Kapi‘olani Medical Center for Women &Children brought in several hundred temporary nurses Sunday to fill nursing jobs after unionized nurses walked off the job and hit the picket line to start a weeklong strike — the first Hawaii Nurses Association strike in about a half-century at the hospital.

Gidget Ruscetta, Kapi‘olani’s chief operating officer, said during a news conference held Sunday afternoon at the hospital, “I am happy to share that our patients are well taken care of. We are fully staffed, and we have no disruption in care. Our emergency department is open, receiving ambulances, and the care is provided for our community,” Ruscetta said.

“This morning for the last couple of hours, we’ve already had 35 people in our emergency room, and we’ve also received ambulances at that time. Our ORs are open, so our operating rooms have already done two emergency surgeries. We are very comfortable, very confident that this workforce is in place for the duration of the strike and we are well taken care of.”

Ruscetta said the critical care areas, all clinical services, the parking garage and cafeteria also remain open.

“All of our services are running,” she said. “No patient care has been affected, and we continue to meet the needs of our patients.”

However, outside the hospital it was hardly business as usual. Along the sidewalks, anywhere from 100 to 350 unionized nurses at the peak were picketing. They were waving signs such as “Safe nurses, safe patients,” “Patient safety first” and “Called heroes, treated like zeros.” A papier-mache nurse and giant rat, which nurses said represented the company, were displayed. Some 50 community supporters also stopped by, and there was a constant cacophony of supportive honks from passing drivers.

Officials with the Hawaii Nurses Association, which represents about 600 nurses at Kapi‘olani, say the strike, which started at 7 a.m. Sunday, will last through 6:59 a.m. this Sunday. More than 90% of the unionized nurses at Kapi‘olani voted to authorize the strike Jan. 5, and the union notified hospital management of the strike Jan. 10. The nurses have worked without a contract since Dec. 1.

Rosalee Agas-Yuu, HNA president and critical care flight nurse since 1993, said, “I love this hospital. It’s hard to strike. However, we want staffing ratios (that set a maximum number of patients a nurse can care for during a work shift) codified into the contract.”

Agas-Yuu said over the past three years, especially after COVID-19, staffing shortages have resulted in mandatory overtime, which is not good for nurses or their patients.

“In the time of a crucial period, they’ll do (the overtime). But day and night in and out, it’s too much,” she said.

Agas-Yuu said the union is concerned that the hospital is grappling with labor shortages and is struggling to retain nurses.

Ruscetta, however, contends that the hospital retains 80% of its nursing staff for more than two years and 75% for more than five years — a rate that she says is better than the industry average.

Contract negotiations have been ongoing since September. Kapi‘olani Medical Center for Women & Children on Jan. 10 and 11 presented what it said was its “last, best and final offer,” which included across-the-board raises and longevity pay but, according to HNA, did not address the staffing ratio concern.

Ruscetta said management understood that one of HNA’s top priorities was wages.

“The wages that we have put on the table for our unionized nurses would make them amongst the highest paid in the state. These are salaries that range between $124,000 to $151,000 a year, and that is for a full-time nurse working three days a week,” she said.

Agas-Yuu contends that the main priorities for the union always have been work conditions and patient care.

“If you talk to all the nurses, they love what they do, but the working conditions are hard for them. Management is utilizing mandatory overtime and on-call,” she said.

Agas-Yuu added that in some departments as many as six nurses at the same time have had to work four hours of overtime on top of their regular 12-hour shifts. Agas-Yuu said nurses working the midnight emergency room shift have a history of working overtime hours.

If adopted, Agas-Yuu said, the ratios would be a first for Hawaii, although similar standards have been adopted elsewhere across the country.

“We have offered staffing guidelines which are different from the hard ratios that the union has proposed, and the difference is flexibility,” Ruscetta said. “We strongly believe that we need the guidelines in place to allow us the flexibility to bring additional nurses in to provide the care that we need for our patients.”

Arlynn Sakamoto, a labor and delivery nurse at Kapi‘olani since 1999, said the strike is hard on nurses and patients.

“One patient came in an hour or two ago and was crying. Her baby was having surgery and she was scared,” Sakamoto said.

Sakamoto said nurses want to be there for their patients, especially those who crave a familiar face. However, she said, the strike is about ensuring that nurses have the kind of work conditions that are needed for good patient care.

“We are in a moment. It’s about time Hawaii nurses get what they need in terms of standards, ratios and wages. It’s time to be heard,” Sakamoto said.

She expressed bewilderment that the bargaining deteriorated to the level of a strike.

“I never thought it would come to this. It’s been about 50 years — the last strike was in 1976,” she said. “But there are not enough nurses. When the traveling nurses come, they can’t believe the working environment. We’ve heard today that the ratios for the temporary nurses are better than the conditions that we have been working under. That’s insulting for those of us on the outside.”

Ruscetta said on any given day, two shifts are run and each shift has 140 nurses. But she declined to provide an exact count or cost for the temporary nursing workforce that was brought in to cover for strikers.

“We have based our temporary workforce on our current staffing levels. Those levels adjust to how many patients we have and how serious their condition is,” Ruscetta said.

Further bargaining is scheduled for Jan. 31 and Feb. 1. Agas-Yuu said she is hopeful that “there is still room to talk.”

“Three years ago the hospital also put out a ‘last, best and final’ offer, and we still negotiated after that,” she said.

If a further breakdown occurs, another strike would not be possible until the union provided the hospital with a 10-day notice.

Ruscetta said the hospital has not received a notice of intent to expand the strike; however, it is prepared to invest to ensure that it fulfills its requirement of care.

“The union made a decision to strike. We did not nor would we ever make a decision to strike. We have a priority and responsibility to this community to care for the children and women in Hawaii and the Pacific Basin,” she said. “When you run a medical center, it doesn’t sleep. You always have to plan. If there was a hurricane tomorrow, if there was a tornado tomorrow, or if there was a tsunami, you have to be ready. We are prepared, and we will activate any of those plans if we need to.”