Nurses counsel patients to pay attention to early warning signs and take care of their health and well-being to avoid costly medical care and the need for drastic intervention.

Unfortunately, hospital leaders failed to heed admonitions when there were clear signs of ill health within their own walls. They ignored personnel issues that have been smoldering for years and erroneously assumed they could continue to operate with immunity. To put it bluntly, they put lining their own pockets ahead of patient care. That’s why today we find ourselves in a dire situation that could have well been prevented.

Recently, the Healthcare Association of Hawaii requested Gov. David Ige to issue an emergency proclamation to address the shortage of health care workers in Hawaii’s hospitals. But if COVID-19 admissions have been down, why are we at the point where we need to issue an emergency proclamation?

We are experiencing the fallout from years of poor management decisions by hospitals that put money before patient safety. Health care facilities have underhired for years to save money. Practices such as not approving a position when an employee leaves if a department budget is in the red, and relying on health care workers to put in overtime to save money are at the root of the situation. It costs a hospital less to pay a worker overtime than to hire another employee with benefits. In the short term it saves a lot of money, but it is extremely short-sighted. The problem only gets worse as health care workers leave due to poor working conditions and excessive overtime. Extreme exhaustion from COVID-19 increased employee departures.

There are many examples from which the public is often shielded. One large Honolulu acute-care hospital has a medical-surgical unit that routinely runs with one nurse per seven patients, even though the accepted norm is one nurse for every four to five medical-surgical patients. This unit has the highest rates of patient falls, workplace injuries, and violence against health care workers within that hospital. It is an unmitigated disaster and hospital management’s inaction shows they don’t care about patient or worker safety. Sadly, it is all about the money for that hospital’s many high-paid executives.

For many years, Hawaii’s nursing schools have done an excellent job of preparing well-educated nursing graduates, but upon graduation they could not find hospital jobs in Hawaii, and had to relocate to the mainland.

In the past year, the hospitals have stepped up hiring new graduates; however, this must be balanced with the need to retain and recruit more experienced nurses for a well-rounded nursing workforce.

The hospitals continue to perform poorly in recruiting and retaining experienced nurses. When the cost of living is factored into the average compensation for a registered nurse, it is lower in Hawaii than anywhere else in the nation. It is no wonder hospitals have difficulty retaining and recruiting experienced health care workers.

The hospitals seem to see the frontline workers as expendable, a budget line item that can be cut to save money, while simultaneously creating new, highly-compensated senior vice president positions.

If truly competitive compensation packages had been offered to frontline workers over the last few years, we would not need an emergency proclamation from the governor.

Hospitals stray from their mission of caring for people when CEOs make multimillions in compensation per year, while refusing to pay competitive wages for frontline workers.

Hospital executives owe it to the people of Hawaii to do better by taking a hard look at themselves and not rely upon government to fix the problems they have created.

Daniel Ross is president of the Hawaii Nurses’ Association OPEIU Local 50.