grow by 16.4 percent from 1998 to 2008, while licensed public nursing jobs will jump by 27.3 percent in the same period.

Surprisingly, the Department's December list of occupations in demand doesn't reflect a shortage on O'ahu. But it does list the factors putting nurses in demand on Kaua'i and Maui: many of the positions involve shift work, and require education and certification relatively few applicants have.

Richard Meiers, president and chief executive officer of the Healthcare Association, says Hawai'i is falling behind its required registered nurse staffing level by 220 new vacancies every year.

"We usually go through this cycle every 10 years or so," Meiers said. The wave was dampened by the advent of managed care in the 1990s, which reduced the demand for jobs in hospitals and other parts of the healthcare system, he said.

"Many facilities closed wards in the past 10 years," he said.

But the slump in demand also caused a lot of nurses to leave acute care and enter other environments, such as homecare, he said. Now that the demand is back, nurses aren't coming back and new ones aren't graduating fast enough, he said.

"The last time there was a shortage, we could go to Canada and other places and get nurses over here, and we did," Meiers said. "In the early '90s, our members were spending $6 million a year flying in nurses from Canada. Today we're nowhere near that," partly because "the industry in Hawai'i is in such poor financial shape."

In a difficult economic environment, hospitals will have to become more nurse-friendly, a report by the Leonard Davis Institute of Health Economics concluded.

That, Meiers said, means retaining qualified nurses through advancement opportunities, lifelong learning, flexible work schedules and policies promoting "institutional loyalty."

Lee Cataluna contributed to this report. Reach Walter Wright at wwright@honoluluadvertiser.com or 525-8054

Correction: The pay scale for registered nurses in Hawai'i ranges from about $35,000 to $64,500 a year without differentials. Licensed practical nurses make from $31,000 to $35,000 a year. A salary figure cited in a previous version of this story was for nurses who work for the state and belong to Unit 9 of the Hawaii Government Employees Association. That figure was adjusted for cost of living. The unadjusted salary figure is $50,916.