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Forecasting Hawaii’s
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Workforce 2005 - 2020

Hawaii State Center for Nursing

2528 McCarthy Mall
Webster Hall 432
Honolulu, Hawaii 96822 - Map -

Ph: (808) 956-5211
Fax: (808) 956-3257


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Forecast data indicate Hawaii can expect a dramatic demographic shift in the aging population over the next 15 years, which will occur at a pace twice that of the rest of the country. Between 2000 and 2020, the number of people age 60 and over living in Hawaii will increase by almost 75 percent. People aged 85 and older will increase by 121 percent. By 2020, 1 out of every 4 people will be 60 years or older and 1 out of 35 people will be 85 years or older.1


The State of Hawaii’s Nursing Taskforce Report (2004) predicts a number of phenomena will emerge with the demographic shift: (1) the demand for long term care (LTC) will increase, (2) the scope of practice in LTC nursing will become more complex, (3) the aging nursing workforce will retire and deplete an already insufficient geriatric clinical and academic workforce, (4) there will be stiffer competition to recruit new nurses into LTC related to lower wages and benefits compared to other job opportunities, and (5) informal care giving of our older people will diminish, increasing further the demand for LTC services. 2 These projections indicate that it is critical to retain existing LTC nurses and identify strategies to attract new nurses into geriatrics.


Aims & Objectives

The purpose of the project is to build partnerships which will lead to statewide educational and practice initiatives that facilitate positive change in the initial and continuing education and training of nurses in LTC. Further, partnerships with LTC facilities will lead to improvements in the recruitment and retention of nurses in the geriatric specialty. Together these efforts will bring about significant policy change within the state.


The aims of the project include bringing together community, state, and nursing educators and leaders to strategically develop and implement a pilot project that integrates education and practice in LTC.


1) Primary objectives of the project are:


a) Build partnerships which lead to strategic educational and practice initiatives that address LTC nursing workforce needs.

b) Strategically plan, develop and pilot an integrated model of education and practice in LTC consisting of a formalized student clinical placement initiative; and a continuing education and a preceptor program for LTC staff.


2) The secondary objective will examine the demographic characteristics of Hawai’i’s LTC nursing workforce. The establishment of a statewide LTC nursing workforce dataset that identifies the demographic characteristics of the population with the supply and demand data of nurses in the LTC sector will assist in strategically addressing the needs of the LTC sector. This data will also be utilized in the evaluation of the project to benchmark outcome measures.


Project Design

The project will introduce and assess three components:


1. Student clinical placements into LTC will occur with faculty instructor supervision.


2. Clinical skill upgrades for LTC staff will occur at each partnered facility. The clinical skill domains requiring upgrade will be identified by each LTC facility.

- Skill competencies will reflect best practice and nursing home quality indicators (QI) derived from Minimum Data Set (MDS) assessment data. The MDS is part of the federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems. Resident Assessment Protocols (RAPs), are part of this process, and provide the foundation upon which a resident's individual care plan is formulated.


3. The Preceptor Training Program consisting of:

Phase 1: Program Development

- The preceptor training program will be developed in collaboration with partners. The program will consist of an expressive component (e.g. leadership; nurturing critical thinking; empowerment) and a cognitive component (e.g. overview of geriatric nursing past, present and future; financial picture of care; how data and research drive LTC; culture of the workplace). Train-the-trainer approach will also be used.


Phase 2:

Certified trainers training

- Each LTC Facility will select exemplary RNs [n=2] to participate in the initial master training program inclusive of clinical skill upgrade facilitated by nursing faculty instructor.


Phase 3: Preceptor / preceptee program Preceptor/ preceptee training will be conducted by the certified trainers with coaching from the master trainer.


Evaluation & Analysis

A variety of qualitative and quantitative methods will be used to measure and assess the three components introduced into the LTC facilities over the course of the pilot project. To examine changes in workplace culture the perceptions of LTC staff will be measured. LTC staff perceptions will be measured prior to the introduction of the pilot project, one year and two years after introduction of the pilot project. The questionnaire will consist of validated tools for LTC that measure 1) job satisfaction, 2) perceived empowerment, 3) organizational commitment, 4) intent to turnover; and 5) perception of workplace change, 6) charge nurse support, and 7) leadership behaviors and organizational climate. Students will complete pre and post questionnaires examining attitudes towards older people and level of confidence in performing clinical skills. Faculty instructors will participate in focus group discussions after student clinical rotations to uncover their perceptions of the experience. Preceptor training participants will complete pre and post surveys to uncover impact of training on practice.



1. Executive Office on Aging, State of Hawaii. Profile of Hawaii’s older adults. May 2003, http://www2.state.hi.us/eoa/information/stats/profile2003.pdf (6 April 2006).

2. Raynor, C.R., and the Hawai’i Nursing Shortage Taskforce. (2004). Hawaii’s Health in the Balance: A Report on the State of the Nursing Workforce. Honolulu, Hawaii: University of Hawaii.


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