Report Title:

Nurse Shortage; Review and Training for Examination


Re-establishes a two-year Operation Nightingale program to help nurses review for state board of nursing examination to address shortage of nurses.


H.B. NO.









relating to nursing.



SECTION 1. The legislature finds that the recent nurses' strike at major hospitals on Oahu underscores the critical need for nurses and the fact that they are in short supply. The State experienced a similar problem in the 1980s and successfully implemented a pilot project named Operation Nightingale through Act 212, Session Laws of Hawaii 1988, to remedy the situation. Originally intended to run for two years, the program was extended through fiscal year 1994-1995 by Act 237, Session Laws of Hawaii 1991.

The reasoning that applied in the 1980s for the pilot program still applies today. Insufficient staffing together with increased patient acuity and occupancy has a detrimental effect on the quality of nursing care. Long working hours for existing nurses affect their stamina and performance. Hospitals have found it necessary to ask nurses to work overtime and to recruit short-term contract nurses from the mainland. Such actions translate to increased medical care costs and a lowering of the quality of care for the people of Hawaii.

There is again a need for a program that would immediately increase the number of licensed nurses in the State. There are many graduate nurses in Hawaii working as licensed practical nurses, nurses aids, ward clerks, doctor’s secretaries, and other similar nursing related work, who have not yet passed the written examination required by the state board of nursing. The time demands of their occupations and other socioeconomic pressures prevent them from otherwise being able to prepare adequately for the licensing examination. With some concerted assistance from the private sector and the State, these graduate nurses may be able to pass the written examination and become licensed nurses.

The legislature therefore finds that it is desirable to re-establish a program of tested effectiveness designed to improve test taking skills of graduate nurses to enable them successfully to pass the required written examination.

The purpose of this Act is to re-establish Operation Nightingale to be operated by the department of health, which shall include the provision of classroom facilities, books and review material, instructors, and any other equipment and personnel necessary for and accessory to the program.

SECTION 2. Nursing license examination preparation program; established. (a) There is established within the department of health a two-year program to be called "Operation Nightingale", the purpose of which shall be to design and operate review and training courses to enable graduates of nursing schools to pass the written examination required by the state board of nursing.

(b) Review and training courses shall be held for four to six months and shall commence six months prior to the dates that the nursing license examination is to be offered.

(c) The department of health shall provide or contract for the provision of review and training courses for:

(1) Registered nurses who have not recently been employed as nurses to facilitate their return to active participation in the nursing profession;

(2) Graduates of nursing school preparing for the examination required by the state board of nursing; and

(3) Graduates of foreign nursing schools preparing for the examination required by the state board of nursing.

The department of health shall develop or contract for the development of refresher courses and specialty programs for nurses wishing to work in shortage areas such as obstetrics, surgery, intensive care, and emergency room care.

(d) These programs shall provide instruction to qualified individuals. Classes may be provided at times that the director of health finds necessary, including evenings or weekends. The duration of each course may be tailored to meet the needs of the community as well as the needs of health care providers. Classes may be held at those sites the department of health deems appropriate.

(e) The department of health shall establish requirements and procedures for the selection of candidates for the program and for appeal by candidates not selected for the program.

(f) Candidate selection and an appeals process for candidates not selected shall be conducted by a committee consisting of the director of health or a designated representative, the president of the University of Hawaii or a designated representative, a representative of the Hawaii nurses association, and a representative selected by the director of health from each of the medical facilities participating in the program. Any vacancy on the committee shall be filled in the same manner in which the original position was filled. Members of the committee shall serve without compensation but shall be reimbursed for necessary expenses incurred in the performance of their duties.

SECTION 3. Duration of program; reporting requirement. The Operation Nightingale program shall operate for two years. The department of health shall submit to the legislature not less than twenty days prior to the convening of the regular sessions of 2004 and 2005, a report of the performance of the program and any other matter that may be relevant to the implementation of this Act.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $200,000, or so much thereof as may be necessary for fiscal year 2003-2004, and the sum of $200,000, or so much thereof as may be necessary for fiscal year 2004-2005, for the implementation of Operation Nightingale, as established in section 2.

SECTION 5. The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 6. This Act shall take effect upon its approval, except that sections 4 and 5 shall take effect on July 1, 2003.