Our Disappearing Nurses

A nursing shortage looms on the horizon, not just nationally, but also here in Hawaii. Can the problem be fixed before it's too late?


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Hob Osterlund is a nurse, one of those essential professionals we tend to take for granted, since they’re always around when we need to have our wounds dressed, our babies delivered, our hearts bypassed.

But Osterlund, like so many Hawaii residents, stands on the threshold of retirement: She turns 60 in September. Therein lies the rub. Just as the baby boomers are entering their golden years in mass numbers — a time that coincides with a greater need for medical care — the nurses who do so much of that caring are getting older, too.

Osterlund, a registered nurse with a master’s degree, lives on Kauai and travels to Honolulu to work three 12-hour shifts at The Queen’s Medical Center. It’s a job she especially values because the hospital has worked hard to make a national name for itself in her specialty: pain and palliative care. She’s been a nurse for 30 years, and still loves it, although her commute is becoming increasingly expensive and the physical, social and economic ills of her patients have gotten more complex. Still, she has no plans to retire just yet.

Many of her colleagues across the nation are retiring, however, and their departure is contributing to a nursing shortage of serious—and snowballing—proportions. The AARP anticipates the nation will be short some 1 million nurses by 2020. In Hawaii, the deficit of 960 nurses recorded in 2006 is expected to grow to 2,700 nurses over the next 12 years—about a quarter of the projected need.

Nurses function as "super communicators," who are able to deal with doctors, patients, families and the ubiquitous computers that are an integral part of modern healthcare.

The shortfall is especially significant because nurses perform the majority of our health-care services, says Barbara Mathews, executive director of the Hawaii State Center for Nursing, which was established by the Legislature in 2003 specifically to address the nursing shortage through recruitment, retention and research initiatives.

“I think we are certainly going to have a severe nursing shortage in Hawaii,” Mathews says. “Is there still time to act? Absolutely.”

The solution, however, isn’t as neat as enrolling more young people in nursing school, or getting more trained bodies into the diverse settings where nurses tend patients. “It’s very complex,” says Sandra LeVasseur, the center’s associate director of research and an associate professor at the University of Hawaii’s School of Nursing and Dental Hygiene. “It’s not just one factor.”

For starters, Hawaii’s nursing programs currently turn away qualified applicants, and will continue to do so, because they can’t handle major expansion. Why? Nursing faculty are also aging: 60 percent are age 50 or over, and perhaps 20 percent of them will retire within five years, LeVasseur says. Since this is a nationwide trend, Hawaii won’t easily be able to recruit teaching staff from elsewhere, either.

Although the Legislature recently provided funds to increase enrollment in the state’s nursing programs, LeVasseur predicts “we’re still not going to be able to produce enough nurses to replace and fill the vacancies that will be present in 2020.”

Hawaii Nursing at a Glance


Registered Nurses in the state

7,300 to 7,500

Of the state's nurses, the number who work on Oahu.


percent of Hawaii's RNs work in hospital settings


the average age of an RN in Hawaii


percent of active RNs who are male


percent of RNs who work 30 or more hours per week


years before 65 percent of active RNs plan to retire and leave the profession

Source: Hawaii State Center for Nursing Registered Nurse Survey 2007 and Hawaii Nurses Association

The problem is further compounded by an astonishing 60 percent of new nurses nationwide quitting their first job within the first year, Mathews says. The center is conducting a study to determine how Hawaii fits into that national trend. It’s unclear whether nurses who quit are leaving the field entirely or moving into other jobs, she says. But it is clear that steps must be taken to smooth the transition between nursing school and the work world so that nurses stay on the job.

Robin Tanner, an Oahu registered nurse who specializes in intensive care, says new nurses tend to be overwhelmed by the many demands of the profession, especially those who graduated from a two-year registered nursing program “where everything is so speeded up, they get on the job and think, ‘Oh, my gosh, this is so much more than I thought.’ You’re walking miles every day, doing things you never imagined you would be.”

Meanwhile, the seasoned nurse who is charged with helping new graduates perfect their clinical skills is busy with her own patient load and duties, and often has no training in how to be a teacher or mentor, says Tanner, who bases her observation on 30 years of nursing experience and involvement with the American Nurses Association. “The stress levels are incredibly high,” she says. “New nurses often go home in tears.”

Kauai resident Andy Parks, who was the first male to graduate from Kauai Community College’s two-year registered nursing program, but left the profession more than a decade ago, agrees.

“Even though most professions are different than what they taught you in school, nursing is one of the worst. Very little of the perfect way they taught you is present on the job.”

The stress is exacerbated, Tanner says, because “unlicensed personnel,” including various aides and therapists, have replaced nearly all of the licensed practical nurses and some of the registered nurses who used to work in local hospitals. Even new graduates trying to learn their own jobs have responsibility for the unlicensed personnel beneath them, she says.

The cost-cutting trend toward compartmentalizing a nurse’s duties, then training unlicensed personnel to do some of those tasks, adds to burnout among seasoned nurses, too, Tanner says. This is partly due to the increased responsibility they have for other workers, and also because nurses often no longer perform such direct care services as bathing or massage, where they can conduct their own careful assessment of a patient’s condition. “My license covers that unlicensed personnel, not the [hospital] managers’,” she notes. “I have to be sure they can do what they’re supposed to do and come back to me with a problem. Many of them are very good at their jobs, but it’s a task. They don’t understand the implications for the patient as a whole. I worry about my license, and I worry about my job satisfaction.”

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