The lack of jobs in Hawaii drives graduates away, which could hurt future demand
The tight employment market has left many registered nurses working in lower-level health care positions such as nurse aides or medical secretaries as a way to gain experience.
As Hawaii's population ages, health officials say eventually this nurse surplus could turn into a shortage as some graduates who can't find jobs move to the mainland or get out of the profession altogether.
"There's definitely a risk for a shortage. We have heard of individuals who have gone out of state to look at other opportunities," said Cindy Kamikawa, vice president and chief nursing officer at the Queen's Medical Center, which employs more than 1,400 nurses at its Punchbowl campus. "Our workforce is relatively stable, and we are seeing retirements, but not at the rate that we would expect."
The turnover rate for nurses at Queen's dropped to 6.1 percent this year from 7.9 percent in 2012.
That's due in part to nurses delaying retirement, which began when the economy collapsed more than five years ago, said Mary Boland, dean of the University of Hawaii at Manoa's School of Nursing and Dental Hygiene.
"Some people are saying they're going to stay closer to (age) 70 if they can. That's what is making it challenging for us to set enrollment targets to be sure we're graduating enough nurses to meet the needs," Boland said. "It's extremely different from 2005 when you had 10 jobs and one student looking to get them. Now you might have 10 students and maybe one job, and people have to wait."
Over the past 18 months, the UH-Manoa nursing program has seen about a third fewer undergraduate applicants as "people see there aren't enough jobs," Boland said.
The Manoa college graduates about 112 nurses annually.
UH Maui College admitted 40 students twice annually at least for the last eight years.
"Now in spring 2015 we're admitting zero," said Anne Scharnhorst, allied health department co-chairwoman at UH Maui College. "It's a really big deal for us."
Part of the problem on Maui is the island has only one major hospital -- Maui Memorial Medical Center -- which is facing substantial deficits as part of the state-run Hawaii Health Systems Corp., Scharnhorst said.
"We have one hospital and it's an HHSC hospital, so they're just drowning, too," Scharnhorst said. "The problem is they're exclusively hiring traveling nurses. That's very expensive but there's no (costly employee) benefits. You bleed now but then you're done."
Maui Memorial CEO Wesley Lo said if the hospital were financially stable, he would hire and train new grads for the hard-to-fill positions that require more experience.
"In the long run this would save money and give us a more consistent workforce," Lo said. "However, given our financial situation, it would cost money to establish and maintain these programs, and the savings would not come to fruition for years. We don't have the financial wherewithal to do this. Basically, based on our financial situation, you have to have enough gas in the car to get there."
Other hospitals like Queen's also regularly contract traveling nurses, especially in critical areas, instead of filling positions with new graduates who are inexperienced.
"The difference is that a new grad is not specialty trained, so someone coming out of school will not be able to immediately go into the (emergency room, operating room or intensive care) area," Kamikawa said. "They need to go through training classes, some as long as three to four months."
The employment issue has prompted educators at Hawaii Pacific University to begin encouraging new registered nurses to take positions outside of acute-care hospitals or opt to continue in graduate degree programs to become more marketable, said Lynette Landry, dean of HPU's College of Nursing and Health Sciences.
"Because of the (Affordable Care Act), there is a reconfiguration in where nurses are getting jobs," she said, referring to a move in the health care industry to reduce costs by decreasing pricey hospital admissions. "We as educators have to think about how we're preparing our nurses. There may be some who go into public health, primary care or long-term care. There may, for the foreseeable future, not be as many nursing jobs in acute care, but in other areas."
The Affordable Care Act, also known as Obamacare, attempts to decrease health care costs nationwide, a move that has pushed payers to reimburse medical providers for quality outcomes rather than volume.
"What that's doing is making employers risk-averse in terms of hiring because they don't know what their long-term -- even midterm -- need is going to be," Boland added.
Evalani Kim, 36, recently got a registered-nurse job at the Queen's Medical Center, though she graduated nearly a year ago and had applied for positions in seven other states. She said she landed the position because she happened to know a manager at the hospital from a previous internship.
"It's extremely competitive. You pretty much have to be an internal employee ... to even have the possibility of getting a nursing position. That's one reason why I already had my mind set on going to the mainland and working," she said. "It's like winning the lottery. You've got to pick the right numbers, be at the right place at the right time and know the right people. Everything has to fall into place."
Jennifer Scott, 27, who graduated from nursing school last fall, was one in a class of about 70 graduates to get hired as an nurse in just three months.
"I do know a lot of my classmates are getting hired now after about six months to a year," she said. "Several of my classmates moved to the mainland for better opportunities for jobs. There is a lot of students graduating from nursing schools, so I guess there's only so many jobs for new graduates. There's a lot of acute-care nursing jobs. The problem is it requires experienced nurses with at least two years or more (experience). There are many opportunities for those nurses that have that kind of experience, but for new grads that have to go through training, a hospital has to invest in you. That's really hard to get."
Boland said the problem has become a statewide economic issue.
"The question is, Do we spend dollars on travelers and recruiting on the mainland versus investing in the new nurse from Hawaii who wants to be in Hawaii?" she said. "We talk so much of wanting to support our state economy and keep our brightest here, but employment is a huge one. How do we work with employers to have them make investments now that will pay off in the long run? I just haven't found the answer to that."