Hawai'i faces a looming crisis in healthcare because of a shortage of nurses that is certain to grow worse.

The profession — both the clinical care sectors and those that are educating the next generation of nurses — is well aware of the problem. A white paper prepared this year by the Hawai'i State Center for Nursing reported that the Islands fall short of the registered nurses needed by more than 1,500. This shortfall is expected to grow to 2,267 by 2010, caused in part by the retirement of many professionals at the same time that the demands of caring for an aging population are mounting.

Meanwhile, according to the report, nursing schools here need to dramatically increase the number of graduates — 330 graduated in 2003, the most current comprehensive tally taken — if the needs are to be met.

There is general agreement that our capacity to train new nurses and nurse educators must expand, and that, once on staff, the nurses must be given more support and incentives to stay on the job.

The community is taking some measured steps to correct the imbalance, partly in response to sheer market forces and partly by design.

An example on the supply-and-demand front: the contract ratified by RNs at major hospitals last year. Pay raises ranging from 12 percent in one year to 23 percent over three years were secured, an accomplishment helped by the worldwide nursing shortage.

But pay alone is not the only issue in nurse retention. More training and mentoring can avert early burnout for novice nurses and foster their pursuit of a long-term career track. The Queen's Medical Center recently benefited from a much-needed federal program, receiving a $1.15 million grant to provide this support.

Nursing programs increasingly are using distance learning to make classes accessible to more students. For example, the University of Hawai'i has a good idea in opening a satellite program in West O'ahu where many prospective nurses live.

Lawmakers locally support incremental improvements but need to do more. In Kansas, legislators recently unveiled a 10-year, $30 million plan for expanding its own training capacity by adding teaching positions, providing more teaching sites and more. Such a comprehensive approach bears watching in Hawai'i.