Nurses fresh out of school are finding it difficult to land a registered nursing job in Hawaii.
There are few job prospects for new graduates, a trend that has worsened over the past five years since the economic downturn forced older nurses to postpone retirement, while demand for medical services dropped.
Laurie Kukkonen graduated with a nursing license last year, hoping to land a job and start paying off what will be close to $100,000 in school loans.
Instead, the 34-year-old Honolulu resident has found a highly competitive field with few opportunities for recent graduates, many of whom wait months — and sometimes years — to land a coveted registered nurse position.
"It’s definitely worrisome. There’s a lot of qualified people out there, and (the market is) oversaturated with new graduate nurses and not enough positions for them," Kukkonen said. "It’s definitely frustrating because you want to start working and gaining experience. You definitely worry about how you’re going to pay back your loans and find a job to support yourself. A lot of us are older, so we have families and life commitments that we need to take care of, so the financial issues at both ends are very difficult."
The job market shrunk further when the Hawaii Medical Centers in Ewa and Liliha closed in December 2011 and January 2012, respectively.
Hawaii has 20,000 registered nurses, but only 84.6 percent are working as registered nurses, according to the Hawaii State Center for Nursing, a state agency that collects information on the nursing profession. About 650 students graduate each year from Hawaii nursing schools, including the University of Hawaii, Chaminade and Hawaii Pacific University.
New graduates often end up taking odd jobs or lower-paying positions as nurse aides or ward clerks while waiting for an RN opening. The average RN earns about $50 an hour, while a nurse aide makes about $18, according to Hawaii Pacific Health, which employs roughly 1,750 nurses.
About 150 new grads are working in non-RN roles while waiting for a position to open at Hawaii Pacific Health, parent company of Straub Clinic & Hospital, Kapiolani Medical Center for Women & Children, Pali Momi Medical Center and Wilcox Health on Kauai, said Carl Hinson, director of workforce development.
"Between 70 and 100 a year are moving into RN positions, but it’s taking them one, two, three years," he said. "We still have an oversupply of new grads. We still need experienced nurses — that’s where our shortage is."
Nurses are considered experienced after working two to three years in a particular area such as the operating or emergency room, he said.
As such, the organization regularly employs new grads to keep them involved in acute care "so that they’re still exposed to everything so as opportunities become available, they’re the first ones we look at," Hinson said.
"This is a nationwide problem," Hinson said. "It’s not like there’s a wealth of opportunity in California so our new grads are fleeing the state. Nationwide, new grads are having a difficult time finding positions right away, so they are going to non-RN roles as a pathway."
The job market has shifted substantially since the years before the economic downturn when the expectation and common practice was that RNs got job offers immediately or soon after graduating, he said.
The difficulty in finding RN jobs prompted the University of Hawaii School of Nursing & Dental Hygiene to offer a course this summer to help nurses who are not employed as an RN increase their skills and competitiveness in the job market, said Dean Mary Boland.
The difficulty of finding RN jobs is likely to worsen in the near term with the rollout of the federal Patient Protection and Affordable Care Act (ACA), also known as Obamacare, as providers, uncertain of how the law will affect payments for medical services, restructure and slim down their organizations.
"There’s certainly a bottleneck right now as people hold on to see what’s going to happen with the ACA," said Deborah Gardner, executive director of the Hawaii State Center for Nursing. "These couple of years are going to be tough. Sometimes supply and demand are not strictly in alignment, especially when you have a health care transition of a historical degree like this one. It’s really going to reshape how we deliver care. "
While there is a short-term shortage of RN jobs, there are reasons to be optimistic that more jobs will open up in the long term.
Obamacare will add pressure to increase access to care. The state also has an aging population that will require more services, and a large number of nurses are preparing to retire in the next three to five years, Gardner said.
Queen’s Medical Center also plans to reopen the Ewa hospital next year, which will create more RN positions for recent graduates. The hospital also plans to double new grad openings to 60 in its nurse residency program this fall because it anticipates some of its existing staff will move to the West Oahu campus.
All that makes Gardner think the shortage of RN jobs in Hawaii is just temporary.
"I would tell you that we’re in the eye of the hurricane," Gardner added. "We know people who are looking are frustrated. Many of them have stopped looking and just taken other jobs. They work at restaurants just to have an income. They’ve got to survive during this eye of the storm."
About 14 percent of working RNs intend to retire in the next five years, according to a 2011 survey by the Hawaii State Center for Nursing.
"I’m still of the opinion that we’re probably two to three years away from seeing a robust change, then we’ll start taking new grads," Hinson said. "The challenge is a new grad needs a lot of one-on-one time with a preceptor and mentor. It could be anywhere from six months to a year when they can function independently. We have no shortage on the front end, but we need experienced nurses to train new nurses. It’s a weird, vicious cycle at the moment."
