Kapi‘olani Medical Center for Women & Children and the Hawaii Nurses’ Association reached a tentative contract agreement today after over a year of contentious negotiations and on the 18th-day of the hospital’s lockout of roughly 600 unionized nurses.

The tentative deal came five days after two federal mediators rejoined the negotiations at the urging of Gov. Josh Green earlier in the week. Negotiations that began at noon Monday lasted through 2 a.m. today, and continued again this afternoon.

“We are pleased to reach a tentative agreement with the Hawaii Nurses’ Association,” Kapi‘olani Chief Operating Officer Gidget Ruscetta said in a statement released at 4 p.m. “This agreement reflects a year of negotiating, listening to our nurses and incorporating their priorities into this contract. As we await the voting results, we look forward to the day our nurses return to the bedside to care for our patients.

In a post on Instagram, HNA celebrated the tentative agreement, saying, “Kapi‘olani nurses have just made history.”

HNA President Rosalee Agas-Yuu said the nurses were overjoyed to have reached a tentative agreement, with a nurse-patient staffing ratio being the biggest accomplishment.

The union’s social media post said the deal included “the first contractually enforceable nurse-to-patient ratios in Hawaii history.”

However Ruscetta said, “Staffing has been a priority throughout these negotiations. Instead of fixed ratios, we and HNA agreed on flexible staffing levels, which allow us the flexibility to adjust care for our patients’ needs.”

The union said nurses would vote to ratify the contract today and are expected to return to work Sunday.

“This contract sets a new standard for what quality patient care will look like for our community,” HNA said in the post. “Hawaii deserves the best health care, and Kapi‘olani nurses were willing to fight to make that a reality. Joined by our patients, families, union siblings, and community supporters, we fought for what was right and refused to give in.”

Green said he was pleased to hear the news.

“It’s very encouraging to hear that the nurses and leaders at Kapi’olani have reached a tentative agreement that will get our trusted nurses back to work with the patients they love, once the nurses ratify the deal,” the governor said in a statement. “Our nurses are super and our hospitals are top notch. As I’ve said, they are an ohana and will be working together forever.”

“We will continue to find ways to repay nursing education debt, and support hospitals by funding improvements to their facilities so that everyone in Hawaii has the best healthcare in our country,” he said.

Kapi‘olani has been paying traveling nurses to replace staffers 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. Management had insisted the nurses would not be allowed back to work until their union “unconditionally” accepted the company’s latest offer.

Pressure on both sides to settle had been building over the last week.

On Sept. 22, the family of a Kapi‘olani patient, 4-year-old Ava Agbayani who died Sept. 17, held a public memorial and candlelight vigil at Ala Moana Beach Park. The child’s parents said they believe diminished care by the hospital’s temporary nursing staff was a factor in their child’s death.

A day later, Honolulu police arrested 10 union supporters for alleged obstruction of a public passageway after they blocked large, charter buses transporting the traveling nurses from entering the hospital’s main entrance driveway. Those cited and arrested outside the hospital included recently elected state Rep. Kim Coco Iwamoto, Democratic candidate for state House Ikaika Hussey and John Witeck of the Hawaii Workers Center.

On Sept. 24, Green and state Attorney General Anne Lopez sent letters to Kapi’olani executives and HNA leaders urging them to work with a federal mediator to help break the negotiation stalemate. A federal mediator had worked with both sides earlier in the year but could not broker a deal and left the talks.

As gestures of goodwill, they suggested Kapi‘olani extend health benefits for union nurses beyond the end of September, and that HNA ensure no services would be disrupted to move both parties forward.

Two federal mediators rejoined the talks Thursday after both sides agreed to the governor’s suggestion.

The nurses have been working without a contract since December. Negotiations over a new three-year contract began in September 2023.

The union has been pushing for minimum nurse-to-patient ratios used in other states, arguing that they have been burdened with too many patients at one time, and that these limits are better for patient safety and retention of experienced nurses. They also oppose mandatory overtime.

Administrators of the hospital, which is run by Hawaii Pacific Health, have said management needs flexibility to respond to changing situations as they arise, and that they were working on a “staffing matrix,” which would adjust levels based on patients’ needs from hour to hour. A staffing council of nurses and their managers would enforce the staffing matrix, they said.

Management had also said that by the third year of Kapi‘olani’s contract offer, registered nurses would receive a base salary of between $133,000 to $160,000 a year for three-day work weeks, in addition to bonuses and incentive pay.

The union countered that the sticking point was unsafe nurse-to-patient ratios, not pay, but also that the three-day workweeks involve 12-hour shifts, sometimes more. They also pointed out that when cost of living is factored in, nurses in Hawaii are not among the highest paid, but the lowest paid, in the U.S.

HNA also said the one-day strike on Sept. 13 was an unfair labor practice strike in protest of retaliation for nurses that were filling out safe staffing forms. An injunction with the National Labor Relations Board protesting the subsequent lockout is still pending.

Kapi‘olani management has said there was no retaliation, and that it has a strong policy against retaliation at the medical center.

HNA also represents about 2,000 nurses at The Queen’s Health System, who are also negotiating a new contract and pushing for safer nurse-to-patient ratios.