Hawaii’s shortage of health care workers worsens

Hawaii is facing a severe health care worker shortage as hospitals are grappling with even more patients than during the height of the COVID-19 pandemic.

The shortage of health care workers has dramatically worsened over the past three years, according to a new report released Tuesday by the Healthcare Association of Hawaii, with job vacancies jumping 76% — from 2,200 job openings in 2019 to 3,873 this year.

Of those openings, nearly 1,000 are for registered specialty nurses, while more than 700 are for certified nursing assistants and nurse aides.

Hawaii is also short of hundreds of medical assistants, licensed practical nurses and other entry-­level positions such as personal care assistants and phlebotomists who collect blood samples from patients.

“We definitely have some very serious challenges in terms of the adequacy of the health care workforce,” said HAH President and CEO Hilton Raethel. “It’s unprecedented, at least in recent history, to have this number of openings across this many job categories for health care professions.”

The survey for the Hawaii Healthcare Workforce Initiative 2022 Report was taken between February and June across 89 professions. It was originally scheduled for release in 2021 following the inaugural report in 2019, but was delayed due to the pandemic.

Based on survey results, the job vacancy rate increased to 17%, compared with 10% in 2019.

HAH says the need, exacerbated in part by the pandemic, puts increased pressure on employers to recruit, train and retain qualified employees.

Full hospitals

At the same time, Hawaii hospitals are facing a record-high census, according to Raethel. On Tuesday there was a high of 2,554 patients in hospitals, which is more than at any point during the pandemic.

Of those 2,554, he said, only 65 are COVID-19 patients, which is approximately what the weekly average has been the past few weeks. So the higher census is not driven by COVID-19.

“What we have learned from our data is that we have a new normal in Hawaii,” said Raethel. “As our population is aging — and part of it is the impact of the pandemic — but our case mix index, which is a measure of severity, has been increasing over the years since 2017. That is pushing up our length of stay.”

This combination of factors is pushing up Hawaii’s daily hospital census.

In 2019 and 2020, Hawaii hospitals fielded an average of just under 2,000 patients a day, which increased to about 2,200 in 2021.

But for the first 10 months of this year, Raethel said, there have been more than 2,300 patients in Hawaii hospitals. In the past week that daily census surpassed 2,500 on five days.

The higher census makes the health care worker shortage even more pronounced and the need to fill those gaps even more urgent.

Continued gap

Although the Healthcare Workforce Initiative — made up of a volunteer group of leaders from various sectors — has launched some promising programs to help alleviate the shortage, these gaps are not likely to be filled for some time.

Some of these include partnerships with high schools and community colleges to get students into entry-level certification programs, along with an expansion of nurse residency and “transition-to-specialty” registered nurse programs.

A pilot “glidepath” program will allow working certified nurse aides to continue earning money while taking classes at their workplace to advance their careers and become licensed nurse practitioners.

The report noted that most training programs are on Oahu and that more are needed on isles such as Lanai and Maui, which have the highest percentage of job openings.

Even with an additional $1.75 million in state funds allocated to the University of Hawaii to hire more nursing instructors, which will help, it will take time to close these gaps because “you can’t just turn out nurses overnight.”

In reality, traveling health care workers brought in from the mainland will be needed to help take care of the high number of patients in Hawaii for a while.

Currently, there are about 600 traveling health care personnel working in the state on any given day, said Raethel.

“Until we can get our own staff grown and trained, we’re going to continue to need the travelers because we’re not staffed for 2,500 patients a day,” he said.

Gov. David Ige in August approved emergency rules authorizing out-of-state nurses to temporarily practice in Hawaii without obtaining a state license if they hold one in another state and meet other requirements.

HAH sought the temporary waiver because of state delays in processing licenses, and will seek an extension for it when the emergency rules expire Dec. 9.

Cost of living

During the pandemic, stress and burnout pushed more health care workers to retire early, while others moved out of state due to the cost of living.

The job turnover rate climbed to 20% this year, up from 16% in 2019.

Jason Chang, HWI co-chair, said The Queen’s Health System has 200 traveling nurses so its own employees can take time off and not have to take on double shifts. The goal is to eventually reduce that number to 50.

“We have a lot of headwinds we’re facing, but there are things we’re trying to do to be good to our employees,” he said.

Another challenge is that Hawaii has some of the highest real estate prices in the U.S., along with a higher cost of living, and workers have been pushing for compensation that reflects these costs and which is competitive nationally.

Raethel said the state pays the second-highest health care worker salaries in the U.S., behind California, but affordable housing comes up as the No. 1 issue during recruitment efforts.

Hawaii hospitals and health care organizations are ready to hire every local college graduate interested in these open positions.

But recent graduates also have been lured to work in other states such as Oregon, where they have been offered sign-on bonuses and where the cost of living is not as high.

HAH said data from the report will be used to advocate for a stronger health care workforce as well as to form strategies on how to help supply meet existing demands.

While the shortage will not be solved overnight, Raethel said it is a wake-up call on a pressing issue.

“This is very credible data,” he said. “It really is a wake-up call for our governor, lieutenant governor, our legislators, our mayors, for all of those bodies to say, ‘OK, if we do not solve this, we will not have enough people in our hospitals, nursing homes and health care agencies to take care of the population.’”

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Isle health care workers

>> In 2019 there were 2,200 job vacancies. In 2022 that number grew to 3,873, a 76% increase.

>> There are 999 openings for registered specialty nurses, a 116% increase from 2019; there are 744 openings for certified nursing assistants/nurse aides, a 78% increase from 2019.

>> The hospital setting accounts for roughly half (48%) of current openings.

>> The job turnover rate climbed to 20%, up from 16% in 2019.

>> On average, vacancies are taking six to 12 months to fill (no change from 2019).

Source: Hawaii Healthcare Workforce Initiative 2022 Report