By Nina Wu
The Honolulu Star-Advertiser
HONOLULU 鈥� Union nurses showed up in full force Monday for the second day of a weeklong strike at the Kapi鈥檕lani Medical Center for Women & Children.
They wielded signs that said 鈥淧atients Before Profits鈥� and 鈥淪afe Staffing Matters!鈥� in front of the hospital, while clanging bells and whooping as passing cars honked in support. More than 100 striking nurses occupied Punahou Street around the corner to Bingham Street, where a sign near the parking garage entrance said 鈥淏urnout Caused This Turnout.鈥�
The Hawaii Nurses Association OPEIU Local 50, representing about 600, and Hawaii Pacific Health, which runs Kapi鈥檕lani, have been unable to see eye to eye on nurse-to-patient ratios as they try to iron out a new three-year contract.
The strike comes as hospitals on Oahu, including Kapi鈥檕lani, are at their busiest due to a high patient census and bustling emergency rooms.
Gidget Ruscetta, Kap鈥檌olani鈥檚 chief operating officer, reassured the public that the hospital is operating smoothly despite the strike, with the help of hundreds of temporary nurses.
鈥淥ur nurses are here and they are working,鈥� she said. 鈥淭hey are skilled, focused and showing great compassion towards our patients and family. They are working really well with our physicians 鈥� our physicians have been pleased.鈥�
Within a 24-hour period, Kapi鈥檕lani has delivered 16 babies, received four ambulance patients, handled two critical care transports for one premature baby and one child for the neonatal and pediatric intensive care units, and performed four emergency operations.
She said skilled temporary nurses are filling in from top institutions such as Boston Children鈥檚 Hospital and the Children鈥檚 Hospital of Philadelphia, among others, but declined to give an exact number or cost.
Some patients, however, are being moved due to noise from the strike on the street below, she said. The hospital is also offering small, noise-canceling headphones to help babies rest.
Nurse-patient ratios
The main point of contention between the two parties remains a proposed nurse-to-patient ratio determining the maximum amount of patients a nurse can have at one time.
Rose Agas-Yuu, HNA president, said these ratios 鈥� not pay 鈥� are the highest priority for the union and that it is part of a national push that already has taken place among nurses in Michigan and New York.
Kap鈥檌olani nurses are taking a stand for nurses across Hawaii, she said, and pushing to be the first in the state to get these nurse-to-patient ratios written into their contract as many continue to handle a higher workload and burnout on the job.
The striking nurses at Kapi鈥檌olani have received support from colleagues joining in from The Queen鈥檚 Medical Center, Straub and Kaiser, she said, with more flying in from Wilcox Medical Center on Kauai.
The doctors and community also have been expressing their support, she said. An online petition launched by the union garnered more than 88,000 letters of support for the nurses as of Monday evening.
Marcella Kopa, an NICU nurse at Kapi鈥檕lani for 18 years, said she felt she had to take a stand because current guidelines are not enforced.
鈥淭here is a shortage of nurses willing to work here because we consistently have higher patient ratios,鈥� she said. 鈥淲e currently have guidelines, but they aren鈥檛 followed because there鈥檚 no accountability.鈥�
In intensive care, the nurse-to-patient ratio is usually 1-to-1 or 1-to-2, she said, but she has had to deal with three or four patients at a time.
鈥淚 really wish it didn鈥檛 come to this,鈥� she said. 鈥淚 really wish I was taking care of all my patients, but at a certain point we have to take a stand for the future of our patients and for the future of quality of care at Kapi鈥檕lani.鈥�
Kapi鈥檕lani management, however, contends that mandating patient staffing ratios is not the answer to shortages.
In an editorial that ran in the Honolulu Star-Advertiser , HPH system chief nurse executive Amy Thomas said that evidence from California , the only U.S. state to have comprehensive staffing ratios in place, shows they have not helped to ease workforce shortages.
鈥淭his is because mandated staffing ratios don鈥檛 address the underlying issues causing staffing shortages,鈥� she wrote. 鈥淭hey don鈥檛 produce more nurses and, if implemented, would further strain the overburdened health care infrastructure across our state.鈥�
Studies have shown the unintended consequences of the ratios, she said in the editorial, which include reduced access to care and added costs passed on to patients.
Kapi鈥檌olani is also concerned these fixed ratios would affect management鈥檚 flexibility while serving the needs of patients on a case-by-casis basis as they ebb and flow.
鈥淏eing the only full-service women鈥檚 and children鈥檚 hospital in Hawaii and the Pacific Basin ,鈥� said Ruscetta, 鈥渨e have a big responsibility to our community, and this is something we have never taken lightly.鈥�
The union has rejected Kapi鈥檌olani鈥檚 offer several times to use a federal mediator to resolve the issues, she said, along with the proposed creation of a new council that would include unionized nurses to discuss how to update staffing levels.
鈥淲e offered across-the-board wages that would make our experienced nurses among the highest paid in the state of Hawaii ,鈥� said Ruscetta, including annual salaries of between $121,000 and $151,000.
Hospitals, meanwhile, continue to be very full, according to Hilton Raethel , president and CEO of nonprofit trade group Healthcare Association of Hawaii .
Statewide, the average number of patients per day is at about 2,440, which is higher than it was pre-pandemic.
鈥淲e thought that the increased census was as a result of the pandemic,鈥� said Raethel, 鈥渁nd that after the pandemic, things would go back to normal. Well, that has not happened.鈥�
While local universities and hospitals have been ramping up their training programs to bring in new nurses, they cannot keep up with the pace of the demand. Over the past 12 to 18 months, some 400 to 500 traveling nurses per day have filled the gap and supported local nurses.
鈥淭raveling nurses are very expensive,鈥� he said. 鈥淵ou have to pay airfares, hotels and all the costs of bringing in travelers.鈥�
While other initiatives, including the use of technology, could help, hospitals across the U.S. continue to struggle with staffing shortages.
Negotiations between HPH and the union began in mid-September, and the Kapi鈥檕lani nurses have been working without a contract since Dec. 1 .
The current strike ends at 6:59 a.m. Sunday. Two additional bargaining sessions have been scheduled for Jan. 31 and Feb. 1.
(c)2024 The Honolulu Star-Advertiser
Visit The Honolulu Star-Advertiser at www.staradvertiser.com
Distributed by