Hawai‘i is failing its nurses: New report
They care for our kūpuna, help us heal after injury or illness and stayed on the front lines during the toughest days of the COVID-19 pandemic.
Hawaiʻi Island nurses hold informational picket
But a new 2025 national report ranks Hawaiʻi 47th out of 50 states for nursing.
'It's disappointing,' said Hilton Raethel, president and CEO of the Healthcare Association of Hawaiʻi. 'Not surprising, but disappointing.'
Raethel believes the new rankings, released by WalletHub, shed light on some real and urgent challenges nurses are facing, especially when it comes to cost of living, job availability and working conditions.
Here are the top things to know about what's making nursing in Hawaiʻi so difficult and what new efforts may finally be underway to help fix it.Hawaiʻi nurses earn some of the highest salaries in the country, but those numbers don't tell the whole story.
'Yes, nurses in Hawaiʻi are paid the second-highest nursing salaries in the country, second only to California,' Raethel said. 'But Hawaiʻi is a very high-cost state. The cost of housing, energy, utilities and food are all very expensive.'
When the report adjusted nursing salaries based on cost of living, Hawaiʻi ranked dead last, 50th in the country.
'For all professions, when you adjust for cost of living, we do not do well,' Raethel said.
For nurses who want to stay in their hometowns, that often means struggling to pay rent, care for their families, or save for the future, even while working full-time in a respected and demanding job.
The report also scored Hawaiʻi poorly on job availability. The state ranks 47th for nursing job openings per capita.
'Some people would say that's a good thing—it means we already have a lot of nurses in the workforce,' Raethel said. 'But [the report] is looking at this from the perspective of opportunity. Nurses who are looking for work, especially new graduates, are going to find fewer openings here than in almost any other state.'
That limited hiring has ripple effects. With fewer nurses on staff, those who do get hired must take on more patients. That increases burnout, which can lead to errors or even nurses leaving the profession.
Check out more news from around Hawaii
Hawaiʻi's score for work environment also ranked poorly, 37th in the nation. That includes policies like mandatory overtime limits, shift lengths, access to professional support and mental health resources.
'In top-ranked states like Washington, there are laws that protect nurses from being overworked,' Raethel said. 'We don't have those same protections here.'
Without strong safeguards, nurses in Hawaiʻi may find themselves exhausted, unsupported and under immense pressure. That stress affects both their own health and the quality of care patients receive.
Hawaiʻi's residents are living longer, which is both a strength and a challenge.
'We have the longest longevity in the country,' Raethel said. 'People in Hawaiʻi, on average, live longer than anyone else in the nation.'
By 2050, the state is projected to have the third-highest percentage of people aged 65 or older. This means nurses will need to care for more kūpuna with complex health needs.
But the infrastructure to support this shift isn't in place yet. 'Without major investments in training and support systems,' Raethel said, 'nurses are going to be stretched even thinner.'
Nurses also face challenges based on geography. Hawaiʻi ranks near the bottom in terms of health-care facilities per capita.
That means nurses and patients on neighbor islands may have to travel far for services or accept long wait times. It also limits job options, professional development and access to life-saving equipment.
'This is a real challenge,' Raethel said. 'Not just for nurses but for the communities they serve.'
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States like Washington and Oregon offer higher adjusted pay, more jobs and better protections. Raethel acknowledges that some Hawaiʻi-born nurses are leaving because of those benefits.
'They want to serve their community, but they also need to survive,' he said. 'When another state offers double the job openings and better pay adjusted for cost, it's hard to compete.'
Raethel pointed to a major win that shows progress is possible.
'Two years ago, the state legislature approved $30 million for health-care educational debt repayment,' he said. 'This year, they approved another $30 million for the next two years.'
This program pays up to $25,000 a year toward student loans for nurses, doctors and other health professionals who work in qualifying settings and commit to staying in the state for at least two years.
'If the educational debt is paid off, nurses can invest in their kids' education,' Raethel said. 'They can look at saving for a house, a condo, an apartment, whatever their dream is.'
The money is paid directly to lenders, which helps ensure the support goes exactly where it's needed.
'That's one way we're helping,' Raethel said. 'It's concrete, it's specific, and it helps nurses take a breath financially.'
Another factor dragging down the state's nursing score is that Hawaiʻi is not part of the national Nurse Licensure Compact. This agreement allows nurses licensed in one participating state to practice in another without getting re-licensed.
'Hawaiʻi is one of about 10 states not part of the compact,' Raethel said. 'That limits mobility and makes it harder to fill short-term staffing needs.'
Joining the compact could help Hawaiʻi recruit travel nurses or bring in mainland professionals more quickly during emergencies.
Despite the low score for nursing, Raethel said it's important to keep the bigger picture in mind.
'Hawaiʻi was recently ranked the 12th best state for health care overall,' he said. 'And Honolulu was named the second healthiest city in the U.S.'
The state's health outcomes, like life expectancy and overall well-being, are amongst the best in the country. But that doesn't erase the challenges nurses face.
'We're a great state to live in,' Raethel said. 'But the cost of living is a challenge for everyone who calls Hawaiʻi home.'
National Nurses Week began May 6, but the conversation about supporting caregivers should last longer than a single week.
'Nurses are the backbone of our health system,' Raethel said. 'They care for us when we're most vulnerable. We need to care for them too.'
That means more than just saying mahalo. It means offering real pay, real protections and real purpose, so that nurses in Hawaiʻi can thrive while caring for their communities.
You can click to read the full report. You can click to learn more about the Healthcare Association of Hawaiʻi.
Get news on the go with KHON 2GO, KHON's morning podcast, every morning at 8
Raethel summed it up simply: 'Aloha means taking care of each other. And that includes our nurses.'
Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
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