Shortage of educators plagues isle nursing schools

"As we get older, there won't be anyone to care for us."

Not only will there be a big shortage in nurses, but there are not enough educators to produce more nurses, says Mary Boland, dean of the University of Hawaii-Manoa School of Nursing and Dental Hygiene.

"It's pretty dismal," she said. "I'm concerned on a couple levels: not having enough nurses and not having faculty we need to educate the next generation."

Unless the supply is increased, she said, "As we get older, there won't be anyone to care for us."

In 2000, Hawaii was short 1,041 registered nurses -- a figure that is expected to reach 2,267 by 2020, according to the Hawaii State Center for Nursing.

Yet, public nursing schools turned away 443 qualified applicants in the 2004-05 school year because of lack of faculty, facilities and opportunities for clinical placement, said Barbara Mathews, the center's executive director.

In a fact sheet on the shortage last fall, the center said: "A shortage of qualified RNs threatens the health and welfare of Hawaii's citizens.

"Without enough RNs, some health care providers (e.g., hospitals, nursing homes and home care agencies) may be forced to limit or discontinue services."

Even if they continue to provide services, the center said, having fewer nurses could affect patient safety.

The nursing shortage is a global crisis, with Hawaii's plight intensified by a population aging faster than the rest of the nation. While demands for care are increasing, baby boomers -- the bulk of registered nurses and nursing educators -- are retiring.

Sandra LeVasseur, associate director for research at the State Center for Nursing, said, "A lot of us in the next 15 years will be retiring, and ... the big question is, Who will replace us?"

The center was created by the Legislature in 2003 to improve nurse recruitment and retention. It has been surveying nursing faculty and students and nursing-care needs to get a clear picture of supply and demand.

The center has only three staff members, but "a tremendous amount of work" is being done voluntarily by nurses on their own time, Mathews said.

Nursing educators and people in the health care field held a summit in March to look at innovative ways to collaborate and educate nurses to meet the needs, she said.

Also in March, UH nursing faculty statewide formed a consortium to redesign nursing education and offer one curriculum on all campuses.

UH received about $650,000 from the last Legislature to expand nursing and dental hygiene faculty and support staff, Boland said.

All community colleges except Kapiolani Community College were allocated money to expand nursing faculty, she said, adding that UH-Manoa's role is "to support them to be sure their faculty have the best preparation."

Qualified applicants still are being turned away, but UH-Manoa admissions to the Bachelor of Science nursing program increased 25 percent from 2004-05 to 2005-06. A 50 percent increase is expected in the coming academic year over 2004-05 admissions, with a total of 133 new students.

The anticipated total student enrollment for the Manoa School of Nursing and Dental Hygiene in the fall is 508, of which 448 are nursing students.

The school's 34 permanent nursing faculty positions will be increased 20 percent in the new school year with funding from the last Legislature.

UH-Manoa also is looking at nontraditional ways to educate nurses, Boland said.

For example, an accelerated program enables people with bachelor's or master's degrees in biology, engineering, psychology or other fields to get nurses' training in 18 months. Two groups of 10 each have graduated, and another one with 24 students is under way.

The community college associate degree program is the shortest pathway to meet licensing requirements to work as a registered nurse, said Michael Rota, assistant vice president for academic affairs in the community colleges office.

But he said, "We've got students waiting to get in, with more demand than space available."

KCC asked for 10 nursing faculty positions in next year's budget and received no funding, Rota said. The other community colleges each asked for 6.5 positions and received one each, with funding ranging from $75,000 to $100,000.

"A portion of money is to develop a competitive salary structure to keep from losing people (faculty members)," Rota said.

"We have a lot of different things pulling at resources," said Patricia Lange-Otsuka, new interim dean of nursing at Hawaii Pacific University. "We have many dedicated educators who love teaching students."

But there is "easily a $20,000-a-year difference" between teaching and working in an acute-care hospital, she said. "Sometimes it does pull faculty."

HPU, a private university, has the largest nursing education program in Hawaii, with more than 1,300 undergraduate students. The program has doubled in size over the past five years and has no waiting list, said Lange-Otsuka.

Enrollment for beginning students was bumped to 140 from 120 per semester to try to address the nursing shortage, she said. "We're hoping we'll have 250 graduates a year in that way."

HPU has 42 full-time nursing faculty and about 60 adjunct or part-time faculty members and it is continuing to hire teachers, Lange-Otsuka said.

Cindy Kamikawa, vice president for nursing and chief nursing officer at the Queen's Medical Center, said the hospital's vacancy rate for registered nurses has crept up from 5 percent or 6 percent to a little over 8 percent.

Vacancies are filled with contract travel nurses and local agency nurses or nurses on staff picking up additional time, she said. "Our other challenge is we've been running a full census and are real busy with patients," Kamikawa said.

"We need to look at retention, how many are being lost, how many are changing jobs and how do we facilitate new graduates to a successful career in long-term nursing," Mathews said.

Stephanie Marshall, former chief nurse at Tripler, is now director for community partnerships in the UH-Manoa nursing school and trying to develop partnerships between UH and public and private agencies and facilities to see if they can expand educational opportunities, Boland said.

"We're committed to being part of the solution," she said. "The waiting list keeps growing. We're turning away extremely well-qualified applicants we know would be successful."