Advertisement - Click to support our sponsors.

A worldwide shortage of nurses has reached Hawaii, with traveling nurses making up more than half of the nursing work force at Oahu's major hospitals.

In May, 53 percent of the nurses and 46 percent of all new nurse hires were travelers, according to the Hawaii Nurses Association.

"It will get worse before it gets better," said Rosanne Harrigan, dean of the University of Hawaii School of Nursing. "In five years here in Hawaii we're really going to end up with a crash."

"It's pretty gruesome," said Nancy McGuckin, Hawaii Nurses Association executive director, pointing out that aging of the nursing work force is a big factor in the worldwide shortage.

The average age of a mainland nurse is 42; here it's 45, she said. "Over the next 15 years, we're going to need to replace half of the nursing work force locally as nurses retire out."

An economy-related shortage also occurs every eight to 10 years, McGuckin said. "Wages are depressed. Working conditions decline. Enrollments in schools of nursing decline. Reserves in the nursing work force are diminished."

Pressure then causes the cycle to reverse, she said, adding that this is the third cycle for Hawaii since about 1980.

Cathy Tanaka, director of staff support services at St. Francis Medical Center, said it has hired traveling nurses for years because of a constant shortage in critical care areas. They come under a six-month contract and many remain on the staff for years, she said.

Of the hospital's 380 nurses, "probably less than 11 percent are travel nurses, primarily in critical care areas," she said.

"Nationally, the shortage has yet to reach its peak," Tanaka said, "so we can anticipate a greater depth of shortage in the next four or five years."

While the nursing work force is aging, nursing applicants nationally are decreasing because of more opportunities for young men and women, she said.

The Queen's Medical Center has 880 registered nurse positions and more than 50 vacancies have been filled with traveling nurses, said Gail Tiwanak, spokeswoman.

She said Queen's has had a number of vacancies for a long time, primarily in critical care, the operating room, emergency room and other areas requiring specialized services.

Salaries for traveling nurses are about the same as for local nurses but costs of hiring them are higher, she said, because the hospital must pay travel and housing fees to staffing agencies.

Health care, nursing education and hospital officials recently held a symposium to focus on the shortage. Colleges and health care organizations also have joined in an effort called "Colleagues in Caring" to address the issues.

Harrigan and Bee Kooker, associate nursing college dean, direct a community project funded by the Robert Wood Johnson Foundation to look at nursing work force issues.

"I don't know if we'll ever quite get away from the economic cycle of it, but certainly we can mitigate that, and seriously deal with our needs as a state in terms of nurses," McGuckin said.

Harrigan said a national nursing shortage crisis is predicted in 10 years as baby boomers reach age 65.

That's expected to happen here in five years, however, because Hawaii nurses are older than they are on the mainland, she said. The average age of nurses on Molokai is 52, she noted.

Admissions to mainland nursing schools have dropped significantly so replacements won't be available for retiring nurses, Harrigan said.

The UH admits 60 to 70 new nursing students annually and currently has more applications for the school than it can accept, Harrigan said.

The school doesn't have enough faculty to increase enrollment and maintain a ratio of one instructor per 10 students, she said. "Our budget has been on a nose dive the past five years."

New graduates also are going to the mainland, Harrigan said, citing these reasons:

Hospitals here want experienced nurses. Bonuses of $2,000 to $6,000 are being offered to nurses to go to the mainland. "And cost of living is a lot less there, so they run. Big cities are desperate for nurses already."

St. Francis has started a program for nurse graduates but "all the hospitals haven't gotten the message yet," Harrigan said. "It's important that they do that as quickly as possible: Do not let our graduates go because we need them immediately," she emphasized.

"It's such a critical issue for all of us. We can't produce nurses overnight. Even associate programs are taking three years."

With an AA or bachelor's degree, a nurse can earn about $45,000 and in two years can make $50,000, Harrigan said. Those with master's degrees earn $60,000 to $65,000.

"So it's not a bad discipline to come into, but women are making other choices. They're saying working conditions and work environments (for nurses) are so challenging, they would rather do something else."

McGuckin said salary adjustments will be needed as more demands are put upon nurses, not only to provide hands-on caring but to deal with technology.

Harrigan said groups are looking at improvements or adaptations to the working environment that might keep older nurses in care-giving.

"People go to hospitals because they need nursing care, not medical care," she added, "and there is going to be nobody there to care for them as the population gets older."