Hawaii’s nurse Hawaii is short 400 nurses, and it's just beginning to feel the brunt of a national nurse shortage, nursing officials warn.
shortage reaching
critical condition
Professionals warn a solid economic
shot int he arm is urgently needed
as national, local factors convergeKapiolani, St. Francis and
Queen's promote programs to
boost grads' experienceBy Helen Altonn
Star-BulletinNurses are being offered as much as $10,000 in some mainland areas just to sign up for jobs, said Rosanne Harrigan, dean of the University of Hawaii School of Nursing.
"I'm getting really, really concerned because I don't see lots of folks being real serious about this."
Harrigan personally saw the effects of the shortage as a recent patient in the Queen's Medical Center. Nurses on her short-staffed unit were racing around so much trying to meet the needs that "one was absolutely dripping (with sweat)," she said.
The national shortage is worsening and is especially bad for Hawaii, which cannot borrow nurses from the next state, Harrigan said.
However, the hospitals do utilize traveling nurses to help fill vacancies, and they often remain as permanent hires after their four- or six-month contract ends.
There will be 100 more vacancies if graduate nursing students and faculty members are pulled off their jobs during a potential UH faculty strike, Harrigan pointed out.
"Our graduates are providing primary care because most are nurse practitioners and mostly in underserved health areas."
Harrigan said she has spent probably a month in Queen's since October. "I clearly know how much our faculty and students do for patients."
But she said, "It's becoming more and more clear nursing is a very undervalued entity, unless you don't have one when you need one."
Fewer students are attracted to the nursing profession because of opportunities in other fields, she said. U.S. Census Bureau figures show the percentage of working registered nurses under 30 years of age dropped 41 percent between 1983 and 1998.
Increased UH tuition will affect enrollment in the nursing college, which now has 206 bachelor's degree students and 63 master's degree students, Harrigan said.
She said enrollment is somewhat stable in the bachelor's program, but because of limited scholarship funds, the college cannot take many qualified applicants.
A bill is pending in the Legislature for funds to support tuition and additional faculty.
Nancy McGuckin, Hawaii Nurses Association executive director, cites two significant factors affecting the nursing supply: an "economic shortage" and aging of the work force.
The economic shortage occurs every eight to 10 years as wages and working conditions decline, improve, then fall back again, she said. "It is cyclical in nature. We had one in 1980, one in the late 1980s to early 1990s, and again here we are, 1999-2002."
On top of that, she said, half of Hawaii's actively practicing 9,000 registered nurses are 45 years old or older and will be retiring in 15 years. "We're going to lose 4,500 of them. ... And you not only lose the work force, you lose all that knowledge and wisdom."
Just to replace the vacancies from retiring nurses, Hawaii would need to graduate and retain 400 nurses per year, McGuckin said.
"Right now, we're graduating 280. So we need to find another 120 graduates, and that's just to replace retiring nurses. It has nothing to do with the turnover or expansion of the health care system," McGuckin said.
When facilities cannot get nurses, they are hiring health assistants, Harrigan said.
Recently at the Waimanalo Health Center, a health assistant was learning how to give shots for immunizations, she said. "The Department of Health has loosened requirements so much that nurse assistants can do previous nursing jobs."
Just graduating a certain number of nurses will not solve the problems unless workplace conditions and wages are improved, McGuckin said. "The problem is, the hospital industry is going to have to compete with other industries for nurses."
Hawaii nurses have been getting 2.5 percent annual pay increases, while mainland nurses have averaged 4 percent annual increases, she said.
Also, she said, "We now have hospitals requiring nurses to do mandatory overtime," which "is not a good enticement for retention or recruitment."
Two national experts on nursing issues were scheduled to brief the state House and Senate health committees this afternoon.
They are Dr. Peter Buerhaus, a nursing professor and senior associate dean for research at Vanderbilt University School of Nursing, and Dr. Jack Needleman, Harvard University assistant professor of economics and health and department of health policy and management.
They will speak at a conference sponsored by the Hawaii Nurses Association and five other organizations on "Nursing's Critical Issues," starting at 8:30 a.m. Friday at the Waikiki Beach Marriott Resort.
Buerhaus and two co-authors, writing in the Journal of the American Medical Association last June, said the big decline in the nursing work force will come as the first of 78 million baby boomers begin to retire and enroll in Medicare in 2010.
New nurses Hospitals are trying some innovative approaches to deal with a nursing shortage, such as starting new graduate programs and sending recruiters to talk to high school students.
finding more doors
to critical-care,
special duties
Kapiolani, St. Francis and
Queen's promote programs to
boost grads' experienceBy Helen Altonn
Star-BulletinIt was almost unheard of in the past for new graduates to work in intensive care, said Rosanne Harrigan, dean of the University of Hawaii School of Nursing.
Now, Kapiolani Medical Center for Women and Children advertises for new graduates for the intensive care unit, she said. St. Francis Medical Center and the Queen's Medical Center also report that they're taking new graduates.
Susan Young, Kapiolani director of nursing for pediatric and transport services, said the nursing shortage is "most difficult for all hospitals, and our location in Hawaii presents challenges, being far from the mainland."
Kapiolani started new graduate programs a few years ago for nurses just leaving the university with little or no experience, she said.
But new grads were used in general medical surgery, not in specialty areas, Young said. "That needed to change. Our facility started with the family birthing area. We've had at least up to five successful programs with 20 new grads going through the last two years.
"It's just been wonderful," she said, explaining the graduates don't merely get orientation but are helped to learn the specialty and the culture of nursing.
She said the program also was introduced in the general pediatric area and the newborn special care and pediatric intensive care units.
It's very specialized and involves nursing graduates from all university and college nursing programs, Young said.
"Nurses that have come from the program are just ecstatic that we've taken them under our wing to do this. We're really proud of it and excited about it. It's a wonderful way for a new nurse to start a career."
Kapiolani recruiters also go to high schools and other places to tell young girls about nursing as a career and the many avenues they can pursue in the field, Young said. "We're proactive, so we're ahead of the game."
In the last several years, St. Francis Medical Center has increased the numbers and times throughout the year it takes new graduates, said Cathy Tanaka, director of critical care and staff support services.
"We really work with them to provide the skills they need in medical surgery and critical care areas," she said. She noted that the graduates are placed with experienced nurses for a certain period.
Tanaka said the hospital remains concerned about the future because young people coming into the profession no longer want to stay in one place.
"They have different goals, and they leave. They want to explore other facilities, other avenues, and become travelers themselves," Tanaka said.
"Longevity with the workforce is not as stable. We have a large pool reaching retirement force, and not as many are entering the workforce. That gap is going to widen."
Lisa Nishikawa, coordinator for nurse recruitment at Queen's, said about 50 positions are open but vacancies have been significantly reduced with new graduate and other programs.
The hospital has had intensive care telemetry classes, which help to promote internal staff and draw people from the community who want to go into specialty areas, she said. Other specialty classes also were held this year.
Queen's has reduced its travel nurses to about 45 from 70 or 75 and is contiuing to decrease the number, she said. It is also encouraging young students to look at nursing as a career, pointing there are many options in the field besides "being at a bedside," she said.