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Nursing Education & Practice

Hawaii's Health in the
Balance: A Report on the State
of the Nursing Workforce

Executive Summary
Snapshot of Nursing Supply
and Demand
Factors Influencing RN
Supply and Demand
Public Health Stakes
Hawaii's Efforts
Call to Action & Conclusion
Taskforce Members

Hawaii State Center for Nursing

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

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


Hawai'i's Health in the Balance:
A Report on the State of the Nursing Workforce, October 2004
(download pdf file)


Who Is the Nurse?


In this report, nurse refers to Registered Nurse, however the term “nurse” is often used loosely to mean Registered Nurse, Licensed Practical Nurse, and direct care worker. The following provides a general guide for differentiating between these providers by basic training and preparation, as well as scope of practice.


Registered Nurses (RNs) complete basic training in a 4-year baccalaureate program, a 3-year diploma program, or a 2-year associate degree program. All graduates must pass a state licensing exam to be licensed as a RN. RNs are the largest group of health care providers and work across all health care settings providing hands-on care. Basic RN functions include patient assessment, administering therapeutic therapies, patient education, integrating complex care delivery, providing emotional support, and supervising support staff such as licensed practical nurses and direct care workers. RNs work to promote health, prevent disease, and help patients cope with illness. They are advocates and health educators for patients, families, and communities. Within patient care, nurses can move into a nursing specialty such as clinical nurse specialist, nurse practitioner, certified nurse midwife, or certified registered nurse anesthetist. These positions require about 2 years of graduate education leading to a master’s degree.


Licensed Practical Nurses (LPNs) complete basic training in a 12-18 month program emphasizing technical skills. Graduates must pass a state licensing exam to practice as a LPN. LPNs primarily provide direct patient care under the direction of a physician or RN including basic bedside care, taking vital signs such as temperature, blood pressure, pulse, and respiration, preparing and giving injections and enemas, monitoring catheters, applying dressings, treating bedsores, and assisting with personal care. In States where the law allows, they may administer prescribed medicines or start intravenous fluids. Experienced LPNs may supervise direct care workers.


Direct Care Workers (DCWs), or paraprofessionals, include nursing assistants, home health care aides, and personal attendants. DCWs have only minimal basic training, for example federal law mandates only 75 hours of training for nursing assistants working in nursing homes. DCWs perform routine tasks under the supervision of nursing and medical staff. They answer patients’ call lights, deliver messages, serve meals, make beds, and help patients eat, dress, and bathe. Aides also may provide skin care to patients; take their temperatures, pulse rate, respiration rate, and blood pressure; and help patients get in and out of bed and walk. They escort patients to operating and examining rooms, keep patients’ rooms neat, set up equipment, store and move supplies, or assist with some procedures. Aides observe patients’ physical, mental, and emotional conditions and report any change to the nursing or medical staff.


Source: US Department of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2004-2005.


I. Introduction


Policymakers, educators, health care providers, labor organizations, and consumer groups all play an important role in shaping the future of nursing in Hawai‘i. With such a diverse set of stakeholders, a shared understanding of the current state of nursing in Hawai‘i is essential. What factors shape nursing supply and demand? Does Hawai‘i have enough nurses now and in the future to meet demand? What are the consequences of a nursing shortage for quality of care and access to care? The purpose of this report is to build a common understanding of these and other key questions. From this reference point, decision makers can develop strategic policies and practices that together will help sustain a qualified nursing workforce to meet Hawai‘i’s health care needs.

We begin by outlining key trends characterizing Hawai‘i’s nursing workforce. This is followed by an overview of factors that influence the balance of supply and demand for nurses. Next, we discuss the implications of a nursing shortage for quality of care and access to care. Current efforts underway in Hawai‘i to address the nursing workforce shortage are then highlighted. Finally, we lay out a set of broad based recommendations to guide future action on the part of all stakeholders.


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