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Nurses in ample supply

Kristen Consillio
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First-year nursing student Derrick De Soto works on a simulated patient in a laboratory at Webster Hall on the University of Hawaii at Manoa campus. He is a recent Moanalua High School graduate entering a field where the supply of registered nurses is outstripping demand.
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Dr. Lorrie Wong, right, monitors student Derrick De Soto.

Hawaii’s longtime nursing shortage has turned into a surplus, leaving many recent graduates without jobs, and the economic slowdown is to blame, nursing executives say.

Nurses who were expected to retire or move to other jobs have postponed their plans, some because their spouses lost jobs or because of substantial losses in retirement savings.

Nurse turnover at Hawaii Pacific Health — the state’s largest health care system, employing nearly 1,600 nurses — has dropped to around 4 percent a year from 18 percent just three years ago, said Gail Lerch, HPH’s executive vice president and a registered nurse.

Demand for medical services also has dropped in recent years as people lost jobs and health insurance or delayed elective procedures. Financially troubled medical facilities such as Hawaii Medical Center have reduced beds, further diminishing nursing jobs.

Hundreds of recent graduates hit the job market just as this "perfect storm" was brewing, leaving many aggravated and anxious to find work in the profession.

Finding a job takes between six months to two years for most registered nursing graduates, and many are working as lower-paid aides, technicians, clerks and other medical-related positions while they look for work. Nurse aides earn about $15 an hour, roughly half the pay for an entry-level registered nurse.

"I’m around nurses, I’m trained … but yet my real position is nursing assistant," said Candice Akiona, a 27-year-old registered nurse who graduated in fall 2008 and makes about $11 an hour at Schofield Barracks. "I’m trained, I’m licensed to be something else — that’s just the frustrating part."

Health officials predict the oversupply of registered nurses to be short-lived as a substantial number of working nurses are expected to retire in the next five to 10 years.

The current surplus "is a blip on the radar screen — a phenomenon that caught everyone by surprise when the economy changed," said Lerch.

"The jobs we were counting on for our newly graduating nurses started drying up," she said. "This phenomenon of new graduates not getting jobs is all over the United States — it’s not just a Hawaii issue. It’s very much economically driven."

About 43 percent of the 11,000 nurses working in Hawaii intend to retire in the next 15 years, according to a 2009 survey by the Hawaii State Center for Nursing.

"Once nurses who planned to retire leave, we’re going to have an acute shortage, we’re going to see the bottom fall out," said Mary Boland, dean of the University of Hawaii’s School of Nursing & Dental Hygiene. "Then we’ll see a dramatic increase in demand."

In the coming years and decades, demand for nurses will increase with the wave of baby boomer retirees. By 2025, Hawaii’s seniors population will represent 21 percent of the total, up from 14.5 percent now.

Meanwhile, as the national health care reform rolls out, the uninsured population will have access to more health care, further increasing demand.

"We’re definitely concerned that if the nurses leave the state of Hawaii, then we will definitely be impacted in the future," said registered nurse Cindy Kamikawa, vice president and chief nursing officer at the Queen’s Medical Center, which employs more than 1,200 nurses. "It (the nursing surplus) is so ironic. We anticipate it to be so short-lived."

The current excess of nurses is in part a result of nursing schools significantly boosting enrollment in recent years to alleviate what had been called a severe nursing shortage. Nursing students typically take two to four years to graduate.

"These enrollees have hit the work force in the last few years when we’ve had our worst economic downturn," said Gail Tiwanak, executive director of the Hawaii State Center for Nursing.

Certain that more nurses will be needed in the future, medical facilities and nursing schools are exploring ways to keep recent graduates in the job pipeline by creating bridge programs.

Hawaii Pacific Health, which operates Straub Clinic & Hospital, Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Wilcox Health and 40 clinics statewide, has created nursing academies and programs that bring new graduates into nursing-related positions with the goal of moving them into registered nursing jobs that become available.

"We’re overhiring in certain areas in anticipation of movement," Lerch said. "We’re trying to do whatever we can to preserve the students in our hospitals."

UH plans to offer a clinical training course next spring for registered nurses who graduated in the past two to three years but have been unable to find work. Nurses also are enrolling in graduate school at higher-than-usual numbers to make themselves more marketable, Boland said.

Medical centers and nursing schools also are exploring creation of the first nurse residency program that would be sponsored by the Hawaii State Center for Nursing.

"These are Hawaii graduates, and we want them to stay in Hawaii," Boland said.


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