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Practical Nursing in Hawaii

Will Hawaii have enough Licensed Practical Nurses in the years to come? The Hawaii State Center for Nursing, Hawaii’s workforce center, wrote in a 2017 report that long-term care facilities were already feeling the effects of shortage. LPNs have a more narrow scope than registered nurses, and in a complex modern healthcare system, not as many of them are needed. However, they do fill a vital need and will continue to do so for years to come. In Hawaii, a land of highly educated nurses, it’s at the LPN level that there is cause for concern.

A Profile of Hawaii’s LPNs

The Hawaii Center for Nursing publishes a biennial report of the state's nursing workforce (http://www.hawaiicenterfornursing.org/data-reports). Data is obtained at the time of renewal.

A key finding: The number of LPNs has declined 16% since 2005. In part, this reflects academic progression; for some, practical nursing is a step toward registered nursing, with its greater scope of practice and greater job opportunities. (This can of course be a positive thing, both for the LPNs who have chosen to advance and for the organizations that have chosen to hire proven staff.)

The decrease in LPN numbers varies by county. Honolulu County has 25% fewer; Hawaii County, just 10% fewer. Notably, Honolulu is the county with the greatest percentage of total nurses in hospital settings.

Maui News reports that costs rise when LPN numbers aren't adequate. Hale Makua uses travel nurses to fill LPN positions. It can be a lot of fun for an LPN to earn his or her living doing short stints in beautiful places. Costs rise, though, for the employing institution. (At Hale Makua, the practice means an additional $500,000 must be budgeted.)

There are some differences in where LPNs work as compared to nurses with higher levels of credentialing. Part of this is geographical. While Honolulu County employs slightly more nurses relative to population, it actually employs fewer LPN. There are greater concentrations of LPNs in Hawaii, Maui, and Kahuai. Job concentration varies a good deal within counties. This is due to concentration of particular types of facilities that hire LPNs.

In Honolulu County, there are several areas with moderately high LPN concentrations: Wahiawa, Kane’ohe, Kailua, ‘Ewa, and the Primary Urban Center. In Hawaii County, LPNs are highly concentrated in Hilo where most of the region's long-term/ nursing facilities are located. In Maui County, LPNs are most highly concentrated in Kahului and Wailuku, but there is also moderately high concentration in Kihei and Ka’anapali. In Muai, the concentration is highest in Lihu’e, Kapa’a, and Waimea.

There is a greater difference in typical work setting. 23% of LPNs are employed in nursing homes. 17% are in physician's offices and 9% in ambulatory care; together these account for more than one-fourth. 16% are in hospital settings -- still a significant percent.

Home health is the primary work setting for 5%. The following settings each employ approximately 3% to 4% of LPNs: dialysis clinics, hospices, school health settings, community health settings, and assisted living facilities.

Data can be interpreted within changing healthcare contexts. Hospital stays are typically shorter than they used to be, the Center notes, but those who are there are typically sicker.

Once the initial crisis is passed, patients may be cared for in other settings, including nursing homes. A majority of nursing home stays are now short-term. The nursing home is, of course, largely the domain of the LPN! The State Center for Nursing postulates that LPN hospital positions will decline as their scope is often not adequate for the increased patient acuity.

LPN Roles and Clinical Specialties

The most common clinical specialty is gerontology; this comprises 23%. Discounting those identified as “other clinical”, the next most common specialties are family health, adult health, acute care, and pediatrics. Each comprises 8% to 10% of Hawaii’s LPNs.

More than half of the state’s LPNs are working in primary care specialties, when primary care is broadly defined to include nursing practice with different age groups, from pediatric to geriatrics. (Community health and mental health are also considered primary care specialties, though each employs a very small portion of the state’s LPNs.)

Among the other specialties reported are home health, nephrology, perioperative care, public health, school health, and palliative care/ hospice.

72% of Hawaii’s LPNs report their primary role as that of staff nurse. Very few report research, faculty, consultant, or executive roles, as would be expected given the relatively lower level of nursing education. 4% described themselves as nurse managers. More than one in five, though, have health-related roles other than general staff nurse or manager.

A scan of job postings in 2018 reveals that there is a very diverse group of employers seeking LPNs. The following is a sampling of roles:

  • Providing nursing care to mentally ill in a state hospital
  • Working in the administrative office of a hospice, with duties to include providing evaluation and assisting the coordinator (as well as performing nursing interventions)
  • Administering medications in an outpatient clinic

There are of course a number of long-term care positions.

Maintaining and Achieving Practical Nursing Licensure

Prospective LPNs complete a certificate or diploma program (LPN programs in Hawaii), then pass the NCLEX-PN licensing exam. Hawaii nurses now have a continuing competency requirement.

Many, of course, are taking far more than the requisite continuing education. 8% of Hawaii’s LPNs are currently enrolled in educational programs.

Career Outlook and Average LPN Salary in Hawaii

The Hawaii LPN occupation has been projected to increase 9% between 2014 and 2024 -- this reflects positions not licensees.

Hawaii LPNs averaged $23.55 an hour in 2016, or $48,980 for a full year of 40-hour weeks. LPNs frequently work 37 to 40 hours a week, according to the State Center for Nursing. 38.2 is the average.

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