Dozens of specialized nurses held a picket Monday evening at The Queen’s Medical Center to express their frustration over lack of progress in their third month of contract negotiations.

The registered nurses, about 50 in all represented by the Hawaii Nurses Association, work as case managers and clinical reviewers at The Queen’s Medical Center on Punchbowl Street.

Daniel Ross, HNA president, said they are asking for competitive compensation and better case manager-to-patient staffing ratios, but proposals have thus far been ignored.

Case managers and clinical reviewers have specialized education and training and at least two years of experience as registered nurses but are paid less than their floor nurse counterparts who care for patients bedside.

“Our goal is to get them equitable compensation with bedside nurses in the same facility,” he said. “We work side by side.”

Case managers help patients and their families navigate the often confusing health care system to get discharged properly, according to HNA, and ensure patients receive the care they need from appropriate providers.

“Their job is to facilitate getting people discharged to safe and proper locations,” he said. “Without them we would have even more backlog.”

At Queen’s they are required to work as a bedside nurse for three years before they are eligible to apply for the position, he said, but make considerably less. The union feels compensation should be at least the same.

“It’s kind of ironic they have to work as a bedside nurse for three years before becoming eligible to apply for this job, and then it makes less than the prerequisites,” he said. “It doesn’t really make much sense.”

Some also carry a caseload of up to 70 patients, which does not allow them to give enough time to each one, he said. The union wants to lower that ratio to 20 patients.

Clinical reviewers are responsible for maintaining high standards of care, according to HNA, and to liaise with insurance companies to ensure proper reimbursement.

Their contract expired Aug. 31, but they have been in negotiations with hospital management since July 25, HNA said.

“The Queen’s Health System greatly values our case workers and clinical reviewers, and we have been actively working with HNA at the negotiations table,” said The Queen’s Health System in a statement. “We are committed to reaching a contract agreement that provides highly competitive pay, promotes quality patient care, and a focus on workplace safety.”

Prior to holding the one-day picket Monday, HNA issued a 10-day advance notification to both the National Labor Relations Board and Queen’s as required by law.

Queen’s recently agreed to more meeting dates, including one next week, said Ross, who is hopeful there can be a resolution.