In the 1850s, Hawaii plantation laborers were subject to strict laws that bordered on slavery. Indentured servants who were absent from work or refused to work could be apprehended by a police officer and coerced to do extra work for their employer. If they ran away, they could be jailed and sentenced to hard labor until they gave in.
While we may find the grave injustices of Hawaii’s past abhorrent, it is bewildering to see the same terrorizing culture and menacing practices today being allowed at Hawaii hospitals, including Hawaii Pacific Health and The Queen’s Health System.
The nurses represented by the Hawaii Nurses’ Association have raised the important issue of safe nurse-to-patient ratios. It’s been a topic of concern for many states, which have taken action to address this issue with laws mandating staffing ratios.
The 25 top-paid modern-day lunas of Hawaii Pacific Health, whose compensation total more than $27 million, according to their 2023 Form 990, hide behind their “legal” right to lock out their nurses and strip them of their health insurance for candidly speaking out about unsafe staffing conditions and for protesting against their unfair labor practices.
Our elected officials have, by their words and actions, condoned this behavior. These government leaders claim it is not their kuleana to intervene. This past legislative session, legislators said their hands were tied and could not get involved in a labor contract issue and told us to work it out at the bargaining table. That hasn’t worked.
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Now Gov. Josh Green, our health care governor who emerged as a hero during the pandemic because he was able to successfully navigate conflict, has suddenly turned his back on Hawaii patients and has chosen to blend into the wallpaper.
Health care reform is not easy. Hospitals don’t want to face reality or listen to their frontline, customer-facing nursing staff. Instead, hospital leaders attempt to divert attention from the core issues. They claim mandated staffing ratios are impossible to implement.
Nurses have pulled back the curtain and have given up their jobs and paychecks because they want the community to heed their warnings. Continuing the status quo does not work. Studies have shown that when registered nurses are forced to care for too many patients at one time, patients are at higher risk of preventable medical errors, avoidable complications, falls and injuries, increased length of hospital stay, higher numbers of hospital readmissions and mortality.
Inadequate staffing also creates a vicious cycle. A 2024 study identified insufficient staffing as the leading reason detecting changes in a patient’s condition are delayed or missed. This leads to adverse outcomes for patients, causing Hawaii nurses to flee to states that have mandated staff ratios. This further reduces the pool of available nurses.
Hawaii nurses are tired and are pushed to their limits day after day. This can lead to patient harm that can be prevented with better staffing. In a recent full-page print ad, Kapiolani proudly noted it hired more than 100 new nurses last year. However, disclosing the attrition rate would provide a clearer, accurate picture of hospital staffing.
Hawaii can look to California and the 10 other states that have adopted innovative staffing solutions. Employment of nurses grew significantly faster in California compared to other states after its nurse-to-patient minimum ratio law was implemented. Without being stretched to care for too many patients, job dissatisfaction and burnout correspondingly decreased. With fewer patients entrusted to their care, nurses can detect changes in patient conditions earlier, improving care.
The question before all of us is what kind of care do we want for our children, family and friends when they are in the hospital.
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Editor’s note: The hospitals’ view on patient-staff ratios ran Thursday.
Rosalee Agas Yuu has been a registered nurse at Kapiolani Medical Center for Women and Children for 32 years and is president of the Hawaii Nurses’ Association, which represents 4,000 health care workers.
