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

VI. Call to Action

The recommendations listed below were developed and approved by the Hawai‘i Nursing Shortage Taskforce.

Priority Recommendation

1. Provide funds to add more nursing school faculty positions so that nursing schools can expand student enrollment. (Legislature)

Other Recommendations

2. Establish a consortium between providers and nursing educators to ensure that Hawai‘i not only has a sufficient supply of nurses but a supply of nurses with the skills and competencies to meet Hawai‘i’s health care needs. (Affiliate Group, Providers, Educators, Hawai‘i State Center for Nursing)

3. Develop a statewide nursing workforce data collection system to support proactive workforce planning including areas such as turnover, retention, and vacancy rates, temporary nurse usage, county-level and military nursing supply, foreign nurse recruitment, nursing education capacity, and direct care worker supply. (Providers, Educators, Hawai‘i State Center for Nursing)

4. Foster recruitment initiatives with special focus on groups underrepresented in nursing such as people of color and men. (Providers, Nursing Educators, Secondary Schools, Workforce Investment Board, Area Health Education Center, Private Business, and the Hawai‘i State Center for Nursing )

5. Implement, evaluate, and disseminate strategies that will lead to higher levels of job satisfaction and improved retention among nurses, including strategies for career progression in nursing. (Providers, Nursing Educators, Labor, Hawai‘i State Center for Nursing )

VII. Conclusion

Between 2000 and 2020, the number of people age 60 and over living in Hawai‘i will increase by almost 75 percent. In turn, demand for health and long-term care services and thus, RNs, will increase. At the same time, nearly 80 percent of the current RN workforce will be aging into retirement at a rate far exceeding what nursing schools can currently replace. While it is risky to pin a number on the shortage, these trends—increasing demand and decreasing supply—suggest that Hawai‘i will face a significant shortage of RNs over the next 20 years. Current projections indicate that Hawai‘i’s nursing shortage will quadruple in size to a 4,500 shortfall by 2020.

Within the context of an economic equation, the nursing shortage can be resolved by increasing supply or decreasing demand. While some observers suggest that demand may be tempered by possible changes in health care financing, there is no evidence that this would be significant enough to resolve the shortage. Therefore, efforts to combat the shortage should focus on increasing supply with an immediate need for the legislature to fund additional nursing faculty positions so that nursing schools do not continue turning away qualified applicants. While no single intervention can fully address the shortage, it is clear that no combination of interventions will be successful without first addressing the shortage of nursing faculty. Without funding for additional faculty positions, nursing schools will continue to turn away qualified applicants, severely limiting Hawai‘i’s ability to increase nursing supply. Other efforts should focus on improving the nursing work environment, developing statewide recruitment initiatives, collecting and disseminating workforce data, securing clinical training sites for students, and building relationships between providers and educators to ensure education and training stay current with practice.

Finally, a shortage of RNs must be viewed through the lens of patient care. Increasing numbers of RN vacancies, and vacancies that remain unfilled for extended periods, can be expected to leave fewer RNs available to provide care—potentially undermining quality of care and access to care. The consequences for public health and safety will be significant. Efforts on the part of providers, educators, policy makers, consumers, and labor should be collaborative and strategic, recognizing the complexity of bringing the workforce back into equilibrium and the risk of inaction. Ultimately, the objective should not be to just increase nursing supply, but to address factors that consistently undermine a qualified, stable workforce. These underlying factors, described within, can be masked by a poor economy or a time of static demand, but quickly emerge when economic forces shift to create a shortage—giving way to the cyclical nature of nursing shortages. Hawai‘i has an opportunity to leverage current concern among all stakeholders in an effort to redefine nursing in Hawai‘i, not just attempt “quick fixes.” Investments made today will not only benefit Hawai‘i over the next 20 years but begin to develop a proactive culture that will sustain a robust, qualified nursing workforce to meet Hawai‘i’s health care needs into the future.