Hawaii's 1.4 million residents are spread across seven inhabited islands. Registered nurses there average $124,340 a year, second only to California.
Licensure
The Hawaii Board of Nursing licenses registered nurses, licensed practical nurses and advanced practice registered nurses through the Department of Commerce and Consumer Affairs. Its office is on Merchant Street in Honolulu, telephone (808) 586-3000. Rules and applications are at cca.hawaii.gov.
Hawaii is not in the Nurse Licensure Compact, and compact bills have been introduced in the legislature without passing. A multistate license does not authorize work here, so nurses apply to the Hawaii board for a license by endorsement. Since the state leans heavily on travel nurses and staffing agencies from the mainland, that adds a licensing step to nearly every contract placement.
Nurse practitioner practice
Hawaii is a full practice state. Nurse practitioners evaluate patients, order and interpret tests, and prescribe under the nursing board's authority, with no physician agreement required. On the neighbor islands, where physician coverage is thin, a nurse practitioner is often the only continuous source of primary care in a community. See nurse practitioner practice authority.
Nursing education
The University of Hawaii at Manoa runs the state's main nursing school and its graduate programs. The University of Hawaii at Hilo trains nurses on Hawaii Island, Hawaii Pacific University and Chaminade University run private programs in Honolulu, and the community colleges supply associate degree graduates on several islands. Keeping graduates in the state is the persistent difficulty, since a Hawaii trained nurse can earn comparable money on the mainland at a fraction of the living cost.
Pay and workforce
High pay in Hawaii comes with the highest cost of living of any state, so the number buys less than the same figure would on the mainland. See registered nurse pay.
Most hospital work is on Oahu, home to The Queen's Medical Center, Straub, Kapiolani Medical Center for Women and Children, and Tripler Army Medical Center. Maui, Hawaii Island and Kauai rely on smaller hospitals, several of them critical access hospitals, and patients needing specialist or trauma care are frequently flown to Honolulu. Inter-island transfer by air is the routine equivalent of a long ambulance run on the mainland. See rural and frontier nursing.
Being an ocean away from the mainland, the state cannot surge staff quickly, which keeps recruitment and retention near the top of every hospital's worries. See nurse turnover and retention.
Related
- Licensure by endorsement
- Nurse staffing agencies
- Travel nursing
- Registered nurse pay
- Nursing by state
Sources
- U.S. Census Bureau, state population estimates for July 1, 2025. Accessed September 8, 2026.
- U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, registered nurses (29-1141), May 2025. Accessed September 8, 2026.
- Hawaii Board of Nursing, contact details and licensing information. Accessed September 8, 2026.
- Nurse Licensure Compact, member states. Accessed September 8, 2026.
- American Association of Nurse Practitioners, State Practice Environment. Accessed September 8, 2026.