Kūlia Health

For Hawaiʻi healthcare facilities

Your nurses are not tired of nursing. They are tired of surviving.

Burnout is the word we reach for. Underneath it sits something quieter and heavier: a paycheck that runs out before the month does, and a body asked to make up the difference in extra shifts. On these islands, that gap is the widest in the nation. Close the gap, and the nurse stays.

Scroll to see what the numbers say

What we see on every island

Survival has a shape. It is a loop, and it tightens.

No one chooses this. It is not thin commitment or weak character. It is arithmetic with a human cost, the same four turns over and over, until a nurse who still loves the work walks out the door anyway.

SURVIVALMODE1234

1. The gap

One income covers maybe two thirds of the month. The rest is owed before it is earned.

2. The second job

So they pick up more. Most nurses do, and almost never for ambition. They do it for rent.

3. The exhaustion

Two timesheets, one body. Fatigue stops being a hard week and quietly becomes the baseline.

4. The leaving

Spent and stretched thin, they disengage, call out, and finally go. And it costs you more than a hire.

The nurse is not the problem. The loop is. And a loop can be broken.

The evidence

We did not invent this ache. The research already named it.

Read these as nurses, not numbers. Each one is a person standing in your hallway, doing the math in their head between rounds.

0.0%

of nurses work a second job. It is not the exception anymore. It is the shape of the workforce.

1 Multi-workplace nurse study

0.0%

of them name one reason: money. Not restlessness, not boredom. The bills.

1 Multi-workplace nurse study

0.0%

would drop the extra job tomorrow if their base pay was enough. They are not chasing more. They are trying to stop running.

1 Multi-workplace nurse study

0.0%

of nurses working multiple jobs live with chronic fatigue. Half say their mental health is worse for it.

1 Multi-workplace nurse study

0%

jump in absenteeism follows financial stress, and money-stressed staff are twice as likely to be quietly job hunting.

2 Workforce financial-stress research

0%

rise in patient deaths tracks a 10% rise in nurses planning to leave. The loop reaches the bedside.

4 Burnout and patient-safety meta-analysis

Why the second job exists

It is almost never a choice. It is the rent.

82.8%say financial need

The tax nobody votes on

Paradise bills monthly.

The same strain lives everywhere. Here it is sharpened to a point: the highest cost of living in the country, an ocean between your staff and a cheaper option, and a place where two or three jobs is simply called getting by.

0
cost-of-living index, against about 142 for California and 100 for the mainland average. The highest in the United States.
$987k
median single-family home on Oʻahu, paired with the highest electricity rates in the nation.
2 to 3
jobs per household is ordinary, not extraordinary. Survival here is a group project.
Cost of living index

Hawaiʻi does not lead the country. It towers over it.

U.S. average
100
California
142
Hawaiʻi
193

One root, two realities

Same survival mode. Two very different costs.

Hawaiʻi is not one market, and we will not pretend it is. On Oʻahu the large facilities run full and nursing roles are competitive. On the neighbor islands every island is short-staffed and turnover runs hot. The strain underneath is identical. What it costs you is not.

On Oʻahu · the large facilities

You can fill the role. That was never the worry.

The quiet cost is the nurse who stays but is running on empty: distracted, calling out, quicker to err, going through the motions. Survival mode does not always quit. Often it just stops showing up while still clocking in. And the nurses you most want to keep are the ones who have the most options elsewhere.

What burnout costs a full unit
19%
Lost productivity
63%
Extra sick days

Your win is not retention. It is a sharper, more present workforce, a better patient experience, and the reputation that keeps you the place nurses choose first.

Neighbor islands · Kauaʻi, Maui, Hawaiʻi Island, Molokaʻi, Lānaʻi

Here the cost is loud, and it is measurable.

Staffing is thin, turnover is high, and people leave for better pay and relief from burnout. On an island a vacancy is not a quick rehire. It is travelers, overtime, and a gap your remaining nurses absorb with their own exhaustion, which only feeds the next departure.

The cost of losing one RN
$56.3k
2023
$61.1k
2024

Your win is people who stay, a pipeline that holds, and far less leaning on agency premiums just to keep the lights on.

Where Kūlia comes in

We do not hand them a second job. We hand them back their evenings.

Whether your challenge is keeping nurses or keeping them present, the root is the same, and so is the fix. The income we put in front of your staff is built to be light. Low hours, low stress, low maintenance, by design. The goal is not to fill the calendar. It is to empty the worry, so the nurse standing at your bedside is fully, actually there.

Low time

Fewer hours, paid better

Higher value per hour from flexible, mostly remote work. Total hours go down, not up. The math finally tips the other way.

Low stress

Stability, not a second shift

The point is breathing room. When the money pressure loosens its grip, a nurse can come back to the work, and to themselves.

Low maintenance

AI that gives time back

We teach the AI and time skills that return hours to the week. Useful at home, and just as useful on your unit.

When a nurse is no longer surviving, you do not just keep them longer. You get them back whole: steadier hands, a clearer head, and a floor that is safer because of it.

Let us close the gap together.

A platform plus personal support that helps your staff ease the strain, build real skills, and stay. Made for Hawaiʻi, never one-size-fits-all.

See partnership options

Sources and notes

  1. Cross-sectional research on nurses employed across multiple workplaces and on nurse dual employment: extra-job prevalence and financial motivation, intent to leave the extra job if base pay were sufficient, and higher fatigue, emotional exhaustion, and burnout among multi-site nurses. NCBI cross-sectional study; NCBI nurse moonlighting study.
  2. Workforce financial-stress and wellbeing research: share of employees reporting money stress, links to absenteeism and turnover intent, and lower turnover at organizations with structured wellbeing programs. Modern Health, Rising Financial Stress Is Reshaping Workforce Well-Being.
  3. 2025 NSI National Health Care Retention and RN Staffing Report: average cost to replace one staff RN ($61,110, up from $56,300), first-year RN turnover of 22.3%, and roughly $289k cost swing per point of turnover. Becker's Hospital Review summary.
  4. Systematic review and meta-analysis on nurse burnout and patient safety, satisfaction, and quality of care. PMC meta-analysis.
  5. Hawaiʻi cost-of-living data: highest cost of living in the US (index near 193), Oʻahu median home price near $987k, highest electricity rates, and the prevalence of working multiple jobs. CNBC, Hawaii has the highest cost of living in the U.S.

Several burnout and moonlighting figures come from studies of specific nurse populations and should be cited as study findings, not universal rates. Verify and refresh each number against a current primary source before public use.

Honest Pathways · Real Pipelines
Kūlia Health · Sarah Woodbury · sarah@kuliahealth.com · kuliahealth.com