Hawaii’s health-care worker shortage requires deeper dive

It’s time to stop trying to fix Hawaii’s medical staff shortage with patch solutions and move on to the deeper systemic challenges that are rampant in Hawaii’s hospitals. For far too long executives have proposed recruiting new registered nurses as a panacea with elaborate programs to attract nursing school graduates combined with an over-reliance on experienced out-of-state traveling nurses. However, these solutions cannot address chronic understaffing in Hawaii’s hospitals.

The ill-considered decisions of hospital leaders are contributing to our healthcare crisis.

The understaffing is the result of cost-saving measures implemented by hospital managers in recent years.

In the state’s largest private system, it is common practice for vacancies not to be filled when a department’s budget is in the red. This causes turbulence in the workplace: Nursing wards are understaffed, nurses have to work overtime, which leads to burnout and retirement. The vicious circle continues.

Management’s solution is to require nurses to be assigned more patients, thereby compromising quality of care and patient safety, as well as agreed nurse working standards.

Emergency rooms illustrate the dysfunction and offer insight into the misplaced values ​​of hospital management. Those who have been to a hospital emergency room can easily tell that something is wrong.

The relationship between staff and patients in the emergency room creates a dangerous situation. To “decompress” the emergency department, patients are held in makeshift overflow areas where, in some cases, basic emergency care is not available. Failure to provide nurses with basic guidance on where to find patient resuscitation equipment can spell disaster in situations where time is of the essence. This is compounded by ambulances taking patients to already overcrowded and understaffed emergency rooms rather than diverting them to hospitals that can better accommodate them.

When emergency rooms are particularly crowded with patients, some facilities resort to adding patients to already full units, leaving 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, resulting in moral injuries to those tasked with bedside care. Is it any wonder that nurses are leaving and hospitals cannot replace them?

It is wrong to think that creating a pipeline of new nurses can solve the labor shortage. Nationwide, one in three new nursing graduates leaves the profession within two years of graduating. Even if they all stayed, a hospital with an overabundance of inexperienced nurses cannot function. There is also a need to retain experienced nurses so they can mentor and mentor the less experienced staff to ensure they are performing at an optimal level.

Retaining experienced nursing staff requires a rethink. Hospitals need to recognize that they are competing for experienced nurses at a national level. This means offering competitive salaries is imperative. According to the most recent survey of employment statistics from the US Bureau of Labor Statistics, Hawaii nurses rank among the lowest in the nation for wages, given our state’s high cost of living.

Instead of paying the high cost of imported temporary workers, why not make wages more competitive with those on the mainland and provide better financial incentives to keep the nurses 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 into battle to uphold those standards, or we will continue to see more of our colleagues do so leave profession.

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