SB321: Join interstate compact to attract more nurses to Hawaii

The following testimony was presented February 10, 2023, by the Grassroot Institute of Hawaii to the Senate Committee on Health and Human Services.

February 10, 2023
1 p.m.
Conference Room 225

To: Senate Committee on Health and Human Services.
      Sen. Joy A. San Buenaventura, Chair
      Sen. Henry J.C. Aquino, Vice Chair

From: Grassroot Institute of Hawaii
           Ted Kefalas, Director of Strategic Campaigns


Comments Only

Dear Chair and Committee Members:

The Grassroot Institute of Hawaii would like to offer its comments on SB321, which would enter Hawaii into the Advanced Practice Registered Nurse Compact.

If this bill is enacted, the Legislature will take an important step toward addressing Hawaii’s nursing shortage, a problem that has existed for years and has become an obstacle to healthcare access in our state.

It is well established that Hawaii is suffering from a shortage of vital healthcare workers, especially nurses. A 2021 report from the Hawaii State Center for Nursing estimated that the state has 300 to 400 fewer nurses than needed to meet demand.[1] Since 2021, we have seen research indicating that nearly one-fourth of Hawaii’s nurses have been considering leaving the workforce, largely due to the stresses caused by the pandemic.[2]

The problem — which existed before the pandemic — has not eased since the emergency was lifted.  Across the state, and especially in rural areas, Hawaii is facing shortages of experienced health professionals, from primary care providers to nurses, specialists and staff.

Fixing the shortage in healthcare workers requires a multipronged strategy that will address everything from Hawaii’s high cost of living to the state’s regulatory scheme for healthcare facilities. Perhaps most important is the need to reform licensing regulations for healthcare professionals.

One-fourth of all licensed workers in the U.S. work in healthcare.[3] Their licenses can be difficult to obtain, are expensive and carry geographic or “scope of practice” limitations.

As discussed in an upcoming policy brief on medical licensing by the Grassroot Institute of Hawaii, the state’s shortage of healthcare professionals makes its restrictions on healthcare workers who already hold licenses in other U.S. states seem redundant and self-defeating.

As the Federal Trade Commission noted in a report on occupational licensing portability:

There is little justification for the burdensome, costly, and redundant licensing processes that many states impose on qualified, licensed, out-of-state applicants. Such requirements likely inhibit multistate practice and delay or even prevent licensees from working in their occupations upon relocation to a new state. Indeed, for occupations that have not implemented any form of license portability, the harm to competition from suppressed mobility may far outweigh any plausible consumer protection benefit from the failure to provide for license portability.[4]

In other words, though medical licensing is intended to protect the public, there is a point at which the level of regulation reduces the number of people in practice without an appreciable public benefit.

One study of licensing among medical professionals found that “licensing is associated with restricted labor supply, an increased wage of the licensed occupation, rents, increased output prices, and no measurable effect on output quality.”[5]

This is where we can benefit from the lessons learned during the coronavirus situation. The governor’s emergency modification to state licensing laws demonstrated a need to embrace license portability, making it a simple matter for a nurse licensed in another state to practice in Hawaii.

The interstate compact approach outlined in this bill would streamline licensing for advanced practice nurses, making it easier for advanced practice registered nurses from participating states to practice in Hawaii without facing time-consuming, costly and redundant regulatory hurdles.

Under the APRN Compact, an advanced practice registered nurse would be able to hold one multistate license with a privilege to practice in other compact states.

By joining the APRN Compact, Hawaii will be on the leading edge of states that are lowering barriers to practice for advanced practice registered nurses. Passing this legislation would be an important step toward attracting more advanced practice registered nurses to our state, thereby addressing our nursing shortage and improving healthcare access for all.

Thank you for the opportunity to submit our comments.


Ted Kefalas
Director of Strategic Campaigns,
Grassroot Institute of Hawaii

[1] Carrie M. Oliveira, Ph.D., “2021 Hawai’i Nursing Workforce Supply: Statewide Report,” Hawai’i State Center for Nursing, 2021.

[2] Holly B. Fontenot, Ph.D., et al., “Impact of the COVID-19 Pandemic on the Hawai‘i Nursing Workforce: A Cross-sectional Survey,” Hawaii Journal of Health and Social Welfare, May 2022.

[3] Ryann Nunn, “Improving Health Care Through Occupational Licensing Reform,” RealClear Markets, Aug. 28, 2018

[4] Karen Goldman, “Options to Enhance Occupational License Portability,” U.S. Federal Trade Commission, September 2018, p. 25.

[5] Sean Nicholson and Carol Propper, “Chapter Fourteen — Medical Workforce,” in “Handbook of Health Economics, Vol. 2,” Elsevier, B.V., 2012, p. 885, cited also in the previously mentioned FTC study, footnote #9, p3.

Subscribe to our free newsletter!

Get updates on what we're doing to make Hawaii affordable for everyone.
Want more?

Get content like this delivered straight to your inbox. We’ll also send updates on what we’re doing to make Hawaii affordable for everyone.

Recent Posts