Tag Archives: Nursing in Hawaii

Welcome to Nursing in Hawaii blog

I don’t often add to this blog these days. Most often I blog at www.joeniemczura.wordpress.com and I invite you to go there. That other blog is pretty much focused on health care and nursing in Nepal (and by extrapolation, South Asia). And even there I go through fits and starts of activity. As you may guess, I am more active when I am actually in Nepal. Interacting and having dialog with my colleagues there provides inspiration for new commentary.

When I was more active I tended to write about issues faced by new graduates when entering the workforce, from the perspective of being a faculty member who was sending them forward with great pride and hopefulness.


I loved Hawaii during the ten years I lived there, and I wish every nurse could have gotten the positive reception I did. The spirit of Aloha is real. I think people from Da Mainland expect that somehow everyone is happy-go-lucky… some sort of cartoon stereotype of what it means to be “native.” But the spirit of Aloha is something you can adopt as a hard-working member of the community.

One of the big surprises is the intelligence and work ethic of the average nurse or health care worker in the Aloha State. Hawaii is a model of how to have a diverse society for the rest of the USA.

Books, did you say?

I also have written two books, on the subject of health care in Nepal, and these can be obtained via Amazon. There is a separate blog for the second book, The Sacrament of the Goddess. I have been asked when the third will come out. Usually the question comes from a person who has no idea what it entails to write a book, (even a book as humble as mine). The answer? I don’t presently think I have it in me to devote that kind of obsessive effort.

Right Here, Right Now

I am back on the mainland USA, this time in Florida where my relatives have established a beachhead. I teach nursing to – “beginners.” This is the most fun level at which to introduce what it’s like to do this work. I am fortunate to share my job with colleagues and administrators I respect and enjoy.


Feel free to browse this blog!


Leave a comment

Filed under Nursing in Hawaii, Uncategorized

Nursing in Hawaii blog is still on Hiatus while I’m in #Nepal until May 30

Thank you for wandering into this blog site!

Though it’s titled Nursing in Hawaii, most of it is devoted to general advice about nursing. There are three blog entries that seem to get the most hits – look on the list at the right and you can see them in all their glory.

Work in Hawaii?

I do have specific advice for nurses from the mainland who want to work in Hawaii. In summary, if you enjoy the cultural stuff, you will love it here. You can maximize your fun by studying the different cultures of the patients and co-workers you will meet. Browse the blog entries to find the gems…. I love Hawaii!


You may wondering why the blog is suspended. Well, the answer is, I have been following a lifelong dream and working in Nepal for a year. I am making a difference in health care in this country, and every day I thank God for designing my life so I can do this.

Read my Book?

My second book is a novel about Nepal health care. It’s titled The Sacrament of the Goddess, and there is a FaceBook page for it. Click here to get to the Amazon site.  Also I have another blog, just for the book.

The book is enjoying popularity here in Nepal, as crazy as that sounds. Want to read a review in Nepali language?

I will return to USA after May 30th.


Leave a comment

Filed under Uncategorized

This blog is not dead, it’s in suspended animation

Why no entries lately?

I keep my blogs separate ( or try to…) and since I’m in Kathmandu, Nepal, the action has moved to my Critical Care Nursing in Nepal blog. Click here and you will be transported to that other place.

The Sacrament of the Goddess

in case you are wondering, my second book, the novel about love in the time of the Nepal Civil War, has been published in USA. You can find it on Amazon. No, it’s not on the New York Times Best Seller list. Not yet anyway.

Nepal edition?

I’m working to get it published in Nepal. The people here are interested in this book – after all, it’s about their country!

Leave a comment

Filed under Uncategorized

Escape the cold with a Nursing Job in Hawaii Jan 8 2014

note: you are missing the boat if you don’t click on the hyperlinks – the colored text. Click here to see how some Americans live

Two phenomenon:

a) record cold in the mainland USA – colder than it’s been in decades due to a “polar vortex


b) a small surge in hits on this blog with the title “Nursing in Hawaii

Q: are they related? or a coincidence?

A: darned if I know! But – it’s no accident that there is always a TV show about Hawaii…..

Fact is, this blog has four or five entries that directly address the nursing job situation in Hawaii, and they have taken an uptick in hits for the last month or so, really noticeable this past week.

The first is:  Read This Before You Move to Hawaii to get a Nursing Job.

Next: It’s Official Hawaii has an “Oversaturated” Nursing Jobs Market

then there is: Hawaii Nursing Jobs Update Oct 2013

and: part One Guide to Hawaiian Culture for the Travelling Nurse

along with: Part Two Guide to Hawaiian Culture for the Travelling Nurse

finally, there are special aspects of culture here, and while this one may seem like a stretch, you can have more fun if you approach it this way: Twelve Steps to Prepare for Global Nursing. If you come here, get off the beach and explore. You will find a wonderful mix of Asian cultures here. There is also something called “local culture” which I love love love.

Humbly, I recommend all of the above. When I lived in rural Maine, we spent winter evenings by the woodstove curled up with a cup of tea of cocoa and reading the seed catalogs. (studying the seed catalogs is more like it.)  I suppose the Youth of Today are curled up by the woodstove with their iPad or laptop (does anyone use a laptop anymore?) surfing the Nursing Jobs Board for Hawaii.

This is not new.

In World War Two, the US Government was desperate to promote nursing as a contribution to the war effort. As part of the marketing campaign, there was a series of books based on the adventures of Cherry Ames, a fictional nurse from Hilton, Illinois ( a fictional town; but I bet it’s cold there today!). The third book of the series was “Army Nurse” published in 1944, and the book opens as Cherry Ames, RN is celebrating Christmas in Panama under the palm trees.  Now, everybody knows she was actually in Hawaii but the information was classified.

What is the answer?

Should you move to Hawaii or – no? Well, if you ask me it’s too late for this year. By the time you get here it will be springtime! The vast majority of nurses working here are from here, and we have excellent schools of nursing. There is a steady stream of military nurses who come through here, as well as spouses of military. In past days when the job market was a bit more inviting, Hawaii was a must-stop for young nurses who wanted to use their profession to work/travel around the USA.  (it used to be, if you had a nursing license and walked into a hospital, you could get a job quickly. Not so much these days).  Alas, we do not presently have an acute shortage.

If you should decide, I invite you to read all my other blog entries to prepare. I have truly loved being here. It’s a special part of America, and the beauty of it extends beyond the climate and scenery.


Filed under Honolulu, Nursing in Hawaii, Uncategorized

Hawaii Nurse Jobs Update Oct 30 2013

Nursing Jobs in Honolulu

As of Oct 30, there are signs that the nursing market in Hawaii is looking better. In April I re-posted a link to an article in the Honolulu Star-Advertiser that said we had a “saturated” job market.

The need for nurses isn’t going away

It’s just that we have a mismatch in the number being produced and the number we can absorb. this mismatch is due to accelerate. click here for a nifty graphic update about the need for nurses.

Geography Lesson

For those of you not living here, some geography is on order.

Most of the big hospitals are located in downtown urban Honolulu (yes, there is a city here. about 900,000 people. if we were on the mainland we’d have an NFL team. we are the 11th-largest city in the USA. we are not a foreign country.). But the population growth on the island of Oahu is planned to take place in the western side of the island, in the part called Kapolei. For years, there was a hospital in Kapolei, run by the Sisters of St Francis. It went bankrupt after running deficits for years, and hundreds of nurses became unemployed. The job market could not absorb so many nurses at the same time. The building sat vacant for awhile. It was/is a nice building. ample parking. central to their neighborhood. convenient for a whole bunch of people.

During that time, if you lived there and you wanted to go to the hospital you would need to drive on H-1, the most congested interstate highway in the USA ( how we got an interstate here, while we are separated from California by two thousand miles of open ocean, is a whole nother matter).

The building was finally bought by Queen’s Medical Center, the biggest hospital here. QMC has a “Magnet Nursing Service” and is very forward-thinking. they have planned to reopen the Kapolei building.

Job Fair(s)

which brings me to the next step. they will hold two job fairs for nurses in Honolulu, one this coming Saturday Nov 2nd in Kapolei, and another Nov 9th, the following week, in Manoa. they are hiring for all kinds of jobs, not just nurses.

Also, anecdotally, I have run into any more of my former students who are now finally getting out of the holding pattern and into new grad residency programs, particularly at Queen’s. The general consensus is that things are easing. I know I am biased, but I think UH is a terrific school of nursing, and I want to make sure our graduates get properly launched into becoming the fine nurses we educated them to be.

the link

If you want to get to a specific link for the job fair, CLICK HERE.

good luck on the job hunt!


Filed under Uncategorized

what did you do for your summer vacation

school begins again soon.

if you really must know, here is what I was doing all summer….


It was fun but I will be happy to be back in a routine.

Leave a comment

Filed under Uncategorized

Choosing a new name for this blog – “Nursing in Hawaii”

This goes out to all my loyal subscribers. THANK YOU for reading.

The blog was formerly named “Honolulu 2011-2012” to distinguish it from Kathmandu Summer 2011, but I will soon be back on Oahu, and writing once again. I had a great summer backpacking on the mainland.

I think I climbed up and over about two hundred of these…. it sure feels that way!

Q.  Where was I?

A: Hiking the Appalachian Trail in the mountains of Tennessee, North Carolina, and Virginia. I hiked about 330 miles.

yes, on foot.

Summer break will soon be over

and it is time to get to work. I will be on the east coast for two more weeks and arrive on Oahu Aug 13th.

New catchy name for the blog?

the new name will be “Nursing in Hawaii” which is broad enough to encompass many topics. please pass along the link to all your friends and encourage them to subscribe. I hope to continue to share advice for the nurses new to the workforce.

I will write about other nursing topics as well. Role socialization has been a favorite; such things as organizational behavior, health policy, etc.

Leave a comment

Filed under Honolulu, Nursing in Hawaii

Did you ever work with one of these doctors? – the 12 Medical Specialty Stereotypes – too good not to share

Health status update

Had the opportunity to speak with an orthopedic surgeon today, in his professional capacity.

I told him “hey, I am really really good at chest X-rays” (true, I am not bragging here I can back it up) “but I don’t know anything about knees.”

After the physical exam, history taking etc he turned to me to say:

“There is a problem with your knee” at which point I laughed.

I said ” That’s it! you have proved that you are not an imposter. that’s exactly what I expected you to say. You are an orthopedic surgeon through and through!

He chuckled and said, “You know, my advisors laughed at me when I said I was going to study infectious diseases. They said orthopedics was the only logical  specialty for me. something to do with my personality type…….”

“And occasionally I am called to look at a clavicle fracture but I don’t do chest X-rays.”

So it was a pleasant collegial exchange, and BTW it was very helpful. Nowhere near as serious as I was worrying about.  A simple cure, I will spare the rest of the details. I still need to lose weight and get into better shape. To overdo the exercise was what got me into this fix in the first place.

I think the nature of nurses is to worry and to think the worst…… which got me to thinking.

Physician Stereotypes

I did a quick websearch and found this site.

which is the source of this cartoon:

who ever drew this was spot on, IMHO.

We do need to laugh every now and again……… you can share with me as to whether you think it’s true or not…..

at the website where this resided, somebody pointed out that General Surgery was missing…. inexplicably so – probably my fave among specialties –

Surgery Jokes?

Possibly because General Surgery is not funny. under any circumstance.

Many years ago in Maine I was ice-fishing with a General Surgeon, the same guy who did the Caesarean Delivery of my oldest child. We were discussing this very subject, and he told me the following:

An internist, a surgeon and a pathologist were duck hunting one weekend. they were sharing dinner in the remote cabin when some ducks flew overhead.

“Judging by the call, and the flight formation, and the time of day, there a seventy percent possibility that it was a flight of mallards, but we can’t truly rule out Canadian Geese” said the internist.

The surgeon grabs a shotgun, and fires it through thee wall in the direction of the sound.

He tosses the shotgun to the floor, turns to the pathologist, and says

“Make sure they are ducks’

perhaps not quite so au courant in this day of advanced imaging…

Oh, and I forgot to ask him as to when I could resume playing the piano. Oh well….


Filed under nursing education

Myths about becoming a nurse practitioner – things to consider about grad school in nursing


If this were a bookstore, you would read the back of the book-decide to buy. Find this on Amazon at https://goo.gl/PGTW30


UPDATE:  as of February 3rd, 2015, this entry has 38,633 (thirtyeight thousand, six hundred and thirty three) separate views. It’s the single most popular blog entry I have written. Please feel free to add your feedback and comments. 

UPDATE #2 My book, The Sacrament of the Goddess, was published in April 2014 in USA.  Click here to see reviews on Amazon and order a copy. see the cover on the left, below. People  in USA think of Everest when they think of Nepal. Or maybe the earthquake of April 2015. Right now, the political situation in Nepal is precarious; and one aspect of working in a Low Income Country is the feeling of being out on a limb. My book explores the peculiar terror of being a neutral medical volunteer when everyone else is choosing sides. It’s a fast-paced pageturner! The book has nothing to do with APRNs, but might give you some insight as to why any body would ever want to be a nurse…. why not buy it and become one of the cool people? 

related link about paying for NP education, click here!

Disclaimer: I myself went to grad school fairly early in my career – after just one year as an RN. In those days (the 1970s) the federal government supported nursing education with generous grants and stipends which we knew would not last forever. I did not incur any debt for grad school, whatsoever. sweet!  I continued to work as an RN after grad school, and the MS credential surely came in handy when I finally needed to have it. So – I am in favor of graduate education.

Buzzwords. The Trend Du Jour.

Advanced Practice Nursing is a big buzzword nowadays and we are using the idea of it to attract people to the nursing profession. Throughout the USA there is a proliferation of “three-year’s wonder” programs, the idea being that the student does an entire nursing program the first year, then takes NCLEX, then spend two more years getting their MSN and NP while they work part-time as an RN. It’s particularly attractive during the down economy we are experiencing, because there are plenty of people out there with prior BS degrees who are looking for a fulfilling job. It is oh-so-seductive to think they can gain the RN skill in just one year.

Okay, so it’s a wave – lots of schools and universities are offering these programs. there are plenty of stats to provide a rationale for the career track we are inventing.

The aging of the population

The lack of Medical Doctors to provide primary care

the overall need for RNs to replace the RNs in the baby boom who will be retiring soon.

etc etc etc

I am not disputing those trends, but I am bemoaning some things that seem to be getting lost along the way.

Myth One – no need to learn basic personal care

To begin with, role socialization into nursing goes out the window when the time is compressed. Many of the persons who come from these programs seem to me to be unaware of how nurses work as a team, how nurses work in a hospital, and how to do any kind of personal care for a sick person. In other words, such things as cleaning up “fecal incontinence.”  When this comes up in conversation, they say “oh, well, I am going to be a nurse practitioner and I will be in an independent practice, I don’t need to learn those things.”

Oh Really?

My retort would be: If You are hoping to get a part-time nursing job to put yourself through school while you get the next two years of grad school under your belt, you will be judged according to the standard of the nurses around you, not to the other standard. It is extremely unlikely that you will be getting anything other than a staff nurse job while you work during school. 

also, don’t discount what a staff nurse learns. accountability and integrity are a big piece of the socialization process. A staff nurse in a labor-intensive setting like a hospital, gets daily role modeling from the older nurses. daily mentoring. any new nurse needs to develop trust with those already in the setting, and people will trust you more if you aren’t afraid to get your (gloved) hands dirty.

Think about this: if a patient has been incontinent of feces, no real nurse ever just lets them lay there. Never ever. You may not have to clean them yourself, but you do need to know how. Being clean is a critical element in the dignity of human beings. a very simple precept, really….. and if you as a student disrespect this, you will not gain the trust of the nurses around you.

Myth Two – independent practice

The next myth for Advanced Practice is that “I will be in an independent practice and I am not going to need to learn to work in the kind of subservient hierarchy that a traditional staff nurse needs to navigate through”

If that is truly the case, you will need to borrow money to rent office space, hire a billing agency, advertise to the community, all those things just like you were opening up a furniture store. Ask yourself if you have the business skills to do it, or to get a loan. There are some great resources out there, I particularly recommend one book by Carolyn Buppert; but – is that what you want to do? Most Medical Doctors gave that up twenty years ago, the hassle of “hanging out a shingle” was way too much. We are training you to provide population-based care, which means many of you will be making frequent rounds in a Long Term Care Facility, as part of a group practice. The retired frail elderly population of USA is burgeoning, right? your job will consist of freeing up time for the doc you work with so they can focus more on the technical side.

The small population of ARNPs who will be doing more acute care will be drawn from among those nurses who went the hospital- nursing route and solidified their skills before they enrolled in NP school.

let’s reserve the topic of subservience for some future blog, shall we?

Myth Three

I will be making a lot more money than a staff nurse

In many states the recertification requirement for any ARNP is 40 to 80 hours per year. If you maintain dual-certification, you may have more. This works out to ten working days per year where you are in classes (or being online). When you are in class, you are not seeing patients, and your income is affected. You will also have to pay higher malpractice costs. If you are in a family specialty, you will have many patients who don’t have insurance.  All these things detract from the bottom line.

Myth Four

If it doesn’t work out, I can always fall back on a job as a faculty member somewhere.

Yes, we do have a shortage of nursing faculty. and the minimal requirement to teach is a Master’s Degree. This is one that puzzles me.  For years now there has been such emphasis on going the NP route, that very few nurses enroll in an education track for graduate school. The result? a shortage of faculty, now being filled by recruiting from among those Master’s Prepared nurses who are unsatisfied with an NP job, and who get hired to teach.

There is a problem with this. A converted-over NP with a MS degree does not automatically have the clinical knowledge base to teach in an inpatient clinical setting; and they also don’t have any course work in pedagogy, the science of teaching, how to lecture, how to construct a valid exam, none of the things an educator needs to know in order to be effective.

So far this trend has been under the radar. Any school of nursing where the administration is addressing this, will be ahead of the game.

Myth Five “I can work as an RN after the first year, and use that money to pay for the second and third years, so it’s really not so expensive after all!”  go to my latest blog entry to explore this one. Plan carefully.

Got it off my chest!

So, what you have just read was a “rant” –  the kind of complaining I always dislike. If I were to stand up at a professional meeting,  I am sure there would be  a pregnant pause when I was done. People would look around the room, and then some sweet and wise person would bravely ask And what do you propose that we do about this?

My answer would be:

for the student: realize that you are entering a profession with a long history of service and where you will learn from all those around you in any setting you enter. The more responsibility you are given, the more direct (and sometimes brutal) the feedback will be.

study the idea of role socialization. don’t let it be a hit-or-miss proposition. realize that your thinking style will be changed by becoming a nurse. oh yes it will…..

don’t disrespect the basic skills of personal care. paradoxically, the more likely you are to work in critical care, the more you will need the kind of  teamwork and excellent personal care skills you learn at a basic level.

don’t disrespect the work done by staff nurses, whether it is in a hospital, long-term care facility, or other setting. not ever.

for the schools: be realistic when advertising what a fast-track program can provide and how it fits into a clinical track. When a MEPN student is disrespecting the work of staff nurses, call them out.

emphasize the whole role socialization piece. Insist that the skills portion of undergrad curriculum is rigorous and incorporates socialization, not simply mechanical performance.

insist that converted over NPs who take on a faculty role be given the maximum in mentorship

reclaim the nursing focus of advanced practice nursing. I think it is too easy to slip in to a purely medical model…..

I am fully aware that I will get feedback on this one……. I don’t pretend that this is the end-all and be all of the discussion – But, as oif you have another idea, 2016 this comment section is closed.


Filed under APRN education, nursing education, nursing faculty jobs in Hawaii, Nursing in Hawaii, Obamacare

Should a New Graduate nurse relocate to find a Nursing Job?

Should I relocate to find a nursing job? (updated Aug 24 2012)

Before we answer the question: why not subscribe to this blog? Go to the box on the right and click where it says “sign me up.”  And while you are at it, buy my book about the time I relocated  (just for the summer), to teach nursing and work in Nepal, the Himalayan country in the mountains between China and India.  It won’t help you find a job but it will remind you of the value of your chosen career. Nurses make a difference in people’s lives, everyday.

And now – Catch-22

Two years ago one of the best students in the graduating class faced a problem: she was determined to be an ICU nurse, but getting discouraged. She’d sent out the resumes, worked her contacts, done everything. The local hospitals were interested but they pointed to “catch-22” – they would only hire if the person already had experience. And how to get that experience? get hired…….

She was offered a job as a nurse’s aide, but resisted the idea. So she took a courageous step. She moved to a large city in California,  where she didn’t know anybody.  It wasn’t San Francisco or L.A., or on the coast;  There was no surfing and no beach. Frankly, her new home was not a city with a lot of tourist appeal unless you like hot weather and dusty desert winds. There, she got the training and experience she’d set her heart on. And this year, with two years of ICU experience under her belt, she moved back to Hawaii. Now she works in ICU at the hospital that was always her dream job.

For her, the gamble paid off. She improved her career trajectory. Things fell into place for her; she was single, no kids, flexible, and resilient. She’d been a top student and always made friends along the way.

Destiny? Kismet?

It’s easy to say in retrospect that it was her destiny, but along the way she had to deal with loneliness and homesickness. During her time in Inland California she didn’t have much of a social life while she pursued professional goals. She worked mainly night shift.  Any of these things may have overwhelmed somebody else.

I think of her when any other new grad asks me whether their career would be better if they looked for Greener Pastures. Sometimes it works and sometimes it doesn’t. The National Council of State Boards of nursing would tell you a cautionary statistic: about 27% of new graduate nurses who do get hired, leave their job within the first year. That is a sobering number. There is never any easy answer.

Before you pack your bags and head to a new location, consult your personal Board of Directors, go back to the school you attended and tell your favorite faculty members about your plans. Ask their advice. Of course, figure out how much it will cost and what your budget is. List the pros and cons. Do all those things.

(added Aug 24th 2012): Travel as a means of escape

re-reading this, it occurs to me that nursing is still a field in which you are portable. It is amazing that you can find a job thousands of miles away, and largely be able to apply what you learned where you are now. The consistency between hospitals throughout this great land did not evolve by accident. In 1978 I moved from Boston to San Francisco with my girlfriend. We spent eight weeks driving cross-country, seeing all the National Parks and we both got nursing jobs well before our savings ran out. It was glamorous! We were leading the lives we dreamed about! We were grownups!  How could I advise the next generation of nurses to be anything less than that?

So… most of all, take your courage with you. 

Let’s get philosophical for a moment.

You’re young, you’re out of college. You chose a major that leaves open the possibility that you *could* take your skills anywhere in the USA, walk in the door, and have a paycheck.

Back in the Day, in the times when there was a nursing shortage, nurses used to do that all the time. There where nurses in my generation who had travelled the USA this way, taking a hitch in New York City, San Francisco, Chicago, Honolulu (of course) and Portland, Maine.

Wherever you go, it will be an adventure. For the rest of your life, you will have a story to tell. It will be a part of you, even if you return home, never to leave again.

You will always have people listing the reasons not to do it.

But you will never know, for sure.


Filed under nursing education, Nursing in Hawaii, resume and cover letter, resume writing