Column: Hawaii’s health-care worker shortage requires deeper dive

It’s time to stop trying to fix Hawaii’s health-care worker shortage with Band-Aid solutions and get to the deeper systemic challenges rampant in Hawaii’s hospitals. For far too long, leaders have proposed recruiting new graduate nurses as the panacea with elaborate programs to attract nursing school graduates coupled with an over-dependence on experienced, out-of-state travel nurses. However, these solutions fail to address chronic understaffing in Hawaii’s hospitals.

The ill-conceived decisions by hospital leaders are contributing to our health-care worker crisis.

The understaffing is the result of cost-saving policies instituted by hospital leaders in years past.

At the largest private system in the state, when a position is vacated, it is a practice that the position will not be filled if a department’s budget is in the red. This creates turmoil in the workplace: Nursing units are short-staffed, resulting in nurses having to work overtime, which leads to burnout and nurses leaving the profession altogether. The vicious cycle persists.

Management’s solution is to require nurses to be assigned more patients, compromising the quality of care and patient safety as well as agreed-upon work standards for nurses.

Emergency rooms exemplify the dysfunction and offer a glimpse into hospital management’s misplaced values. Those who have been in a hospital ER may readily recognize something is amiss.

The ratio of staff to patients in the ER creates a dangerous situation. In an effort to “decompress” the ER, patients are held in makeshift overflow areas that in some instances do not have basic emergency supplies readily available. When nurses have not received a basic orientation on where to find equipment to resuscitate patients, this could spell disaster in situations where time is of the essence. This is exacerbated by ambulances bringing patients to already overcrowded and understaffed emergency rooms instead of diverting them to hospitals that can better accommodate them.

When the ERs become particularly overwhelmed with patients, some facilities have been resorting to admitting patients to already full units by parking occupied beds in the hallways without providing more staff to care for the additional patients. It is impossible to provide safe care in these situations, leading to moral injury to those tasked with bedside care. Is there any wonder why nurses are leaving and hospitals can’t replace them?

It is misguided to think the worker shortage can be resolved by creating a pipeline of new nurses. Nationally, 1 in 3 new graduates in nursing leaves the profession within two years after graduation. Even if they all stayed, a hospital cannot function with an overabundance of inexperienced nurses. Retaining experienced nurses is also necessary so they can mentor and guide the less experienced staff to ensure they function at an optimal level.

Successfully retaining experienced nursing staff requires a new way of thinking. Hospitals must realize they are competing for experienced nurses on a national basis. This means it is imperative to offer competitive salaries. According to the most recent U.S. Bureau of Labor Statistics occupational employment statistics survey, Hawaii nurses rank at the bottom of the nation in terms of wages, when factoring in our state’s high cost of living.

Instead of paying for the high cost of imported temporary labor, why not make wages more competitive with mainland facilities and offer better financial incentives to keep the nurses who are already working here in Hawaii?

We became nurses because we care about people. Hawaii’s patients deserve better. If we are made to work in environments that prevent us from living up to our high standards, then we are willing to go to battle to uphold those standards, or we will continue to see more of our colleagues leave the profession.

Daniel Ross is president of the Hawaii Nurses Association, OPEIU Local 50, AFL-CIO, which represents 4,000 health-care workers employed by Hawaii’s major health-care providers.