A third straight day of contract negotiations ended Saturday without resolution between Kapi‘olani Medical Center for Women & Children and the union representing about 600 nurses who have been barred from work for the past week.

Talks between management of the nonprofit hospital and the Hawaii Nurses’ Association began at 10 a.m. and lasted until almost 6 p.m.

After Saturday’s talks concluded, Kapi‘olani Chief Operating Officer Gidget Ruscetta said in a statement, “We are seeing progress and have had productive discussions after three straight days of negotiations with the Hawaii Nurses’ Association. We mutually agreed to meet again tomorrow and remain committed to reaching an agreement.”

Pressure on both sides has been building, with nurses demonstrating at the state Capitol last week while Kapi‘olani pays traveling nurses to replace nursing staff locked out on Sept. 14 after their union held a strike on Sept. 13. The one-day strike followed a weeklong nurses’ walkout in January.

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Parents of one Kapi‘olani patient, a 4-year-old girl who died Tuesday, also have publicly said they believe diminished care by the hospital’s temporary nursing staff was a factor in their child’s death.

Tyson Agbayani first told KITV on Thursday that his daughter Ava was admitted to the hospital Sept. 14, the first day of the lockout, for a cold that later turned into pneumonia.

Ava died three days later after receiving what Agbayani described as a lower level of care compared with past experiences for Ava, who was born prematurely at Kapi‘olani and had chronic lung disease, cerebral palsy and epilepsy.

“She didn’t get the proper care,” Agbayani said in an interview with the Honolulu Star-Advertiser. “I saw nurses there doing the bare minimum.”

Agbayani said Ava and twin sister, Kylie, spent their first 170 days of life in the neonatal intensive care unit at Kapi‘olani and that Kapi‘olani’s nurses knew them well and provided exceptional care, including five times when Ava was hospitalized in 2022.

“We had the best nurses,” he said. “They (Ava and Kylie) were so fragile. They were born at 23 weeks. But we always felt like they were in good hands.”

During Ava’s hospitalization last week, Agbayani said some nurses didn’t seem fully prepared or familiar with the hospital.

“It was just so chaotic,” he said. “I knew it wasn’t supposed to happen like that. We were there enough to know the level of care she was supposed to be receiving.”

Ruscetta said in an earlier statement, “Our heart goes out to this family. We treat the sickest and most medically fragile children in our state and the loss of any child is very painful. We are continuing to investigate and at this time we have no reason to believe that what happened was due to the quality of care at Kapi‘olani Medical Center for Women & Children.”

HNA President Rosalee Agas-Yuu also expressed supportive thoughts and prayers to the Agbayani family.

“All the nurses of Kapi‘olani Medical Center for Women & Children are grieved by the loss of this young child,” she said in a statement. “Our hearts are burdened by the family’s tragic account of what happened at the hospital since we have been locked out. We recognize this is not the time to point any fingers, but we strongly urge Kapi‘olani leaders to seriously consider the offer that the nurses presented to them (Thursday) afternoon. We want to return to work to care for our patients with safe staffing ratios to prevent any more unsafe patient conditions. It’s time for us to move forward as a community.”

The nurses have been working without a contract since December. Negotiations over a new, three-year contract have dragged on for more than a year, and at one point involved a federal mediator. The major sticking point has been staff-to-­patient levels.

Nurses have said that they have been burdened with too many patients at one time, sometimes without adequate training, and that they need ratio limits for patient safety and to avoid mandatory overtime.

Administrators of the hospital, which is run by Hawaii Pacific Health, have said that management needs flexibility to respond to changing situations as they arise, and that they are working on a “staffing matrix” to address the concerns from nurses.

Agas-Yuu said nurses are really focused on the staffing matrix.

Talks today are scheduled to begin around 10 a.m.