A weeklong strike by hundreds of nurses at Kapi‘olani Medical Center for Women & Children — the first in nearly 50 years — concluded Saturday night with no resolution yet in sight.
The nurses cleared the sidewalks, packed up their signs and went home, hopeful that their concerns were seen and heard with an impactful strike that at times resulted in tensions with management over noise and patient access to the hospital.
The strike officially ended at 6:59 a.m. today, before the start of the next shift.
Gidget Ruscetta, Kapi‘olani’s chief operating officer, said she welcomes the nurses back to the morning shift.
“Our goal, which I know is the same as our nurses, is to continue to provide uninterrupted care for our patients and this community,” she said.
During six days, she said the hospital delivered more than 90 babies and performed 130 operations, with a temporary workforce in place.
“It’s been emotionally challenging for everyone,” she said. “We were able to continue serving our community like we always have. That is our commitment, and the focus is our patients and making sure our community knows we are always here for them. I want to take the opportunity to thank our entire Kapi‘olani and Hawaii Pacific Health team for providing that excellent, uninterrupted care during that time.”
The Hawaii Nurses’ Association, which represents about 600 nurses at Kapi‘olani, disagrees with HPH, which operates the medical center, on the terms of a new, three-year contract, primarily over nurse-to-patient staffing ratios.
While HNA wants fixed ratios written into the new contract, hospital management is proposing alternative solutions to improve staffing issues without locking ratios into place in order to better respond to patients’ varying needs.
But hospital management and the union said they are ready to talk at their next bargaining sessions scheduled for Wednesday and Thursday.
A historic strike
The strike, during which nurses were not paid, included sign- waving between 6 a.m. to 8:30 p.m. daily, starting last Sunday to Saturday. It was the first strike the union has held at Kapi‘olani since 1976, said HNA president Rose Agas-Yuu, which the nurses felt was necessary.
“We felt the strike was very effective, in the way it not only galvanized the nurses at Kapi‘olani, but with the community support and politicians coming on board,” said Agas-Yuu, a critical transport nurse. “The nurses are eager to get back to their patients.”
If the goal of the nurses was to be visible, they were, with several hundred nurses occupying Punahou Street around the corner to Bingham Street in bright yellow T-shirts that said “Retain, Recruit, Respect NURSES,” and waving signs that said “Safe Staffing Matters!’
If their goal was to be heard, they were, as the cacophony of clanging bells, honking horns, whoops and chants of “Safe Staffing Now” accompanied the usual din of traffic along the busy corridor throughout the day.
Some brought their kids, some brought their pet dogs — and at times, they broke out and danced the electric slide.
It caused disruption.
According to Ruscetta, HPH asked the union for cooperation Tuesday after becoming aware of at least two patients in active labor that had difficulty getting to the medical center.
One family circled the block twice before getting to the entrance, she said, and another patient eventually walked in because of difficulty getting to the drop-off entrance blocked by picketers.
Ruscetta said she wanted to reassure the public that both patients were admitted and doing well despite these challenges.
Additionally, some of the youngest patients could not sleep with the noise on the street below — particularly the Punahou-Bingham corner — and were moved at the request of their families.
Tickets for noise
The issue came to a head when the Honolulu Police Department, which monitored the strike, issued citations following noise complaints from patients’ family members and residents. Officers on Thursday issued approximately a dozen warnings and three citations to drivers who honked loudly near Kapi‘olani for violations of a city ordinance making it “unlawful to make loud noises.”
The issuance of one citation that went viral on social media reportedly went to a patient’s father who blew an air horn on the sidewalk to celebrate his son’s discharge after several months at the hospital. The penalty is a fine of up to $100 and/or 60 days imprisonment.
Agas-Yuu said the nurses were disheartened to learn of anyone getting cited for expressing their support. She also apologized for the disruptions but said “it’s hard to control those types of situations” that happen with a strike.
The union is also energized by the support from the community during the strike, she said, from patients as well as retired nurses, some of whom striked in 1976, and fellow nurses across the state.
Separately, the nurses launched an online petition during the strike seeking support and gathered more than 141,000 signatures within the span of a week.
Jodi Kumasaki, mother of a preemie born at Kapi‘olani, supports the nurses.
Today, her 4-year-old son Brayden continues to require follow-up visits due to a tracheal tube, stomach tube and other health conditions.
During visits to the hospital over the years, she has felt how busy the nurses have been, juggling multiple patients at one time.
“There’s so many times we’re walking the halls looking for somebody to help us,” she said.
Her son was in the Pediatric Intensive Care Unit in December after a procedure for observation, and she recalls his nurse was also assigned to a critically ill baby at the same time. She feels the patient-nurse ratio should have been 1-to-1.
“So I mean it’s just crazy to see how they were stretched during COVID, and how it still is today,” she said.
Nurse-to-patient ratios
According to Agas-Yuu, the nurse-to-patient ratios — not pay — are what the nurses are fighting for because they are continually overburdened with too many patients at a time.
This is unsafe for nurses and their patients, she said, and the reason why many nurses have left Kapi‘olani.
She pointed specifically to standards issued by the Association of Women’s Health, Obstetric and Neonatal Nurses, headquartered in Washington, D.C., as the standards the union wants.
More nurses need to be brought in at any given time to maintain these ratios, which include 1-to-1 for many situations, including a woman in labor with diabetes or preeclampsia.
The 1-1 ratio would also apply to newborns undergoing surgical procedures, or 1-1 or 1-2 ratios for newborns requiring intensive care.
Ruscetta said HPH is proposing the creation of a staffing council — made up Kapi‘olani management and union nurses — to develop an updated staffing model aligned with guidelines from the American Nurses Association.
“Our proposal addresses what the nurses are asking for,” she said. “Staffing in health care, as you know, is very complex. So in both our proposal and the union’s proposal, there are more than 40 sets of staffing levels we are talking through.”
Patient care is also unpredictable, said Ruscetta. Rather than having fixed ratios in place, the focus should be on the individual patient and level of care needed.
Additionally, HPH is ready to bring in a federal mediator, but the union is not.
“We firmly believe this is the right time to have a federal mediator,” said Ruscetta. “We have requested multiple times to have that mediator present and the union has still refused. When I look outside and see our nurses striking, that’s a clear message to me we are far apart and we need that federal mediator.”
But Agas-Yuu said HNA feels there are still items on the table to discuss and does not feel it is the right time for a federal mediator to step in.
Although the nurses at Kapi‘olani are the first in Hawaii to highlight staffing ratios during a strike, several other nurse unions have done so before them in other U.S. states.
Following a three-day strike last January, about 7,000 nurses at Mount Sinai and Montefiore ratified historic contracts that include enforceable nurse-to-patient staffing ratios, according to the New York State Nurses Association.
In New Jersey last year, some 1,700 union nurses held a four-month strike that resulted in a tentative agreement with Robert Wood Johnson University Hospital in New Brunswick, according to local news reports.
One of the key issues established in the agreement is safe nurse-to-patient staffing ratios.
Hospital management has pushed back, saying these ratios are not the solution to staffing shortages.
In Michigan, proposed state legislation mandating ratios has been opposed by the Michigan Organization for Nursing Leadership.
The group says mandated ratios are an ineffective “one-size-fits-all” solution that would put hospitals in an impossible situation, risking their ability to stay open and deliver care.
Negotiations between HPH and the union began in mid-September, and the Kapi‘olani nurses have been working without a contract since Dec. 1.
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Recommended nurse-to-patient ratios
>> 1-to-2 or 3: Woman in obstetric triage after initial assessment, in stable condition.
>> 1-to-2 or 3: Newborns requiring intermediate care.
>> 1-to-2: Women in labor without complications.
>> 1-to-1: Woman laboring with minimal to no pain relief or medical interventions.
>> 1-to-1: Newborns requiring intensive care.
>> 1-to-1: Newborns undergoing circumcision or other surgical procedures.
>> Minimum of two nurses in hospital for obstetric emergencies.
Source: AWHONN Standards for Professional RN Staffing for Perinatal Units
