to advocate for the
improvement of the
healthcare system in
the communities where
we live and work.
The official Newsletter of
Hawaiʻi - American Nurses Association
Quarterly publication distributed to approximately 9,400 RNs and LPNs in Hawaiʻi.
August 2022 | Vol. 3 No. 1
Join Hawaiʻi-ANA & ANA Today!
Only $15 per month.
9am – 3pm | Hilton
to find out more or to join!
Links to Other Nursing
Hawai’i Board of Nursing
Hawai’i Association of Professional Nurses
Hawaiʻi Nursesʻ Association-OPEIU Local 50
Hawai’i State Center for Nursing
Hawai’i Nurses Association
Philippine Nurses Association of America
American Association of Nurse Leaders Hawaii
Hawaiʻi - American Nurses Association will be hosting the 2022 Annual Conference
on Saturday, October 22nd from 8:00am - 4:00pm in-person at the Hilton Hawaiian
Village in the Tapa Room, and shared by live webinar across the islands. Theme:
“Together, We Can!”
This conference is open to all nurses in Hawaiʻi. Invitations are sent out to other nursing
organizations in Hawaiʻi for their members to join in the festivities, so please spread the word!
The conference will feature local and national nursing leaders. Focus will be on nurses’ ability
to be powerful voices in policy and government, how to get involved in legislative activities,
and how policy positively impacts your nursing practice and the care your patients receive. We
will offer continuing education*, networking opportunities, booths where vendors will provide
information on their products and services, great food, and much more!
Hawaiʻi-ANA Business Meeting will be open to Hawaiʻi-ANA members where the Board of
Directors will share our strategic and financial plans soliciting input from members for direction
of our Association. Results of the annual election of new Board and Nominating Committee
members will also be announced.
Join us Saturday, October 22nd, 2022 from 8:00am to 4:00pm in person or via Zoom
webinar for engaging opportunities to network with colleagues from around the state!
*Northeast Multistate Division (NEMSD) is accredited as a Provider of nursing continuing professional
development by the American Nurses Credentialing Center’s Commission on Accreditation. Hawaii-ANA is a
member of the NEMSD. This activity is being provided by Hawaii-ANA as a member of NEMSD.
current resident or
U.S. Postage Paid
Permit No. 14
Hawai’i-ANA Annual Call for Nominations.2
Why I Became a Member ..........3
Our Mission & Purpose ............3
A Memoir of the 2022
ANA Membership Assembly ..... 4-6
ANA Acts on Climate Change
and Key Nursing Issues .............8
Student Nurses Page ...............9
Hawai’i-ANA Membership .........10-11
ANA-ONLY Members ..............12
The power of nursing returns to
Washington, DC in force .........4
The New Graduate
RN Workforce Report ...........13-16
ANA’s Racial Reckoning Statement . . 7
Page 2 • Hawaiʻi Nurse August, September, October 2022
ANNUAL CALL FOR
Official Announcement of 2022 Call for Nominations
for Elected Positions, on behalf of Hawai’i-ANA
Nominating Committee and Board of Directors.
As required by the Hawaiʻi-ANA Bylaws 2021, notice is hereby given
to all Hawaiʻi-ANA members of the opening for nominations
for election to office of the following positions:
Directors at Large (2 positions)
Nominating Committee (3 positions)
Please consider volunteering your time and talent. Your impact can
make a difference in the lives of many! Join your colleagues already
serving their communities and profession: the benefits are boundless!
Be a voice for
change in the
Advocate for our
profession and our
Learn new skills!
BOARD OF DIRECTORS
Executive Director: Linda Beechinor, DNP, APRN,
President: Katie Kemp, BAN, RN, GERO-BC
President-Elect: Nancy Atmospera-Walch, DNP,
MPH, MCHES, LNHA, CCHN, CMC, BSN, RN
Vice President: Linda Beechinor, DNP,
Secretary: Marion Poirier, M.A., RN
Neighbor Island Director: Denise Cohen, PhD,
Director-at-large: Bob Gahol, RN, BSN,
MBA, MPA, MMAS, MSS
Director-at-large: Taryn Amberson, MPH,
BSN, RN, CEN, NHDP-BC
Director-at-large: Robin Zachary, DNP, Ed.S, RN
Director-at-large: Tiffany Hooks, DNP,
For more information on nominating yourself or a colleague please visit the Hawaiʻi-ANA website
Nominating Committee Chair: Pokiʻi Balaz, DNP,
EMBA, MSN, BSN, APRN-Rx, FNP-BC, NP-C
Member: Brian Fikes, MS, APRN, ACHPN-BC
Member: Soroya Acosta, BSN, RN-BC
Member: Doreen Nakamura, DNP, MBA, RN,
Member: Michael Kaneshiro Chou, RN, PCCN, CMGT-BC
2022 Call for Nominations for Elected Positions
Dear Colleagues –
On behalf of Hawai’i-ANA Nominating Committee and the Board of Directors, we are pleased to announce that
the annual 2022 Call for Nominations for Elected Positions is now open.
Please consider volunteering or nominating for any of the following open positions. Open positions are listed below.
All terms are for 2 years, to begin at the close of the 2022 Hawaiʻi-ANA Annual Conference October 22, 2022.
The Vice-President reports to the President and is responsible for the newsletter and social media;
membership growth and diversification; development, communications, and coordination of District activities;
other activities as assigned by the President; and, in the absence of the president, shall assume the duties of
that office. The Vice President is a member of the Executive Committee.
The Treasurer shall be accountable for the fiscal affairs of Hawai’i-ANA and shall provide reports and
interpretation of Hawai’i-ANA’s financial condition to the Board of Directors, the Annual Conference, and the
membership. The treasurer shall be chairman of the Finance Committee. The Treasurer is a member of the
Director-at-Large (two seats)
The Director-at-Large serves on the Hawai’i-ANA Board of Directors to represent the membership who
elected them. Duties are commensurate with assignments made by the Executive Committee, such as to chair
and participate in committee work of Hawaiʻi-ANA.
Nominating Committee (three seats)
The Nominating Committee member serves per the committee duties outlined in Article II, Section 2.3. of
the Hawaiʻi-ANA Bylaws 2021.
For more information on how to become a candidate in this election, go to the Hawaiʻi-ANA Website.
August 1, 2022 - September 21, 2022
September 22, 2022
October 1, 2022 - October 22, 2022
October 22, 2022
Nominations for positions are open
Slate of eligible candidates will be published to the membership
Voting is open to the membership
Results of the elections will be made available
In accordance with Hawaiʻi-ANA Bylaws 2021, nominations are open August 1, 2022 and will close September
21, 2022. The slate will be published to all members with information about each candidate. Voting will be by
secret ballot, beginning October 1, 2022 and closing October 22, 2022. The election will be conducted via an
independent third-party vendor to assure security. Results of the election will be announced at the Hawaiʻi-
ANA Business meeting on October 22, 2022.
Arthur L. Davis Publishing Agency, Inc.
Editor and Publisher are not responsible nor liable for editorial or
Hawai’i Nurse is published four times a year, February, May,
August, and November, for the Hawai’i - American Nurses
Association, a constituent member of the American Nurses
Association. Hawai’i Nurse provides a forum for members to
express their opinions. Views expressed are the responsibility of
the authors and are not necessarily those of the members of the
Articles and letters for publication are welcomed by the editorial
committee. Hawai’i-ANA Editorial Committee reserves the right to
accept or reject articles, advertisements, editorials, and letters for
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Address editorial comments and inquiries to the following
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copies are sent to all Hawai’i nurses and posted on the
Hawai’i - American Nurses Association website at hawaii-ana.
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Office at the address above or email firstname.lastname@example.org.
For advertising rates and information, please contact Arthur L.
Davis Publishing Agency, Inc., PO Box 216, Cedar Falls, Iowa
50613, (800) 626-4081, email@example.com. Hawai’i-ANA and
the Arthur L. Davis Publishing Agency, Inc. reserve the right to
reject any advertisement. Responsibility for errors in advertising
is limited to corrections in the next issue or refund of price of
Acceptance of advertising does not imply endorsement or
approval by the Hawai’i - American Nurses Association of
products advertised, the advertisers, or the claims made.
Rejection of an advertisement does not imply a product offered
for advertising is without merit, or that the manufacturer lacks
integrity, or that this association disapproves of the product or
its use. Hawai’i-ANA and the Arthur L. Davis Publishing Agency,
Inc. shall not be held liable for any consequences resulting from
purchase or use of an advertiser’s product. Articles appearing in
this publication express the opinions of the authors; they do not
necessarily reflect views of the staff, board, or membership of
Hawai’i-ANA or those of the national or local associations.
August, September, October 2022 Hawaiʻi Nurse • Page 3
Why I Became a Member...
“It makes me feel like I’m a part of something greater
and actually making a difference in my community
and my profession.”
“I love networking and meeting so many nurses
around the island”
“With a new mentoring program and combined
networking/education events, there is ample opportunity for
nurses in all career stages to connect and grow with others.”
Hawaiʻi-ANA empowers nurses to
advocate for the improvement of the
healthcare system in the communities
where we live and work.
Our purpose is to:
1. advocate for nurses in the
workplace, legislature, and the
2. provide opportunities for
continued education, community
engagement, and promotion of
the nursing profession.
3. build a network of empowered
nurses to inspire change and
improve our healthcare system
“As an active-duty military spouse subject to frequent relocations,
Hawai’i ANA has helped me connect to my local and
interdisciplinary nursing community.”
“It feels great to serve my community”
Page 4 • Hawaiʻi Nurse August, September, October 2022
A Memoir of the 2022 American Nurses Association
(ANA) Membership Assembly by Hawaiʻi-ANA
President-Elect Dr. Nancy Atmospera-Walch
June was a very exciting month for the Hawaiʻi
- American Nurses Association as it is the month
where the three of its Executive Board Members
were excitedly planning their trip to Washington D.C.
to attend the first Face to Face ANA Membership
Assembly post-covid. Talking about covid,
unfortunately, President, Katie Kemp, could not join
Executive Director/Vice-President Dr. Linda Beechinor
and I, as covid got to her on the day we were all
going to fly out!
Upon arrival in Washington D.C. on June 8,
2022, my husband Gerhardt Walch and I invited
Dr. Beechinor and some of my dear friends from
Philippines Nurses Association of American (PNAA)
Metropolitan DC chapter: Dr. Christine Garcia-Pabico
(also Director, Pathway to Excellence Program at
American Nurses Credentialing Center) and her
husband, with Maricon Banzon-Dans (also Assistant
Director, Pathway to Excellence Program at ANCC), to
the prestigious Sulgrave Club. The evening went fast
as everyone had stories to share about their favorite
travel places while enjoying our sumptuous dinner
and a private tour after. What a beautiful beginning
for an exciting visit in the nation’s capital.
(LEFT) ANA President Dr. Ernest Grant with Hawaiʻi-ANA President-Elect Dr. Nancy Atmospera-Walch
(RIGHT) Hawaiʻi-ANA President-Elect Dr. Nancy Atmospera-Walch with Executive Director/
Vice President Dr. Linda Beechinor
The ANA Membership Assembly officially started
on June 9, 2022. Dr. Beechinor and I went down to
the meeting proudly wearing our Lei Poʻo (Haku Leis),
which immediately communicated to all that we are
the Hawaiʻi-ANA representatives. It is amazing how
many praises we received. Thanks to Dr. Beechinor
for hand-carrying them and we were able to wear
them for the entire Convention.
Welcome Remarks from ANA President Dr. Ernest
Grant were followed by a keynote address from U.S.
Congresswoman Lucille Royball-Allard (D-CA).
The power of nursing returns to Washington, DC in force
Jun 10th 2022
For the first time in three years, nurses, students,
and other leaders gathered today in Washington, DC
for ANA Hill Day on June 9, a related event to the ANA
Membership Assembly Meeting June 10-11. They will
bring nursing priorities to meetings with members of
Congress and their staff to build support for federal
legislation addressing workplace violence and burnout,
preventing unnecessary delays in patient care, and
removing barriers to APRN full practice authority.
Nearly 300 participants from across the country
are sharing their perspectives and expertise during
hundreds of scheduled visits on Capitol Hill and virtually.
Before setting out, participants attended a breakfast
briefing, where they learned more about ANA-supported
legislation and were welcomed by ANA President Ernest
J. Grant, PhD, RN, FAAN.
“We are here today to do what nurses do best:
advocate,” Grant said. “The meetings you will take part
in today will forge and strengthen the relationships
with your elected lawmakers and their staff that will
ensure that our voices are heard, and that the nursing
profession is given its well-deserved, hard-earned seat at
the table,” said Grant.
The three key issues that Hill Day attendees are
calling attention to are:
• Improving Seniors’ Timely Access to Care Act
• Full practice authority for Advanced Practice
Registered Nurses (APRNs)
• Valuing the Nursing Workforce – Workplace
Violence Prevention for Health Care and Social
Service Workers Act (4182/H.R. 1195)
Grant participated in the ANA Hill Day version of a
“fireside chat” with U.S. Rep. Lucille Roybal-Allard (D-
CA), the first Mexican-American woman elected to
Congress and co-chair of the Congressional Nursing
Caucus. Roybal-Allard, whose health policy analyst is an
RN, who talked about the need to pass legislation that
would grant full practice authority to APRNs through the
Improving Access to Workers’ Compensation for Injured
Federal Workers Act (H.R. 6087), which would expand
the role of nurse practitioners and physician assistants in
providing services to injured federal workers under the
federal workers’ compensation program. The bill passed
the House in early June and is expected to pass the
Roybal-Allard encouraged RNs to take steps in their
own communities to advocate for patients and the
profession. “Get to know your elected officials and their
staffs at the state and local level. They are the ones who
create the laws and policies that affect your profession.
Offer to help and educate them.”
ANA and its organizational affiliates, comprised largely
of specialty nursing associations, are poised today to
share updates and explore areas for collaboration on key
In a ceremony later Thursday evening, ANA will honor
the recipients of the 2022 President’s and National Awards.
The 2022 ANA Membership Assembly, a meeting of
the association’s governing body, begins Friday, June
10 to address a range of issues, including the impact of
climate change on health, workplace violence, and nurse
staffing, as well as organizational-focused actions.
Stay up to date and join the conversation
For news on ANA Membership Assembly and related
activities, follow us on ANA’s Facebook and Twitter
channels. To follow Hill Day, search #ANAHillDay on
August, September, October 2022 Hawaiʻi Nurse • Page 5
Dr. Beechinor and Dr. Atmospera-Walch then
UBERed to the Capitol for this day called “ANA Hill
Day.” We met with Congressmen Ed Case (D-HI) and
Kaialiʻi Kahele (D-HI) and his Legislative Correspondent,
Kadara Marshall. We were not able to see US Senator
Brian Schatz, but we had a great meeting with his
assistant, Gabrielle Schecter. We also had a virtual
meeting with US Senator Mazie Hironoʻs assistant
Artin Haghshenas. With all of them Dr. Beechinor
and I advocated for their support on three issues:
1) Advanced Practice Registered Nurses (APRNs)
by supporting the removal of burdensome barriers
permanently for all four APRN roles, 2) We requested
their support of removing practice barriers for nurses
and improving access to care, and 3) Improving
Seniors’ Timely Access to Care Act of 2021. In each of
our visits, we showed our Aloha Spirit by gifting them
with our local and delicious shortbread cookies or
macadamia nut chocolates. The best part for us was
being able to eat in the Capitol Cafeteria which had just
opened again to the public.
In the evening of that second day, we attended a
Welcome Reception, and it was a great surprise to see
two very great friends from PNA: Dr. MJ Dia, PNAA
President, representing PNAA as an Organizational
Affiliate, and Dr. Nelson Tuazon, as a member of the
ANA NOMELEC Committee (pictured below)
And here I am as a 1st Attendee for being the
President- Elect of Hawaiʻi-ANA. “Go PNAA SPARK and
The reception was followed by the Presidential
Award Ceremony. This year, President Grant awarded
seven magnanimous nurse leaders, recognizing their
significant contributions to the advancement of ANA’s
strategic activities on behalf of registered nurses and
the nursing profession. This year’s recipients were
honored for their outstanding efforts to advance
inclusivity, promote equity and diversity, and address
the issue of racism in the nursing profession. These
are some of the 2022 recipients:
● Karen Daley, PhD, RN, FAAN, Board
Member, American Nurses Foundation:
During her tenure as ANA President, Dr. Daley
had the vision to leverage the combined
strength of ANA, the American Nurses
Credentialing Center, and the American Nurses
Foundation (the Foundation) to create the
ANA Enterprise. She currently serves on the
Foundation Board, where she helped lead
dramatic growth in annual fundraising to
support research, education, and scholarships.
In addition, Dr. Daley represents the Foundation
on the National Commission to Address Racism
in Nursing, a collaborative of leading nursing
organizations examining the issue of systemic
racism in the profession.
● Rumay Alexander, EdD, RN, FAAN,
Scholar-in-Residence, American Nurses
Dr. Alexander spearheads ANA’s strategic
initiatives surrounding equity, diversity, inclusion
and racism in nursing across education,
practice, policy, and research. She was pivotal
in the launch of the National Commission to
Address Racism in Nursing. She also developed
a new definition of racism to set a foundation
for the work ahead and was instrumental in
the creation of the Commission’s Foundational
Report on Racism in Nursing. Her insightful
guidance informed the path forward for ANA’s
own Racial Reckoning journey.
• Beverly Malone, PhD, RN, FAAN, CEO,
National League for Nursing:
Dr. Malone brings her extensive experience
as a global health care leader, innovator, and
nursing champion to guide initiatives to improve
inclusivity and equity in the nursing profession.
She contributed expert considerations to ANA’s
racial reckoning journey, ensuring that it
focuses on acknowledgement, accountability
and the need for healing in the nursing
profession. Dr. Malone previously served two
terms as ANA president. In 2022, Dr. Malone
was featured as one of 25 outstanding women
for Women’s History Month by Diverse: Issues
in Higher Education.
Memoir continued on page 6
These are the nurses of American Nurses Association state associations at “ANA Hill Day” June 9, 2022, in front of the U.S. Capitol, the meeting place of
the United States Congress and the seat of the legislative branch of the U.S. federal government.
Can you identify the two nurses representing Hawaiʻi-ANA?
Page 6 • Hawaiʻi Nurse August, September, October 2022
Memoir continued from page 5
June 10, 2022 and an all-day meeting, meals, and
more meetings! I found myself thoroughly enjoying the
ANA Assembly and I am grateful that Dr. Beechinor was
with me, a first timer attendee. As a former active ANA
and Hawaiʻi Nurses Association (HNA) Board member
before it separated from ANA, Dr. Beechinor knew many
people. It was exciting as we were meeting the nurses
who want to lead ANA in the next year. The candidates
were impressive and for me, it was hard to decide as
I have not been active in attending the ANA national
conventions; thus, I really did not know the candidates.
But I was lucky as Dr. Beechinor knew a lot of them or
knew someone who knew them as she is a Veteran to
I was invited to the ANA Foundation Leadership Donor
Luncheon and since my husband had another meeting
to attend, Dr. Beechinor took his place. It was a great
event as I learned that the Jeannine Rivet National
Leadership Award was made possible by the United
Health Foundation. It was great as I know the President
of the United Health Care in Hawaii, the business side of
the UHC Foundation, who also was one of the Philippine
Nurses Association of Hawaii Sponsors during its recent
The third day ended with a relaxing by Invitation only
ANA Wes-PAC Reception at their new office PH Roof
Garden: (2 photos below)
Hawaiʻi Flag joined the other Constituent States’ Flag.
Standing in the front and looking around as the 500
attendees were looking at us was just so emotionally
energizing and I knew Dr. Beechinor and I were floating
I also participated in one of the Question and Answer
sessions, and all of a sudden, everyone was wanting to
have a picture with me. Actually, one said, “Can I have
a picture with the Hawaiʻi Celebrity?” I didn’t realize that
my simple statement on Abuse and Workplace Violence
made such an impact on the attendees. I met new and
wonderful people, and I’m looking forward to seeing
them again in the near future.
To add to the emotional day, I was saying GoodBye
to Dr. Grant. I met Dr. Ernest Grant in 2018 and saying
goodbye to him today knowing that he will not be with
us next year, was a very difficult act to do. The love for
him from everyone was palpable in the entire room, and
the farewell presentation from North Carolina ANA was
moving and filled with kind and loving statements.
There was a run off for the Secretarial position, and
even this was effortless. Time to find out who won the
election! I just VOTED & now, we will find out the result.
How wonderful to have the outcome on the same day.
And the WINNERS are:
• President: Jennifer Mensik Kennedy, PhD,
MBA, RN, NEA-BC, FAAN, of the Oregon Nurses
• Secretary: Amanda Oliver, BSN, RN, CCRN, of
ANA – Illinois.
• Directors-at-Large: Edward Briggs, DNP,
MS, APRN, of the Florida Nurses Association;
Jennifer Gil, MSN, RN, of the New Jersey State
• Director-at-Large, Staff Nurse: David Garcia,
MSN, BSN, RN, PCCN, of the Washington State
We got together for this photo with the
Representatives from our Island Constituencies: Virgin
Islands, Hawai’i, and Guam (above).
I was feeling so great, I told Dr. Linda that we were
going out to dinner and celebrate the exemplary ending
of the 2022 ANA Membership Assembly. We had another
delicious dinner at the impressive Private Cosmos Club,
However, going to the Cosmos Club was an ordeal as
the traffic was constipated (literally) due to the PRIDE
Parade. But we tolerated it as the ANA’s success was
The American Nurses Association (ANA) is the Queen
of every Nursing Organization in the world, with its 4.3
million RN members nationally.
The ANA Enterprise has three distinct components
that makes the engine of ANA running efficiently and
smoothly: ANA website
The American Nurses Association (ANA)
The American Nurses Foundation (ANF)
The American Nurses Credentialing Center (ANCC)
During the 2022 ANA Membership Assembly, it
was very visual on how the three organizations work
so independently and yet collaboratively that each
component’s contributions to the ANA Enterprise was
felt, seen, and heard. A very organized and impressive
organization and I am proud but humbled and grateful
that I am a part of this magnanimous organization that
is Making a Difference in this world for the health and
betterment of humanity.
June 12, 2022, Sunday. My elated feeling
continued, so I arranged a last get together Sunday
brunch with more friends from DC/Maryland. I
am so thankful, The Pacific Club has so many
reciprocity club members in DC and yes, we went
to another private club, The Georgetown Club.
My longtime friend, one of my Bridesmaids, and
the Godmother of my daughter, Ann McHale was
able to join us. You may remember her from The
Queen’s Medical Center. And we had one Lei Poʻo
(Haku Lei), for her, which was befitting as we had
a pre-birthday celebration. Her birthday is also our
I have to close this article with joy and gratitude
for the unbelievable experience I had during the
short trip to our nation’s capital. Aloha, until we meet
Saturday, June 11, 2022, which means we are on our
last day of the ANA Membership Assembly 2022. It also
means it is the Voting Day, and Yes, I voted! The voting
process was very impressive and organized, but what
impressed me the most was the neutrality of everyone
helping in the voting process. As I entered the Voting
Room, I was told very nicely to remove the campaign
button of one of the presidential candidates, which I had
placed onto my name tag. So, I have to say it again, that
the last three days have been busy but full of learning
and positive experiences for me as a 1st time attendee.
This was a very memorable day for me, and
Dr. Beechnior as Hawaiʻi-ANA was introduced and
acknowledged as the 51st ANA C/SNA and had our
August, September, October 2022 Hawaiʻi Nurse • Page 7
ANA’s Racial Reckoning Statement
This is a journey.
Throughout our history, the American Nurses
Association (ANA) has sought to lead nursing into the
future. Through acts of omission, when we failed to
act, and commission, when ANA’s actions negatively
impacted nurses of color, we have caused harm and
perpetuated systemic racism. This statement serves
as a starting point for a journey during which we
seek to acknowledge past actions that continue to
impact the profession today and as a starting point
of a new journey toward the future.
ANA begins this journey in conjunction with the
efforts undertaken by the National Commission to
Address Racism in Nursing (the Commission). This
statement focuses on ANA’s own actions, while the
Commission seeks to address racism in nursing
within the broader profession. We recognize that
as a leader, ANA holds accountabilities at both
the organizational and the broader professional
level. Through both efforts, we are striving for a
more inclusive, diverse, and equitable professional
organization and a nursing profession that meets the
needs of all people.
Our intention with this statement is to publicly
identify and acknowledge our past actions while
addressing the harms that continue today. The
section on ANA Reckoning is not meant to be a
complete listing of all ANA actions that have caused
harm. Historical exclusions of and transgressions
against Black nurses will be discussed in this
document. This harm has undoubtedly extended
to all nurses of color. In addition, there is much
debate about labels and terms to identify racialized
minorities. We have chosen to use the term “nurses
of color” to reflect all nurses representing race and
ethnic groups. It is our intention to be fully inclusive
in the use of this language.
In the end, it is our actions that will truly
reflect the sincerity of this apology and serve
as the underpinning for forgiveness. For it is
forgiveness that we seek — forgiveness from
nurses of color, the nursing profession and the
communities that have been harmed by our
actions. We fervently hope that this statement, its
subsequent work and the efforts of the Commission
will contribute to healing — individual healing for
nurses, reconciliation with the ethnic-minority
nurse associations and healing of the profession.
ANA wants this statement to reflect genuine
reconciliation and acknowledgment and hopes that
it is a step toward forgiveness. Ultimately, we seek
to contribute to the healing of nursing.
There is much that can be said about ANA’s
history and failure to include and represent the
views and needs of nurses of color. The examples
below are not to be considered as a complete
reckoning of ANA’s past, but they are representative
of times and actions when ANA failed.
To begin, we must acknowledge that from
1916 until 1964, ANA purposefully, systemically
and systematically excluded Black nurses.
ANA’s predecessor organization, the Nurses’
Associated Alumnae of the United States and
Canada, was open to alumnae associations of
schools of nursing, including Black hospitals and
nurse training schools (Hine, 1989). The Nurses’
Associated Alumnae became the American Nurses
Association, and in 1916, the membership rules
shifted away from an alumnae-based membership
to that of a state- and district-based membership.
This resulted in Black nurses being denied
membership in some state nurses associations.
Despite significant advocacy and pressure from
the National Association of Colored Graduate
Nurses (NACGN), this discrimination persisted.
In 1946, the ANA House of Delegates voted to
adopt a statement that urged the “removal, as
rapidly as possible, of barriers that prevent the
full employment and professional development
of nurses belonging to minority racial groups”
(Carnegie, 1991, p. 76). And in 1948, the ANA
House of Delegates established an “Individual
Membership Category” that was open to all nurses
who were not accepted through a state or district
association. However, it was not until 1964 that a
final district in Louisiana dropped its discriminatory
rule for membership (Carnegie, 1991). This timeline
reflects the failure of ANA leaders to aggressively
pursue changes in its discriminatory membership
rules and allow for full membership regardless
of race. While membership within ANA was hard
fought by NACGN, the full inclusion of Black
nurses within ANA leadership and decision-making
remains unrealized and elusive for all nurses of
One representative incident from 1939 involved
Estelle Massey Riddle Osborne, president of
NACGN from 1934-1939. In 1939, President
Osborne was invited by ANA President Julia C.
Stimson to meet with ANA’s Advisory Council
to discuss the status of Black nurses in the
profession. The site of the meeting was the St.
Charles Hotel in New Orleans, where Black guests
were required to use the service entrance and
freight elevator. President Osborne called on
ANA and President Stimson to adamantly protest
this discrimination. Instead of protesting the
discriminatory policy, President Stimson offered to
enter the hotel with President Osborne through the
service entrance. In the end, President Osborne
decided against attending and ANA failed to step
into a space of advocacy and support (Hine, 1989).
President Osborne was the first Black nurse to
earn a master’s degree in the U.S. and became the
first Black nurse elected to the ANA board in 1948.
However, after her four- year term, there were no
Black nurses elected to the board again until 1970
(Carnegie, 1991). This lack of representation on
the policy level for 22 years concerned many Black
nurses, and when it was brought up at ANA’s 1972
convention, it was communicated that the only
obligation of ANA from the dissolution of NACGN
was the awarding of the Mary Mahoney Award.
In 1965, ANA approved a position paper on
nursing education that recommended the minimum
preparation for “beginning professional nursing
practice should be a baccalaureate degree” (ANA,
1976). The stated rationale for this change was
the increasing complexity of nursing activities and
patient care. One result of ANA taking this position
was the disenfranchisement of institutions and
schools of nursing that were available to students
of color and the exclusion of nurses who graduated
from those programs. ANA sought to advance
the educational level of nurses without ensuring
that all nurses would have the same access to
the education necessary to achieve the desired
educational level for entry into the profession.
There continues to be a need to examine how
this policy advances nursing today and to
examine strategies for ensuring that educational
opportunities are equally available to all students,
especially students of color.
In 1970, Dr. Lauranne Sams organized a meeting
with 200 Black nurses for the primary purpose of
organizing a Black nurse association. The group
reported the following concerns (Carnegie, 1991):
1. Concern over the absence of Black nurses in
leadership positions at ANA.
2. Limited opportunities for Black nurses to support
and shape ANA policies.
3. Persistent tokenism.
4. Limited recognition of Black nurses’ contributions
to the profession.
5. Lack of significant increases in the number of
Black registered nurses.
6. No recognition of achievement with awards (other
than the Mary Mahoney Award).
7. Limited appointments of Black nurses to
committees and commissions.
In 1973, in her first address to the newly created
National Black Nurses Association (NBNA), Dr. Sams
considered the question of why a Black Nurses
Association was needed:
“No, I am speaking about all the past deficits and
discriminatory practice which have continuously
disgraced and limited the full potential, the
development, the selfhood, and the self
determination of Black folk. I am speaking about
today, Here and Now.”
In telling the history of the formation of the
NBNA, the article From Invisibility to Blackness: The
Story of the National Black Nurses’ Association by
Gloria R. Smith notes that there was a desire on
the part of the Nurses’ Associated Alumnae of the
United States and Canada and ANA for Black nurses
to be members, but these professional associations
granted them few privileges “other than paying
dues” (1975, p. 225).
Although by 1964 there were no tangible rules
preventing membership for nurses of color, it
was evident that exclusionary practices and a
failure to represent all nurses remained. Similar
to the concerns raised by Black nurses, in 1974,
led by Dr. Ildaura Murillo- Rhode, a group of 12
Hispanic nurses who were also members of ANA
came together to consider establishing a Hispanic
Nurses Caucus within ANA because “ANA was not
being responsive to the needs of Hispanic nurses”
(National Association of Hispanic Nurses, 2022).
Ultimately, this core group and their organizing
efforts led to the establishment of the National
Association of Hispanic Nurses (NAHN). Today,
“NAHN members advocate, educate, volunteer,
seek partnerships, and conduct programming
in the Latino community to improve outcomes,
elevate literacy, heighten education, and influence
policy. We also work collaboratively with others
to improve health equity and to create a future in
which everyone regardless of race or ethnicity has
opportunities to be healthy.”
ANA recognizes that issues of racism persist
today and continue to harm nurses of color.
Findings from the Commission’s 2021 national
survey on racism in nursing (n = 5,600) noted that
racist acts are principally perpetrated by colleagues
and those in positions of power. Over half of
nurses surveyed (63%) said they had personally
experienced an act of racism in the workplace with
the transgressors being either a peer (66%) or a
manager or supervisor (60%). Fifty-six percent of
respondents also noted that racism in the workplace
has negatively impacted their professional wellbeing.
During listening sessions with nurses of color
convened by ANA and the Commission, persistent
themes of stereotyping, prejudice, discrimination,
exclusion, oppression, tokenism, inequity, and
insistence on conformity and assimilation were
found (National Commission, 2021). The impact of
these experiences is demoralization, exhaustion,
spirit murder (murder of the soul), invisible
workload, silence, invisibility and self-doubt.
“The power in nursing is primarily held by middleage
to old-age white women who have just
recently begun to consider racism in nursing
care. There are racist principles that have
been carried down through history and never
(Anonymous Quote, National Commission to
Address Racism in Nursing, 2021)
As leaders of ANA, we apologize for the named
and the unaccounted-for harms. Our past actions
have caused irreparable physiological, psychological
and socioeconomic harm, not only to nurses of
color but to all patients, families and communities
that depend on ANA as the national leader of the
nursing profession. We failed to live up to the
professional values established through the Code
of Ethics for Nurses (ANA, 2015) and our social
contract that guides the relationship between the
Racial Reckoning Statement continued on page 8
Page 8 • Hawaiʻi Nurse August, September, October 2022
Racial Reckoning Statement continued from page 7
nursing profession and society and their reciprocal expectations (ANA, 2010).
In addition, as ANA sought to “professionalize” nursing, we failed to support a
robust education approach that included the appropriate preparation to care
for ALL our patients, especially patients of color.
More specifically, we apologize to all nurses of color. Not only is the
profession richer for your having persisted, but the people you cared for and
continue to care for today have been better served. ANA failed to uphold your
work and support you as you advanced in nursing and worked to improve the
profession. Having failed you, ANA also failed in supporting and caring for
communities of color and other marginalized people.
We apologize to the ethnic-minority nurse associations that have ably
represented the needs of their nurses and communities. Early in the
profession’s history, there was a stated desire for one association to meet
the needs of all nurses. ANA only represented the needs of some nurses and
some patients. Nurse leaders of color stepped into the breach. ANA’s failure
to lead resulted in a fragmentation of the profession that contributed to a
fragmentation in nursing care for minoritized communities.
As important as it is to reconcile ANA’s history, our path points toward
the future and actions that should be taken as a means of holding ANA
accountable, continuing reconciliation to repair the breach and becoming a
restored association. Each of the actions below will lead to additional actions
and efforts as ANA continues the journey.
Therefore, the ANA Board of Directors will:
• Continue to reckon with and apologize for past harms that are made
known to ANA.
• Engage in direct reconciliation with each of the ethnic-minority nurse
• Develop and implement a diversity, equity and inclusion impact analysis
that is considered in all policies and positions of the association.
• Initiate an oral history project dedicated to amplifying the contributions
by nurses of color to ANA and the nursing professions.
Therefore, the American Nurses Association will:
• Continue to serve as a partner in and support the National Commission
to Address Racism in Nursing as it strives to create antiracist practices
• Advocate for and follow established guidance on the reporting of race
and ethnicity in professional journals and publications.
• Advocate for appropriate representation and inclusion in textbooks and
other educational material.
• Actively engage in a program of diversity, equity and inclusion within the
• Provide transparency into the race and ethnic makeup of the ANA Board
of Directors, leadership and staff.
• Deliberately work to build diversity within ANA’s volunteer and
We, as ANA, are on a journey — a journey of reckoning and reconciliation,
forgiveness, and healing. This journey will take some time, but it is one
that ANA is fully committed to. We invite others to join us as ANA seeks to
strengthen who we are as a professional association and the broader nursing
profession through inclusion, diversity and equity as we strive for antiracist
nursing practices and environments.
“As nurses we need to unlearn much of what we thought we knew about
racism — and get comfortable being uncomfortable about our profession
and our own way of being — need to see nursing through a new lens and
be open to what we might see versus stating that racism does not exist.”
(Anonymous Quote, National Commission to Address Racism in Nursing, 2021)
American Nurses Association. (2015). Code of ethics for nurses with interpretive
statements. American Nurses Association.
American Nurses Association. (2010). Nursing’s social policy statement: The essence
of the profession. American Nurses Association.
American Nurses Association. (1976). One strong voice: The story of the American
Nurses Association. American Nurses Association.
Carnegie, M.E. (1991). The path we tread: Blacks in nursing, 1854-1990. National
League for Nursing Press.
Hine, D.C. (1989). Black women in white: Racial conflict and cooperation in the
nursing profession 1890–1950. Indiana University Press.
National Association of Hispanic Nurses. (2021). History. https://www.nahnnet.org/history.
National Commission to Address Racism in Nursing. (2021). Defining Racism. finaldefining-racism-june-2021.pdf
National Commission to Address Racism in Nursing. (2021). Summary Report:
Listening Sessions on Racism in Nursing. final-racism-in-nursing-listeningsession-report-june-2021.pdf
National Commission to Address Racism in Nursing. (2022). Survey Shows Substantial
Racism in Nursing. (nursingworld.org).
Sams, L. (1973, September). Presidential Address. National Black Nurses Association.
Smith, G.R. (1975). From invisibility to blackness: The story of the National Black
Nurses Association. Nursing Outlook, 23(4), 225-229.
ANA Acts on Climate Change and Key Nursing Issues
Jun 14th 2022
Shannon McClendon, firstname.lastname@example.org
Keziah Proctor, email@example.com
SILVER SPRING, MD – The representatives of ANA’s Membership Assembly,
the governing and official voting body of the American Nurses Association
(ANA) have acted on compelling and critical issues that greatly impact the
nursing profession and the health of global populations. More than 300 nurses,
observers, and other leaders attended a two-day governance meeting in
Washington, DC, June 10-11. Eligible representatives elected national leaders
including the next national president and acted on nurse staffing, verbal abuse
and workplace violence, and climate change.
• Nurse staffing: Recognizing that the COVID-19 pandemic has exacerbated
long-standing nurse staffing issues, the Assembly considered changes to
existing ANA policy related to nurse-to-patient ratios. Participants stressed
the need for enforceable staffing standards and shared their successes
and challenges in implementing various models. Assembly representatives
approved a recommendation that ANA supports safe patient standards
including ratios that are acuity and setting-specific as per nursing
assessment and enforceable, and that ANA will engage with its constituent
and state nurse associations (C/SNAs) to develop further details regarding
standards, implementation, and enforcement. Assembly representatives
also called on ANA to collaborate with organizational affiliates and C/
SNAs to begin to develop evidence-based staffing standards for all nursing
disciplines for publication.
• Addressing verbal abuse and workplace violence: Often, healthcare
stakeholders’ approach to workplace violence (WPV) in health care
focuses on responses to, and prevention of, physical assaults in hospitals.
Discussions often overlook verbal abuse, which can be a risk factor for
physical violence. In addition, practice and policy recommendations
developed for inpatient settings may not be appropriate for or helpful in
community settings, such as schools, community health centers, public
health facilities, and similar places where WPV can occur. Assembly
representatives called on ANA to engage key stakeholders to identify,
develop and advance strategies resulting in a comprehensive culture of
safety and zero-tolerance approach to verbal abuse and violence in all
care settings, advance workplace violence prevention priorities in nursing
practice and public policy, and advocate for better data collection to inform
• Impact of climate change on health: Citing statements from
International Council of Nurses, the World Health Organization, and the
American Academy of Nursing, along with editorials from several health care
journals on the danger of climate change on global health, representatives
proposed that ANA, as the leading nursing organization, should take a
strong leadership position in addressing the impacts of climate change on
human and population health and help prepare nurses to engage patients in
conversations about climate change and its health impacts; impacts which
disproportionately affect the most vulnerable populations. To help address
the public health crisis caused by climate change, Assembly representatives
approved the recommendation that ANA, C/SNAs and individual member
division (IMD) include climate crisis and its consequential impact on human
and population health as an essential component of their policy platform.
Voting representatives also endorsed that ANA revise and establish as an
official position the 2008 House of Delegates Statement on Global Climate
Change and Human Health. Finally, the representatives called on ANA, C/
SNAs and the IMD to promote nursing knowledge on the relationship
between climate change and human and population health.
# # #
The American Nurses Association (ANA) is the premier organization representing
the interests of the nation’s 4.3 million registered nurses. ANA advances the
profession by fostering high standards of nursing practice, promoting a safe
and ethical work environment, bolstering the health and wellness of nurses, and
advocating on health care issues that affect nurses and the public. ANA is at the
forefront of improving the quality of health care for all. For more information,
August, September, October 2022 Hawaiʻi Nurse • Page 9
STUDENT NURSES PAGE
Hawaiʻi Student Nurses Association (HSNA) is a
member of the National Student Nurses Association
HISNA has six chapters in these Hawaiʻi
undergraduate nursing programs:
- Chaminade University of Honolulu
- Hawaiʻi Pacific University
- Nancy Atmospera-Walch School of Nursing
(NAWSON) at UH Manoa
- University of Hawaiʻi Hilo
- University of Hawaiʻi Maui College
- University of Hawaiʻi Kapiʻolani Community College
Are you an undergraduate nursing student but not
a member of Hawaiʻi Student Nurses Association?
Join HISNA Today!
*If your school does not have a chapter of HISNA, please
contact Linda Beechinor, Executive Director at Hawaiʻi-
ANA for assistance (firstname.lastname@example.org or
text/call (808) 779-3001.
All student nurses in Hawai’i can become Student
Subscribers to American Nurses Association for FREE
Join Hawai’i-ANA as a Student Subscriber
These Student Nurses in Hawai’i are
ANA Student Subscribers:
Amanda Lauren Barlan
Joda P. Derrickson
Sheila Mae Cabasag
John Eharis III
Hawaiʻi-ANA respects the insights and contributions of students as the nurse leaders of tomorrow.
We’re here to support you in your journey, every step of the way. There’s no need to wait for
licensure to start benefiting from Hawaiʻi-ANA and ANA – as a Student Subscriber, you’re ahead of
the game with access to:
Welcome to the Profession Kit
The Welcome to The Profession Kit is a comprehensive collection of digital resources created
specifically for you by fellow health professionals who have been in your position.
Developed especially for new nursing graduates and early career nurses, this digital kit is an
online resource hub designed to help you find your first job, enhance your employability, and
grow your nursing career.
Exclusive Online Student Community
Join a vibrant online community where thousands of nursing students just like you are navigating
nursing school and facing similar challenges. As a Student Subscriber, you have exclusive access to
the student community which offers a unique experience built on networking, sharing, and trust.
As a Student Subscriber, you’ll enjoy access to member-only digital content on nursingworld.
org. Additionally, you’ll have access to the full suite of ANA digital publications such as American
Nurse Today and ANA SmartBrief. As well as full ANA Position and Policy papers on important
nursing issues, such as safe patient handling and the opioid epidemic.
Advocacy Alerts and ANA’s Legislative Blog
When nurses speak, Washington listens! As the premier organization for all RNs, ANA brings
nurses together to advance their careers and the profession through legislation and advocacy.
Get involved to learn the key issues facing nurses right now. Also get access to ANA’s advocacy
Access to Resources
For example, the vital Code of Ethics for Nurses, the ANA Career Center, and The Healthy Nurse, and
Healthy Nation Grand Challenge.
In addition, Hawaiʻi-ANA offers
o this monthly newsletter “The Hawaiʻi Nurse” that goes out to over 9000 nurses in Hawaiʻi, and you
can receive it as a student subscriber!
o to connect nurses and nursing students in Hawaiʻi, to address state and national issues of interest
to our profession
o this Student Nurse Page: dedicated to student issues
o opportunity to publish student papers: we solicit scholarly papers quarterly for publication and
distribution throughout Hawaiʻi
o attendance and participation in Hawaiʻi-ANA Board meetings, annual events during Nurses’ Week,
annual Membership Assembly, and other volunteer community activities that include networking and
continuing education programs throughout Hawaiʻi.
Lyka Faye Dumbrigue
John Jacob Ferrer
Menierva Lynn Lagundi
Page 10 • Hawaiʻi Nurse August, September, October 2022
BE PROUD OF YOUR MEMBERSHIP IN YOUR STATE PROFESSIONAL ASSOCIATION.
If your name is here, you enjoy the benefits of joint membership with ANA and Hawaiʻi-ANA, with 343 other RNs in Hawaiʻi.
If your name is here you can vote in Hawaiʻi-ANA Elections in October, 2022.
JOIN HAWAIʻI-ANA if your name is NOT here.
Patricia W. Nishimoto
Marion F. Poirier
Mary G. Boland
Jennifer O. Galicinao
Shelley Ann Repercio
Mary Frances Oneha
Kirsten Fisher (nee Bennet)
Ma. Lourdes Brexy Abara
Christian Joseph Gaerlan
Shelly Lynne Jaynes
Maria Fe McGehee
Emily Levitt -gopie
Daryle Ann Ho
August, September, October 2022 Hawaiʻi Nurse • Page 11
HAWAI’I-ANA MEMBERSHIP (continued)
Hawai’i-ANA Members continued from page 9
Deborah Michiko Fried
Pola Isabelle Bonete
Rica Lorraine Rabanal
Erin Von Der Ahe
Cassie Ann Claveria
Elvie Marie Quemado
Paula Nichaelle Aquino
Welcoming 24 New
Members of Hawaiʻi-ANA,
between 05/10/2022 and
Daryle Ann Ho
Amy J Lee
Nancy Manali-Leonardo Honolulu
Dulce Gonzalez Melgar Honolulu
Louisse Gayle Aque
Krystel Anne Ordonez
Meryl Kate Rebamonte Honolulu
Celestia Parsons Yellowstone National
Janine Jessica Aguinaldo Waipahu
Danette Butterfield Ewa Beach
Attend Hawaiʻi-ANA Board and Committee Meetings:
all members are welcome to attend. Introduce yourself
and learn about the many opportunities available to you
as a member of Hawaiʻi-ANA.
Log into our webpage under
Upcoming Events at Events Page
Click on the Meeting of your choice to register for the
event and acquire the zoom link, such as the next
Board of Directors Meeting:
Saturday, September 10, 2022 at 9:00am HT
Committees you can participate in:
- Advocacy Committee
(policy/legislative & coalitions)
- Student Nurses Committee
- Mentorship Committee
(new graduates, senior students,
- Events Planning Committee
- Marketing Committee (website,
social media, newsletter, advertising)
- Districts & Membership Engagement
Committee (DME: works with Student
Nurses Committee to link Schools of
Nursing in each District)
- Continuing Education Planning
- Finance Committee
Contact Linda @ email@example.com or text/
call (808)779-3001 for assistance with any networking
Philip Higgins Weimer
Justin Ager Tabbay
Maria Lourdes Akagi
Kamomilani Anduha Wong
Dolores Soler Bergau
Maria Moreno Chow
Leslie Ann Yanagihara
Deborah Virginia Lichota
Page 12 • Hawaiʻi Nurse August, September, October 2022
If your name is on this list of 93 RNs, you are a member of ANA-Only, and you are not a member of your state nurses
association at Hawaiʻi-ANA. As a member of ANA-Only you cannot vote in elections or represent Hawaiʻi-ANA.
Want to join Hawaiʻi-ANA jointly with ANA? Just email Linda at firstname.lastname@example.org and say you
“want to be a joint member of ANA and Hawaiʻi-ANA.” We will help you (bonus: it is less $$!).
Joint membership with ANA and Hawaiʻi-ANA
costs $15 a month or $180 annually
and provides these benefits:
Elizabeth L. Asahara
Free Navigate Nursing webinars with FREE CE
Merita Sao Auelua
Save $100 on ANCC certification (initial or renewal)
ANA Community of members-only online discussion groups
Manuel Calupe Jr
Clementina D. Ceria
Advocacy to strengthen nursing’s voice
Opportunities to network with over 240,000 ANA members
Mae Kimberly Corpuz
American Nurse journal
OJIN - The Online Journal of Issues in Nursing & ANA SmartBrief
ANA Mentorship Program
Discounts on ANA books, professional development resources, and CE
Belinda A. Dungca
Jolly Anne Uclaray
Professional tools such as CINAHL, PubMed Citations,
and the Global Disease Alert map
Cherry Elaine Medina
Personal Benefits - Professional Liability Insurance (NSO)
Personal Benefits - Term Life and AD&D (Prudential)
Eden S. Goto
Susan Von Essen
Personal Benefits - Student Loan Solutions (Laurel Road)
Personal Benefits - Financial Wellness (Prudential)
Linda M. Hamada
Personal Benefits - Travel Discounts (BookingCommunity)
Shelley A. Womack
Personal Benefits - Long Term Care Insurance (Mutual of Omaha)
Ralf Ian Pasion
ANA Career Center access
Beverly M. Hookano
Melanie C. Pekala
Want to join Hawaiʻi-ANA jointly with ANA? Just email Linda at email@example.com and say you
“want to be a joint member of ANA and Hawaiʻi-ANA.”
August, September, October 2022 Hawaiʻi Nurse • Page 13
The New Graduate RN Workforce Report
ANSWERS TO FREQUENTLY ASKED NEW GRADUATE RN QUESTIONS
The New Graduate RN Workforce Report on the Hawai’i State Center for Nursing’s
website Released April, 2022.
To subscribe to Hawaiʻi State Center for Nursing (HSCN) newsletters: click here.
How many New Grads are in Hawai‘i’s
Workforce and Where Do They Work?
We estimate that as of July 2021, there were
approximately 15,070 RNs employed in a variety of
roles throughout Hawai‘i (Hawai‘i State Center for
Nursing, 2021a). Of these, 11% were new graduates.
Why is this information important to you?
“The Center’s strategic plan through 2023 places emphasis on research as a vehicle
through which the Center will be data-driven and evidence-based in its decision-making
• program development, revision, and implementation;
• participation in statewide initiatives related to nursing and healthcare workforce
• support of public policy with implications for the practice of nursing.”
Hawaiʻi State Center for Nursing (2022, April 29). Workforce Reports. Retrieved from
New graduates are not equally likely to work in all
settings. When we examine the composition of the
RN workforce in each of five major types of practice
settings, we find that new graduates account for
nearly 20% of the workforce in post-acute/longterm
care settings but 10% or less of the workforce
in any other setting. Similarly, when we examine
the distribution of RNs’ employment setting by their
new graduate status, we find that new graduates
are notably more likely to work in post-acute/longterm
care settings and less likely to work in acute
care hospitals than non- new graduate RNs. Taken
together, these data indicate that new graduates are
overrepresented in post-acute/long-term care settings.
Report continued on page 14
Page 14 • Hawaiʻi Nurse August, September, October 2022
Report continued from page 13
What’s the Educational Background of the
New Grad Workforce?
A prevailing belief about the new graduate RN
workforce is that Hawai‘i’s schools of nursing are the
primary contributors of new graduates to the local
workforce. Our current Supply Survey data validate
this belief. Nearly 75% of the new graduate RNs
currently working Hawai‘i received their initial nursing
education from a local school.
The current statewide nursing shortage (Hawai‘i
State Center for Nursing, 2021d) warrants renewed
focus on addressing the barriers that limit in-state
schools’ ability to expand enrollment in their prelicensure
RN programs and graduate enough new
nurses to meet workforce demand. We have written
several times over the last four years that the two
primary constraints on local schools’ capacity to
educate new nurses are the nursing faculty shortage,
especially for University of Hawai‘i System schools,
and a limited supply of curriculum-appropriate clinical
placements. If these crucial resources continue to
be limited, we are concerned that local schools will
be unable to sustain the RN workforce, especially as
the number of people in the population with greater
healthcare needs grows, such as kūpuna and people
with long-lasting effects of COVID-19.
Despite being affected by constrained resources,
Hawai‘i’s in-state schools of nursing graduated an
average of about 430 new prospective RNs from ADN,
BSN, and GEPN programs each year between 2018
and 2020 (Hawai‘i State Center for Nursing, 2022b).
Students from BSN or GEPN programs account for
69% of these new graduates. This is consistent with
the 71% of new graduate RNs who told us on our
Supply Survey that they were initially educated in a
BSN or GEPN program. The high proportion of new
graduates entering practice with a BSN or graduate
degree has contributed to Hawai‘i having one of the
most highly educated RN workforces in the country
since 2017 (Campaign for Action, 2019).
To access electronic copies of the
Hawai’i Nurse, please visit
How Long Does It Take for New Grads to Enter
One of the most important issues for employers,
schools, and new graduates is how long it takes
new graduates to enter the workforce after
graduation. While the job market is the primary
driver of new graduates’ time to initial employment,
having difficulty scheduling or passing the NCLEX-
RN or lengthy license application review times can
also delay new graduates’ initial job attainment. To
address this possibility, we asked new graduates
how long it took them to get licensed after
More than 40% of new graduates reported that
they were licensed less than three months after
they graduated. Within six months of graduation,
more than 80% of new graduates had licenses
in-hand. These data suggest that there are no
significant barriers keeping new graduates from
getting their licenses and becoming eligible to
enter practice quickly after graduation. Without
barriers to licensure, employers can expect an
influx of new graduates to the workforce twice
per year in March and August, about three
months after December and May graduations,
We also asked new graduates to report
how long after graduation it took them to get
their first nursing jobs. By three months after
graduation, 36% of new graduates were working
in their first nursing job. By six months after
graduation, 65% of new graduates had entered
the nursing workforce.
The amount of time it took new graduate RNs
to enter the workforce varied considerably by their
initial employment setting. New graduates whose
first jobs were in non-acute settings had a shorter
time to initial employment than those whose
first jobs were in hospitals. The majority of new
graduates whose first jobs were in post-acute/longterm
care (74%), ambulatory (82%), or home health/
hospice settings (88%) were employed within six
months after graduation. In contrast, 54% of new
graduates who took their first jobs in hospitals were
working within six months of graduating. Almost 20%
of new graduates whose initial nursing jobs were in
hospitals took a year or longer to enter the nursing
Why Aren’t There Jobs for New Grads in Hawai‘i?
Strong competition for new graduate jobs in
acute care sometimes creates the impression that
the job market in Hawai‘i is inhospitable to new
graduates. In reality, there are ample opportunities
for new graduates to get to work quickly, though
those opportunities may not exist in hospitals.
New graduates who went to work in home
health had the shortest time to initial employment;
75% of new graduates in home health were in
the workforce within three months of graduating.
Among new graduates who chose jobs in postacute/long-term
care or ambulatory settings, about
40% were in the workforce less than three months
These data demonstrate that local new graduates
can get hired in Hawai‘i within a few months of
graduation if they are willing to take their first jobs
in non-acute care settings. Despite most non-acute
settings offering a faster path to initial employment,
hospitals are the most in-demand setting for new
graduates’ first jobs. Hospitals have fewer jobs to
offer than there are new graduates who want them,
a fact which is sometimes interpreted as hospitals
not wanting to hire new graduates. We address that
interpretation in the next section.
Why Don’t Hospitals Want to Hire New
Among graduates from nursing schools in Hawai‘i,
75% indicated that they wanted their first employment
setting to be in a hospital. In contrast, only 31% of
new graduates reported that they actually obtained
employment in a hospital following graduation. This
corresponds to the share of new graduates that
hospitals in the Hawai‘i NRP (HNRP) Collaborative
reported hiring. Between 2018 and 2021, hospitals
that were members of the HNRP hired an average
of about 90 new graduates each year (Hawai‘i State
Center for Nursing, 2021c). If we estimate that
hospitals that were not members of the HNRP hired
another 30 nurses annually, then hospitals hired about
31% of the 400 new graduates who completed ADN or
BSN programs each year during the same time frame.
August, September, October 2022 Hawaiʻi Nurse • Page 15
Hospitals’ willingness and ability to hire new
graduates varies as a function of several factors such
as the availability of resources to provide transition
to practice support, relative need for generalists vs.
specialty RNs (which new graduates are not), and
relative demand for nurses vs. other types of nonnursing
health professionals. Though these and other
factors influence the acute care new graduate RN
job market, we argue that the single most influential
factor driving hospitals’ limited hiring of new graduates
is that hospitals employ a smaller share of the entire
RN workforce as compared to 15 years ago.
As models of healthcare emphasize disease
prevention, health maintenance, and aging-in-place,
demand for nurses in ambulatory and home health
settings has increased. Simultaneously, the average
patient length of stay in hospitals has become
shorter which has increased demand for nurses in
post-acute/long-term care settings and created a
corresponding decrease in the share of nurses that
work in hospitals. According to historical Supply
Survey data, the proportion of the total RN workforce
that reported a primary employment setting in a
hospital decreased from 62% in 2007 to 42% in
2021. As more nursing care is delivered in nonacute
settings, hospitals employ less of the total
RN workforce, and by extension, less of the new
A good question may be why do so many new
graduates want to work in hospitals as compared
to other settings? There are some good reasons for
this, such as:
• Most of nursing students’ clinical hours are
conducted in hospitals. This promotes new
graduates’ familiarity with hospitals as a
practice setting and (erroneously) establishes
an expectation that most nursing practice
happens in hospitals.
• The patient load for nurses employed in
hospitals is generally much smaller than that of
nurses who work in most post-acute/long-term
care settings. Having fewer patients to care for
during any given shift makes for a less stressful
and more manageable practice environment,
especially for new nurses.
• Hospitals are more likely than other settings to
offer new graduate NRPs which help to ease
new graduates’ initial transition into practice.
Nurses who complete a new graduate NRP are
more likely to remain in their jobs for at least
a year than nurses who do not receive formal
transition to practice support.
• Nurses who work in hospitals are paid more per
year on average than nurses who work in other
settings, sometimes by an extraordinary margin
(Hawai‘i State Center for Nursing, 2022a).
While some of these advantages are unique to
acute care and cannot easily be replicated in other
settings, it is important for non-acute employers to
recognize the specific advantages that hospitals
have in the new graduate job market. If non-acute
employers can implement programs or initiatives that
can increase the desirability of their own settings,
then they can draw some of the new graduate
employment demand away from hospitals. Doing so
would benefit new graduates and employers in all
settings over the status quo.
Before we close this section, we want to note
that hospital hiring has been unusually high in 2021
and 2022. Members of the HNRP hired nearly 290
new graduates for the 2021-2022 NRP year, most of
whom were hired by hospitals. This is the largest
number of new graduates hired by HNRP facilities
in a single year since at least 2015 (Hawai‘i State
Center for Nursing, 2021c). The recent spike in
hospitals’ hiring of new graduates is in response to
a statewide nursing shortage stemming largely from
the COVID-19 pandemic.
As a result, we expect that future Supply Survey
data will reflect a higher proportion of new graduate
hires into acute care than the historical data would
How Many Local New Grads Has Hawai‘i Lost to
Out of State Jobs?
When our stakeholders express their concern
about the local job market being unfriendly to
new graduates, we are often asked to quantify the
number of local graduates who have left the islands
for jobs in other states or countries. Unfortunately,
we do not have the data necessary to answer this
The major limitation of our Supply Survey is that
nurses complete it when they renew their Hawai‘i
nursing license. If a graduate from a local school
never got a Hawai‘i license or decided not to renew
a Hawai‘i license because they started working in
another state, they do not have access to our Supply
Survey. Additionally, in 2021, we had an unusually
low response rate as compared to prior survey years
(Hawai‘i State Center for Nursing, 2021b). Ordinarily,
our sample is large enough that we have enough
data to compare local graduates who left the state
to those who stayed in Hawai‘i. Those comparisons
do not provide a definitive estimate of the number
of local graduates who have left the state, but we
can formulate a profile of them so we can better
understand their decision to leave. The unusually
small sample size in the 2021 study prevented us
from being able to make those comparisons this year.
Though we do not have the data we need to
develop a profile of the local new graduates who
left the state this year, we did have enough data in
2019. We provided a thorough discussion of what we
knew about the local nurses who left the state in our
Education Capacity Report for Academic Year 2018-
2019 (Hawai‘i State Center for Nursing, 2020, pp.
22–26). Two findings from that report are especially
First, in 2019 about 90% of local new graduates
reported a primary residential location in Hawai‘i.
If we extrapolate that proportion to the number of
new graduates from in-state schools, Hawai‘i loses
about 40 prospective RNs to other states or countries
annually. Whether the loss of 40 new graduates
is cause for alarm is a matter of perspective, but it
is the case that most of our local graduates remain
in Hawai‘i. Second, local new graduates who left
the state were much more likely to be employed in
hospitals as compared to new graduates who stayed
in Hawai‘i. These data suggest that new graduates
who had a non-negotiable preference to work in
acute care were willing to take jobs out of state
rather than delaying their entry to the workforce
as did many of their counterparts who remained in
Do Most New Grads Receive Formal Transition
to Practice Support?
NRPs provide new graduate nurses with formalized
support, mentorship, and education during their
transition from their role as student to their role as
practicing clinicians. As a result, NRPs are widely
regarded as playing an important role in increasing
first- and second-year retention rates for new
In 2021, less than 30% of new graduate RNs
reported that they had either completed or were
currently participating in an NRP. The low overall
rate of NRP participation among new graduates
is explained by the absence of formal NRPs in
non-acute settings. As of October 2021, all of the
members of the HNRP Collaborative were acute
care hospitals (Hawai‘i State Center for Nursing,
2021c). While the Center has worked with postacute/long-term
care to identify and reduce barriers
to implementing NRPs, formal new graduate RN
residencies remain largely a resource provided by
hospitals. As a result, 60% new graduates whose
first or current nursing jobs were in hospitals were
more likely to have completed or currently be
enrolled in an NRP. In contrast, only 6% of RNs
whose first or current jobs were in non-acute
settings have participated in an NRP.
Are Most New Grads Likely to Leave Their Jobs?
Much of the interest in establishing new graduate
NRPs stems from concerns over high rates of firstyear
attrition. Because the transition from student to
nurse is challenging, in the absence of formal support
many new graduates find the nursing profession
overwhelming. Many leave their first employers
within a year in search of more support. In the
worst cases, some new graduates leave the nursing
Report continued on page 16
Page 16 • Hawaiʻi Nurse August, September, October 2022
Report continued from page 15
profession altogether. Because of the high rate at
which new graduates in Hawai‘i are employed in nonacute
settings that do not have formal NRPs, we are
interested in whether an unusually high proportion
of new graduates are contemplating leaving their
Another worrisome finding is that new graduate
nurses’ intention to leave their current position
varies markedly by their primary practice setting.
Specifically, new graduates employed in postacute/long-term
care settings were much more
likely than nurses in any other setting to have
plans to leave their current jobs within a year. In
contrast, new graduates working in acute care
hospitals were more likely than nurses in any other
setting to indicate having plans to remain in their
Though we do not have the data to test a causal
relationship between NRPs and new graduates’
intention to stay in their current jobs, our data do
suggest that the statewide workforce would likely
benefit from an expansion of NRPs into post-acute/
long-term care settings.
Are New Grads More Diverse & Representative
than More Experienced Nurses?
As compared to nurses who graduated prior
to 2017, new graduate RNs are more likely to be
men, of mixed ethnic ancestry, Native Hawaiian,
or Hispanic/Latinx, but by small margins. Despite
small and important improvements, men and
Native Hawaiians continue to be substantially
underrepresented compared to the residential
population of the state.
We asked nurses to report how likely they were to
leave their current positions within the next 12 months
(equivalent to the middle of 2022). In comparison to
the rest of the RN workforce, new graduate RNs
expressed less optimism and more uncertainty about
their career intentions for the next year. While more
than 60% of experienced RNs reported that they were
likely or very likely to stay in their current job through
the middle of this year, fewer than 45% of new
graduates reported the same.
Perhaps the most alarming finding related to new
graduates’ 12-month plans was that 33% of all new
graduates were uncertain of whether they would
remain in their current role for the next year. New
graduates’ lack of certainty about changing jobs
creates a challenge for employers who are unable to
plan for turnover that they do not know is coming.