Hawaii hospitals seek emergency rules to address workforce shortages


Nicole Pasia


Workforce shortages exacerbated by the COVID pandemic are pushing Hawaii hospitals to call for emergency rules that would remove licensure barriers for providers coming in from the mainland. If put in place, the rules would last 120 days and allow nurses licensed in other states to come and work in Hawaii for up to 90 days without applying for an in-state license. 


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Hawaii has approximately 147 COVID hospitalizations as of Aug. 3rd, according to data from the Hawaii Emergency Management Agency. The data also shows 184 out of 313, or 58.7%, of ICU beds are occupied as of Aug. 3rd. COVID patients occupy 19 ICU beds. 

Hilton Raethel, President and CEO of the Healthcare Association of Hawaii, said a number of factors are creating a “very challenging environment” for Hawaii to recruit and retain health care workers, including the high cost of living and inflation. 

“We’re not the only industry in Hawaii that is struggling to attract a sufficient workforce,” he told State of Reform. “The challenge is that for health care, the consequences are more immediate than they are in other organizations. We cannot control when patients come in to see us, at least to our hospitals. So you have to find sufficient workers to take care of patients when they do come to see us.”

Regarding the rise in cases from the Omicron subvariant BA.5, Raethel said hundreds of health care workers are being affected on any given day. Additionally, aside from health care workers themselves continuing to test positive, the cases are also causing administrative barriers as organizations look to bring more health workers into the state. 

“[The Hawaii Department of Commerce and Consumer Affairs (DCCA)] … has been impacted by the pandemic in a number of ways also, including having a number of staff out,” Raethel said. “… So that has been a barrier in terms of us getting sufficient health care workers in the state and it impacts other industries as well.”

To ensure the remaining health care workforce does not get burned out in the midst of longer-term workforce recruitment solutions, HAH is working with DCCA, the Attorney General, and the Department of Health on more immediate measures. 

HAH originally called for an emergency proclamation, similar to the one that ended in March 2022, that allowed out-of-state health workers to practice in Hawaii without applying for in-state licenses. According to Raethel, the Attorney General determined there is not sufficient justification for an emergency proclamation, leading HAH to pivot to implementing emergency rules instead. 

“We continue to work on long-term solutions, and the DCCA continues to hire additional staff, both temporary and permanent staff, but it takes time for them to do that,” Raethel said. “This 120 day window will allow us to bring in sufficient health care workers into the state while these longer-term solutions are put in place.”

Raethel highlighted HAH’s long-term workforce solutions, such as increasing the number of faculty for nursing education programs. Hawaii hospitals are also collaborating with the Hawaii State Center for Nursing to implement nursing residency programs, which allow nursing school graduates to work in hospitals or other health care settings. The State Center for Nursing also released a report this month detailing the state’s nurse education capacity from 2020-2021.