The Nursing Shortage of Hawaii

According to the Bureau of Labor Statistics, “nurses make up the largest group of healthcare professionals in the nation.” And although the majority of the nursing shortage is being felt nationwide, Hawaii has been taking a beating and it is only expected to worsen. Consider this, with 23,000 registered nurses, just over 14,000 of which are currently practicing, and just over 1.2 million people in the State of Hawaii, it is safe to state that Hawaii has a nursing shortage. (U.S. Census Bureau) With a ratio of roughly one registered nurse to every 90 people, quality patient care is currently under scrutiny in hospitals throughout Hawaii.

In an effort to understand and look at ways to combat the nursing shortage in Hawaii, we will be asking ourselves the following questions. Why is there a nursing shortage in Hawaii? What has the shortage done to existing nurses? How has Hawaii nursing schools contributed to the nursing shortage in Hawaii? What does a nursing shortage mean for Hawaii? And finally, what actions should we be taking to alleviate the nursing shortage in Hawaii?

Let’s first look at what are contributing factors to the nursing shortage in Hawaii. “In 2000, Hawaii experienced a shortage of 1,041 registered nurses. It is expected to grow to 1,518 registered nurses by the end of 2005 and to 2,267 registered nurses by the end of 2010. Furthermore, nearly 80% of Hawaii’s current registered nurse workforce is expected to retire by 2026.” (State of Hawaii Employee Outlook) Thus, as demand increases dramatically, supply will remain relatively stagnant.

What has the shortage done to existing nurses? Well consider this, “because hospitals operate 24 hours a day, seven days a week, nurses have to put up with all sorts of demands.” (Dela Cruz) Hospital census coupled with higher patient acuity is ever increasing and nurses are reporting less time to take care of patients, less satisfaction with working conditions, monetary compensation, and overall job satisfaction. Side affects of the nursing shortage include constant strains on schedules, mandatory overtime, increasing workloads, high turnover, loss of compassion and inattentiveness while on the job. The Joint Commission on Accreditation of Healthcare Organizations (JACO) reported that, “24 percent of patient errors resulting in critical injuries and or death were related directly to inadequate staffing.”

Who’s to blame? It is not a matter of whom to blame; rather what have we, as a society, been doing to contribute to the nursing shortage. The American Association of Colleges of Nursing (2002) reported a 2.1 percent drop in entry-level nursing student enrollments. In Hawaii, an average of 400 nurses retire annually, but only about 280-300 nurses graduate each year. If graduation rates do not increase dramatically, there will not be enough new graduated to replace retiring nurses and meet new demands. “In 2003, Hawaii nursing schools turned away nearly 300 qualified nursing applicants because they did not have enough faculty positions to meet the student demand.” (Hawaii’s Health in the Balance)

A shortage of qualified registered nurses threatens the health and welfare of Hawaii’s citizens. Without enough registered nurses, some healthcare providers (i.e. hospitals, nursing homes and home care agencies) have started to limit or discontinue services. In some cases, providers continue to provide services but with fewer staff members, potentially affecting patient safety. Ponder about that for a second, how does that make you feel?

There is clear evidence that reducing the nurse-to-patient ratios lead to safe workplaces, less stress and high overall satisfaction. So what are we doing to combat the nursing shortage in Hawaii? With the nursing shortage plaguing Hawaii, The University of Hawaii – Manoa (UHM) felt the need to establish a way to alleviate the nursing shortage. Therefore, they launched a program in 2002 that offers a fast-track nursing program that took less than half the time it takes to complete the traditional three-year Bachelor of Science nursing program. The UHM program joined two other accelerated programs already available in Hawaii. The goals of course to train, educate and graduate a higher number of nurses in the years to come. Additionally, in an effort to analyze data trends, develop a plan for implementing recruitment and retention strategies and research practices and quality outcomes in nursing, the Hawaii State Center for Nursing, affiliated with the UH School of Nursing and Dental Hygiene, was established by the Legislature in 2003. (Sawada)

Increasing supply or decreasing demand can resolve the nursing shortage. While some observes suggest that demand may be tempered by possible changes in health care financial, there is no evidence that this would be significant enough to resolve the shortage. “Investments made today will not only benefit Hawaii over the next 20 years but begin to develop a proactive culture that will sustain a qualifies nursing workforce needs well into the future. (Hawaii’s Health in the Balance) What can you do to help?


American Nurses Association. (2001). Analysis of American nurses association staffing survey. Nursing World Staffing

Bureau of Labor statistics. (2002). U.S. Department of Labor. Bureau of Labor Statistics

Dela Cruz, L. (2002). Not enough caring. ­Hawaii Business Magazine. Retrieved July 26, 2005 from EBSCOHost Database, University of Phoenix Library.

Sawada, K. (2003). New UH Center addresses nursing shortage. Pacific Business News. University of Hawaii Nursing Shortage

State of Hawaii employment Outlook for Industries and Occupations, 2000-2010, State of Hawaii, Department of Labor and Industrial relations, Research and Statistics Office.

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