Daniel Ross, a registered nurse at the Queen’s Medical Center, thinks about leaving his job every day.

The 60-year-old RN has been in the profession for 40 years. Ross said he’s witnessed many nurses experience burnout due to staffing shortages over the years, but the unforeseen coronavirus pandemic has heightened stress in the profession.

“I tell you, every day I ask myself if this business is worth it,” said Ross, president of the Hawaii Nurses’ Association. “I feel like nurses are expected to work as martyrs, but we’re not martyrs.”

A University of Hawaii survey, which was released last month, found that sentiment is widespread.

Nearly a quarter of Hawaii nurses who responded said they had considered leaving the workforce, mostly due to Covid-related safety concerns, job fatigue and caregiver strain.

The state has long grappled with serious staffing shortages due to recruitment and retention challenges. The problem forced the Department of Health to bring in traveling health care workers from the mainland to help with overwhelmed hospitals during some of the worst periods of the pandemic.

Between 2019 and 2021, the state Department of Commerce and Consumer Affairs reported that about 5,000 nurses had left the field, lowering the total active workforce to 28,000 in 2021. The number of nurses needed to fill the shortage is unclear.

In the online survey of 421 nurses, 23% of the respondents said they had considered leaving their jobs, citing safety concerns, family and caregiver strain and job fatigue, among other reasons. Nearly a quarter of those who considered leaving were planning to retire, while 21.6% said they no longer wanted to be a health care provider.

The survey was conducted between November and December 2020 by a team of researchers at UH Manoa. It was led by Holly Fontenot, research director at the university’s Nancy Atmospera-Walch School of Nursing.

Fontenot said the results of the survey were in line with other national and local studies.

“The good thing about the outcomes of this study was that you could identify pretty clearly that nurses have a strong commitment to the profession,” Fontenot said. She noted that 77% of nurses said they had not considered leaving the profession and that most respondents said the pandemic had strengthened their commitment to their jobs.

A 2021 survey by the Kaiser Family Foundation and the Washington Post about front-line health care workers said that 28% of nurses wanted to quit their jobs due to the pandemic. Another survey last year by the Hawaii State Center for Nursing found that 1 in 4 nurses felt the need to leave the nursing profession due to stress.

Ross said he actually thought the percentage of nurses who considered leaving their jobs would be higher.

Ross said the nursing shortage was a problem before the pandemic and nurses already were tired when Covid hit in March 2020. He criticized the hospitals for not hiring enough nurses and the lack of preparedness for the pandemic.

“Covid exacerbated everything,” he said. “We’ve had these problems going on all along, created by poor management decisions that put money before people because we were understaffed before Covid.”

“We wouldn’t have been stressed with staffing levels if we’d been properly staffed before Covid hit,” he continued. “But we weren’t.”

Ross underscored that the level of frustration among nurses is huge and expressed concern that Hawaii nurses aren’t paid enough, especially when compared to nurses on the mainland.

Nurses earn an average annual salary of more than $104,000 in Hawaii compared to more than $120,000 in California.

“If you look at the average RN salaries by state, Hawaii is the second highest in the nation, but if you factor in the cost of living, we’re dead last,” Ross said. He cited an April report by SimpleNursing, which said Hawaii’s cost of living makes nurses’ earnings “feel more like $55.1K per year.”

The UH study has prompted plans to try to come up with new strategies to retain nurses in Hawaii, including the establishment of a working group focused on the issue, according to Laura Reichhardt, director of the Hawaii State Center for Nursing.

The volunteer group is composed of nurse leaders in the health care systems and organizations across the state, as well as scholars from Hawaii’s nursing schools.

Reichhardt said the group will meet next week to come up with recommendations to be ready by late summer. She said it’s too early to tell how the group will implement their recommendations.

“One of the big concerns is not having enough nurses, and they need to be given relief for them to recharge,” Reichhardt said. “We have to think of new strategies because we are in a new environment.”

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation, Cooke Foundation and Papa Ola Lokahi.