What was planned as a one-day strike quickly turned into the "lockout" of hundreds of union nurses at Kapi‘olani Medical Center for Women and Children over the weekend.
But how did we get here? And what are the issues at hand? Hawaiʻi Public Radio breaks down why tensions are on the rise and what all of this means for hospital staff and patients.
Why are Kapiʻolani union nurses on strike?
About 600 nurses under the Hawaiʻi Nurses’ Association have worked at Kapi‘olani Medical Center without a contract since Nov. 30, 2023, when their last one expired. Kapi‘olani and HNA have been negotiating a new three-year contract since Sept. 13, 2023.
The nurses have gone on strike twice since contract negotiations began. The first was a weeklong demonstration from Jan. 21-28, and the second was a one-day strike on Friday, Sept. 13 — the first anniversary of when negotiations began.
Some HNA leadership said the January strike was directly related to the association's disappointment with contract talks, but a point of emphasis during both strikes has been working conditions and staffing. Nurses have said that their supervisors are assigning them too many patients at a time, which in turn, hurts their well-being and ability to provide adequate care for patients.
Nurses want the new contract to include a “ratio,” or “matrix,” that guides how many patients can be assigned to nurses at any time.
Since the January strike, HNA has encouraged nurses to fill out “Unsafe Staffing” reports to document instances where there aren’t enough people to provide proper care. HNA said the reports provide a paper trail that documents Kapi‘olani’s persistent staffing problems and “unsafe” working conditions.
One point the nurses wanted to get across at Friday's strike was Kapi‘olani management’s response to those staffing reports. Nurses have said that they’ve been “bullied” and “intimidated” for wanting to fill out the “Unsafe Staffing” reports.
Kapiʻolani nurse Marcella Kopa said supervisors are “gaslighting” nurses by telling them there isn’t a problem. She said, “From the beginning, I felt intimidated to fill it out. Managers often tell us, ‘Oh no, that doesn't qualify. This is a safe assignment.’”
On Friday, many nurses could be seen holding signs pushing back against Kapi‘olani’s “retaliation” for filling out the reports. One of the signs read, “Zero tolerance for retaliation.”
What is the staffing “matrix"? And why is it at the center of the contract negotiations?
The “matrix” that HNA wants in the nurses' new contract would, in essence, reduce the number of patients assigned to a nurse at one time.
The appropriate number of patients per nurse doesn't appear to be straightforward because there are different kinds of patients with different levels of need.
HNA President Rosalee Agas-Yuu provided an example of what problematic staffing could look like when a nurse is taking care of newborns in the Neonatal Intensive Care Unit, or NICU.
“They work with tiny ones that really don't need much effort to move, but because they're so small, you have to be very, very on key with everything because you don't want to get (them) too much fluid because they're so small, and you want to make sure that their heart rate, their blood pressure is okay. It's just a little bit more of a challenge," Agas-Yuu said.
"The fight is the employer wants to give you four of them, and with everything that they have to do nowadays with the young babies, three is more than enough. The nurses have been trying to give testimony about the challenges of having four babies in one assignment,” she added.
Neither HNA nor Kapi‘olani provided Hawaiʻi Public Radio with a specific, desired ratio or matrix. However, Kapi‘olani suggested HNA wants a fixed ratio of nurses to patients, but Kapiʻolani wants more flexibility in assigning patients to nurses.
“When you look at a health care system, being so complex, every patient is not the same. So, when you're talking about a ratio, a fixed ratio, that says that every patient is identical and that the care they need is the same every time and the type of care they need would be the same," Kapi‘olani COO Gidget Ruscetta said.
“We're asking for the ability so that the nurses can work with their managers and they can assess multiple times a day the types of patients they have," she added.
Ruscetta said Kapiʻolani’s matrix is partly based on information from the American Nurses Association, and the Association of Women's Health, Obstetric and Neonatal Nurses.
Some of the other sticking points in contract talks revolve around filing the “Unsafe Staffing” reports and mandatory overtime for nurses.
Kapiʻolani said it has offered HNA “across-the-board” raises for all registered nurses and additional pay that would make them “among the highest paid experienced nurses in the state.”
By the contract’s third year, RNs would earn a base salary of $133,000 to $160,000 for a three-day workweek. Kapiʻolani said the offer also includes “a generous benefit package, bonuses and incentive pay.”
Kapiʻolani said it is also amenable to including a matrix in the new contract. It said its offer “provides the ability to adjust based on the individual conditions and needs of patients, which can change multiple times throughout the day.”
Agas-Yuu was pleased that there has been an agreement to include a matrix at all. She said it could be the first of its kind for health care providers in the state.
However, she said HNA still wants to make sure the matrix numbers would work for nurses throughout the length of the contract.
Why are nurses locked out of the hospital?
Nurses scheduled to work on Saturday showed up at 7 a.m. — but were not allowed in the doors.
That's because Kapiʻolani decided to impose a lockout of all HNA nurses. The hospital said union nurses aren’t allowed back to work until HNA “unconditionally” accepts its contract offer.
The lockout started on Saturday, Sept. 14., and will last indefinitely. Kapiʻolani said traveling nurses will provide care while HNA nurses are locked out.
It’s thought to be the first time in Hawaiʻi’s history that a hospital’s management has imposed a lockout of nurses over disputes in contract negotiations.
Kapi‘olani's CEO said the unusual move is meant to bring an end to the ongoing contract differences.
“I want to be really clear that the lockout is not because it was this strike. The lockout is in place to get an agreement. … They gave us the notice that they’ll have a one-day strike. (On Saturday) we'll start a lockout. Under the National Labor Relations Board, a union has the right to call a strike under that law. That's their right to do. That same law gives the employer the ability to have a lockout," Ruscetta said.
In response, HNA filed an unfair labor charge against Hawaiʻi Pacific Health and Kapiʻolani, which is an HPH facility, with the NLRB on Sept. 6. It’s asking for an injunction to stop the hospital’s lockout.
HNA is calling the lockout another form of retaliation for filling out the staffing forms.
U.S. Rep. Jill Tokuda was at Friday’s strike in support of HNA nurses. She decried Kapiʻolani’s decision to lock out the nurses.
“I can tell you that when I heard about the lockout, that hit me hard. Those, to me, are very aggressive mainland kinds of tactics. At the end of the day, we need these men and women to be back where they are, doing what they do really well," Tokuda said.
What's next?
Last Thursday, HNA and Kapiʻolani management met in a last-ditch effort to reach a contract agreement. The two sides failed to agree, setting the stage for both the strike and the lockout.
HNA marched to HPH’s offices on Tuesday, Sept. 17, and union leadership said more contract negotiations were planned for this week.
Meanwhile, the nurses will continue to be locked out of Kapiʻolani. A decision hasn’t yet been made on HNA’s injunction to stop the lockout.
Gov. Josh Green's office said the state has been contacted about possibly intervening in contract negotiations. In a statement provided by the office, Hawai‘i Attorney General Anne Lopez said, "No legal basis, however, gives the governor the authority to intervene, even when requested by one party, in negotiations between a private union and a private employer."
“Should both parties however formally request his assistance, the governor can certainly offer support through mediation to help facilitate an agreement. He has shared with me he would like to see the strikes and lockouts end for the good of all,” Lopez said.
