Hawaii hospitals already struggling with staffing shortages are now being further stymied by delays in the processing of professional licenses required to work in the state.

Due to the urgency of the situation, hospitals have asked Gov. David Ige to issue an emergency proclamation waiving state licensing requirements for out-of-state health care workers for at least 90 days.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said a request was submitted to the governor’s office on Thursday.

“We have close to record hospital census numbers,” said Raethel, whose group represents acute care hospitals and assisted living facilities. “We are approaching crisis levels of staffing in some of our hospitals.”

Although the most recent omicron wave has not resulted in an influx of hospitalizations due to COVID-19, hospitals have nevertheless been at full capacity with other patients, he said. And the pandemic’s impacts are nevertheless being felt in the form of ongoing staff shortages, with no relief in sight.

Ige’s office did not respond to requests for comment on the emergency proclamation and waiver request by the Honolulu Star-Advertiser’s deadline.

The waiver request includes professions ranging from registered and licensed practical nurses as well as to nurse aides, medical and osteopathy physicians, pharmacists, physical, occupational therapists and speech pathologists, psychologists, X-ray technicians and more.

“It is an emergency situation,” said Raethel. “We didn’t ask for it lightly, and we would not have asked for it unless we absolutely believed it was necessary.”

On any given day, Raethel said, more than 1,000 front-line health care workers are out sick at both hospitals and long-term care facilities due to COVID-19 infections or exposure.

Hospitals are bracing for this to get worse as more transmissible omicron subvariants BA.4 and BA.5 continue rising in Hawaii, given that they have driven up hospitalizations on the mainland.

“The only reason we were able to survive during the omicron and delta surges is because at that point in time we had 700 to 800 mainland staff on the ground,” said Raethel. “We have as many patients in our hospitals now as we did during the delta and omicron surges.”

With a state emergency proclamation in place, out-of-state health care workers could work in Hawaii as long as they held licenses in other states. With the expiration of the emergency proclamation in March, that is no longer the case.

While there are some health care workers available and ready to work, they’re facing delays in renewing or receiving credentials from the state Department of Commerce and Consumer Affairs, which is in charge of professional and vocational licensing.

The DCCA’s licensing division oversees 27 licensing programs and is responsible for the licenses of more than 50 different professions and vocations.

But the DCCA itself is suffering from staff shortages and having a hard time keeping up with the state’s volume of applications for professional licenses.

The delays have kept some health care workers waiting up to three months, according to HAH.

There are an estimated 300 traveling nurses working in Hawaii, but hospitals are looking to bring in another 200 to 300 to help with shortages because they are at about the same capacity as during the surges, Raethel said.

While previous waves of traveling nurses were funded by the federal government, hospitals are now footing the bills.

“There’s not 300 extra staff available to be hired here in Hawaii,” Raethel said. “They just don’t exist — otherwise, we would have hired them. We need to bring more staff in from the mainland. We can’t do that unless they get licensed.”

Raethel said at least three other U.S. states, including New York, Texas and California, have emergency proclamations in place that waive state licensing requirements. Some other states offer either a temporary license or permit option that can be issued within one to three business days.

Another reason hospitals are full is the inability to transfer patients to long-term care facilities — which are also short-staffed and unable to take new patients. Raethel estimated 200 to 300 patients are waiting at hospitals to be transferred to long-term care facilities or nursing homes.

Kona Community Hospital recently erected a military-grade tent at its campus on Hawaii island in order to address the overflow to its emergency department, according to spokesperson Judy Donovan. There were recently as many as 30 patients in the emergency room but only 21 beds.

Kona Community is at full capacity in part, because it is unable to transfer more than 30 patients to skilled nursing or long-term care facilities. Those facilities are unable to take patients due to staffing shortages.

“We’re very concerned about hospital capacity,” said Donovan. “We visit it every day in our morning meetings.”

Hilo Medical Center is also exceeding capacity, according to spokesperson Elena Cabatu.

The center has additional beds in overflow areas that it has been able to open up, and could make more beds available, but does not have the staffing to do so.

Hilo Medical Center is also unable to transfer its patients to larger Oahu facilities because it is at full capacity.

Despite additional recruitment efforts, the shortage of health care professionals — which existed prior to the pandemic — continues to present a challenge. An upshot of the pandemic has been health care workers burning out, opting for early retirement or moving out of state.

Cabatu said Hilo Medical Center has lost staff to early retirements and career changes, while others moved to the mainland to be closer to family during the pandemic.

The center recently doubled enrollment to 46 for its nurse residency program, where graduates get on-the-job training. The center has also offered bonuses for nurses, but has not had an overwhelming response.