THE SENATE
S.R. NO.
112
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
SENATE RESOLUTION
REQUESTING THE HAWAII STATE CENTER FOR NURSING TO CONDUCT A STUDY COMPILING RECOMMENDED SAFE PATIENT STAFFING RATIOS.
WHEREAS, the issue of safe staffing in hospitals has escalated into a growing public health concern in Hawaii and other states across the nation and can no longer be defined as strictly a collective bargaining issue; and
WHEREAS, the nursing community is the largest segment of Hawaii's health care workforce and is indispensable to the health, safety, and well-being of the residents of the State; and
WHEREAS, as more care is delivered in outpatient or home and community-based settings, the acuity of patients who are admitted to hospitals has intensified, requiring significantly more attention, complex monitoring, and clinical intervention by frontline nurses; and
WHEREAS, the Legislature commissioned the Legislative Reference Bureau to conduct a comprehensive study on nurse staffing pursuant to House Concurrent Resolution No. 187 (2024); and
WHEREAS, the Legislative Reference Bureau submitted its 2025 report, Time for Triage: A Summary of Best Practices, State Requirements, and Successful Efforts to Reduce Nurse Staffing Shortages, which cited several studies demonstrating that patient outcomes improve with higher nurse staffing ratios, or nurse-to-patient ratios, through results such as shorter hospital stays, fewer complications, fewer readmissions, less risk of death, reduced hospital-acquired infections, increased patient satisfaction, improved patient compliance with treatment plans, improved pain management, and fewer medication errors, and that nurse staffing ratios may be especially important for patients of color; and
WHEREAS, the Joint Commission, the nation's leading health care accrediting body, has established National Performance Goal 12, effective January 1, 2026, which formally recognizes that hospital staffing levels and competencies must align with patient needs as a critical component of clinical quality and patient safety; and
WHEREAS, data from the 2025 Hawaii Nursing Workforce Supply Statewide Report and the 2026 Informational Brief on The State of Hawaii's LPN and RN Workforces by the Hawaii State Center for Nursing show there is an adequate number of registered nurses in the islands to meet existing demand, indicating the number of registered nurses statewide is not a barrier to safe staffing; and
WHEREAS, the Hawaii State Center for Nursing reports findings from a 2023 Nursing Wellbeing, Recruitment, and Retention Strategic Initiative Working Group literature review that Hawaii registered nurses felt so stressed at work that they considered leaving the nursing profession, and that nurses increasingly indicated physical and mental health as leading contributors to their desire to leave the workforce; and
WHEREAS, creating supportive work environments with safe staffing levels is essential to attracting the next generation of nurses to Hawaii's workforce and retaining the experienced nurses currently practicing in Hawaii's health care facilities; and
WHEREAS, transparency in staffing standards allows for better-informed decision-making by health care providers, policymakers, and the public; now, therefore,
BE IT RESOLVED by the Senate of the Thirty-third Legislature of the State of Hawaii, Regular Session of 2026, that the Hawaii State Center for Nursing is requested to conduct a study to compile a comprehensive list of recommended safe patient staffing ratios for various hospital units and health care settings; and
BE IT FURTHER RESOLVED that the Hawaii State Center for Nursing is requested to use the specific unit-by-unit staffing standards and ratio requirements outlined in House Bill No. 1865 (2026) and Senate Bill No. 2763 (2026) as the foundational framework for the study that compiles the staffing standards recommended by professional specialty organizations, including but not limited to the:
(1) American Association of Critical-Care Nurses;
(2) Emergency Nurses Association;
(3) Association of Women's Health, Obstetric and Neonatal Nurses;
(4) American Society of PeriAnesthesia Nurses;
(5) Association of periOperative Registered Nurses;
(6) Oncology Nursing Society;
(7) Academy of Medical-Surgical Nurses;
(8) American Psychiatric Nurses Association;
(9) Society of Pediatric Nurses; and
(10) American Nephrology Nurses Association; and
BE IT FURTHER RESOLVED that the Hawaii State Center for Nursing may, in consultation with its advisory board, include in the study standards for a nursing specialty or sub-specialty established or recommended by regulation or statute in other states, recognized authorities in other countries, and other professional associations; and
BE IT FURTHER RESOLVED that the Hawaii State Center for Nursing is requested to submit the study, including any findings, recommendations, and proposed legislation, to the Legislature and Department of Health and publish the study in a publicly available online dashboard no later than twenty days prior to the convening of the Regular Session of 2027; and
BE IT FURTHER RESOLVED that this body urges Hawaii's health care facilities to use every effort to implement safe patient staffing ratios that reflect the standards compiled and tracked by the Hawaii State Center for Nursing; and
BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Health, who in turn is requested to submit copies of this measure to the Chief Executive Officers of each hospital and health care facility licensed in the State; and the Executive Director of the Hawaii State Center for Nursing.
OFFERED BY:
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Report Title:
Hawaii State Center for Nursing; Staffing Ratios; Study