Unionized nurses at Kapi‘olani Medical Center for Women &Children said they will go on a weeklong strike later this month, and management assured the public that they have a plan to maintain the hospital’s quality of care.

The Hawaii Nurses’ Association, which represents about 600 at Kapi‘olani, on Wednesday notified management of the strike after the two sides failed to reach a deal in contract negotiations. The strike is scheduled to take place from 7 a.m. Jan. 21 through 6:59 a.m. Jan. 28.

After nearly four months of negotiations, the union says the main contention is its demand for nurse-patient ratios that set the maximum number of patients a nurse is assigned to care for in a shift. Union members say this, more than pay, has been their top priority because nurses have been overburdened with a higher number of patients.

Hospital management, meanwhile, says fixed ratios affect its ability to be flexible and to meet the needs of its patients in a fluid environment.

Rose Agas-Yuu, HNA president, said the strike was called due to management’s failure to bargain in good faith and unfair labor practices. Kapi‘olani by Wednesday afternoon had presented what it said was its last, best and final offer, with little movement forward.

“We offered to accept many of their terms and conditions and asked for some concessions, but we were stonewalled,” Agas-Yuu said in a statement. “Kapi‘olani’s leaders have publicly stated they are committed to caring for our community and would always prioritize patients, but this was not reflected in our private negotiations.”

Kapi‘iolani officials said the 10-day strike notice was disappointing, given that management had presented a fair and generous offer to HNA, addressing items identified as priorities for the nurses.

“Throughout the negotiations, Kapi‘olani Medical Center for Women &Children has addressed the priorities presented on behalf of our nurses with the intent of moving forward together,” said Gidget Ruscetta, Kapi‘olani chief operating officer.

“Despite the union’s decision to strike and refusal several times to negotiate with a federal mediator, we want to reassure the community that we will continue to serve our patients and their families,” Ruscetta said. “Kapi‘olani will be here to serve our community, 24 hours a day, seven days a week and we will never waver from that responsibility.”

“We are committed to high quality care for our patients,” she said. “We want to reassure Kapi‘olani patients and families that we have already activated plans to ensure that we will continue to serve our community. We have secured a temporary workforce of experienced nurses who are licensed in the state of Hawaii. They are prepared to provide the specialized services that we need for the patients at Kapi‘olani. These are highly skilled, highly trained nurses who are prepared and ready to provide the care needed for our patients.”

Kapi‘olani officials also said it offered across-the-board raises and longevity pay that would make experienced nurses among the highest paid nurses in the state.

The nurses would make between $124,000 to $151,000 annually for a three-day workweek, not including premium pay, overtime and shift differentials, according to a news release from Kapi’olani.

Agas-Yuu said management refused to address “the key issue of unsafe patient-nurse ratio” which must be a priority “to set standards of patient safety and creat(e) a culture of quality care and excellence.”

Hospital management countered that it has offered staffing guidelines strongly aligned with most of HNA’s proposed staffing assignments.

Kapi‘olani appreciates all the work that nurses do, Ruscetta said, as they provide the most impact for patients, but fixed ratios would hinder the ability to meet changing needs.

“We need the flexibility to bring in additional nurses when we need them for the immediate care of our patients,” said Ruscetta in a Honolulu Star-Advertiser interview, noting that needs can change from hour to hour. “It’s all about being able to do what we do best, which is to keep all the focus on our patients — patient care by far is our No. 1 priority here at the medical center.”

“We know how hard our nurses work, and we support them and work with them on an ongoing basis,” she added. “That’s why for us, these staffing guidelines are so very important.”

Hawaii Pacific Health, which operates Kapi‘olani, said it continues its ongoing efforts in recruitment and workforce development training programs.

Over the past year, Kapi‘olani hired over 100 nurses, Ruscetta said, and so far this month has hired 19 that already started working.

Union members contend that nurses have been overwhelmed since the start of the COVID-19 pandemic in 2020, and are burning out and leaving.

On Friday, 96% of Kapi‘iolani’s nurses voted to authorize the strike, with talks scheduled for Wednesday and today. The nurses have worked without a contract since Dec. 1.

Paulette Vasu, a longtime labor and delivery nurse at Kapi‘olani, said the staffing ratios are important for keeping competent, experienced nurses on staff.

“The nurses are very fired up,” she said. “We feel now is the time for change. I’m getting ready to retire in a few years, and we’re doing this for the younger nurses that are coming up. We want them to stay at Kapi‘iolani and be happy at Kapi‘olani.”

Agas-Yuu said having enforceable staffing ratios in a contract would be a first for the state and that Kapi‘olani nurses are taking a stand for nurses as well as patients statewide.

“The nurses want a change,” she said. “The nurses are the ones that put out the strike authorization. We’re ready. They’re ready.”