Due to the COVID-19 pandemic, US healthcare facilities have been experiencing high rates of nursing workforce shortages, and the Hawaiian islands are no different. Laura Reichhardt, director of the Hawaii Center for Nursing, which was established in 2003 to address nursing workforce issues, spoke with State of Reform about some of the nursing challenges in the state, and ways in which they are being addressed.
“National data shows that the burnout is actually getting worse—that more nurses are considering leaving. When we do see, when there is data available, about what their choices are if they leave their job, they’re looking for other jobs that will improve their wellbeing. They’re specifically picking jobs that will support not just their livelihood, but also their wellness at work.”
—Laura Reichhardt, director of Hawaii Center for Nursing
Reichhardt said Hawaii-specific data about nurse wellness is currently being researched, with expectations of a fall data release. She said Hawaii has difficulty recruiting experienced nurses, but that there is a strong job market for new graduates.
“Challenges that we still have are that in Hawaii, we have a larger number of vacancies in all settings, and I think some of that is due to organizations realizing we need more nurses, our patients are sicker, and you just can’t take care of as many sicker patients as you can with someone who has a lower illness severity,” she said.
Reichhardt said that working nurses continue to feel burnt out, overextended, and sometimes have to juggle patient care with organizational changes. Every aspect of nursing, including nursing education faculty, are experiencing significant shortages. She brought up the common use of travel nurses in Hawaii during peak flu seasons, when there is an anticipated short-term peak that doesn’t require an annual increase to staffing, but that travel nurses are not a stable workforce.
“They’re by nature transient, and they may not have organizational awareness or cultural awareness if they’ve never worked in Hawaii, or they’re not from Hawaii, they may not know our culture and communities. So, those are reasons why organizations may choose not to invest long term in travel nursing,” she said.
According to Reichhardt, organizations are working towards building a long-term nurse workforce, but she still expects travel nurses to be utilized. Travel nurses provide the local nurse workforce with care support and ensure they are not overextended. Additional efforts are being made across the state to address the shortage of nurses.
“We have a strong program for clinical education. It’s called the Hawaii Clinical Placement Collaborative, and we support about 80 percent of clinical education in our state through helping schools of nursing and clinical nursing organizations partner and secure clinical education,” she said.
Reichhardt mentioned how Hawaii has the first-in-the-nation statewide Nurse Residency Program, which was expanded into all counties during the COVID-19 pandemic, as well as all acute care hospitals. The residency program seeks to reduce the turnover rate of newly graduated nurses. Reichhardt said 7 percent of the state’s nursing workforce was directly involved with the program through either teaching or through being hired into an organization to undergo a residency program.
“Nationally, the 12-month retention rate for new grads is about 72 percent, and last year, we were able to celebrate a 99 percent retention rate. Over seven years, the 12 month retention rate for new grads is 97 percent. So really, really, supporting our new grads in being successful in their first year, which is a big indicator in staying in nursing.”
—Reichhardt
The program is being expanded to long-term and post-acute care settings, which will allow working nurses who seek to go into specialty areas to do so within the state, rather than having to travel to the mainland. Reichhardt acknowledged that nursing education needs continued support within the state, but that the state must be able to recruit from other states or countries, which has its own challenges, including licensing.
Reichhardt said the center is assigned to convene a task force regarding the Nurse Licensure Compact under Senate Concurrent Resolution 112. The Nurse Licensure Compact would allow nurses to practice in person or virtually with patients across the nation without additional licenses, and would allow nurses to work across state borders to provide vital services during disasters. The compact would also allow nurses, who are spouses of active duty military members, to continue working without needing to obtain a new license during each relocation.
“We will start convening that working group next month, and that is to inquire whether the state should introduce legislation to adopt the Nurse Licensure Compact,” she said.