The union nurses at Kapi‘olani Medical Center for Women &Children on Wednesday ratified a new, three-year contract that was ironed out after more than a year of negotiations with management.

Approximately 600 nurses had until 6 p.m. Wednesday to vote, with 98% voting to ratify the contract.

The new contract was agreed upon after two strikes, a lockout by management and two rounds of negotiating efforts with federal mediators. With the assistance of two federal mediators in the past week, both parties finally got to the finish line.

Hawaii Nurses’ Association President Rosalee Agas-Yuu said nurses were overjoyed with the new staffing matrix both parties agreed to after yearlong efforts.

“The nurses are very happy with it,” she told the Honolulu Star-Advertiser. “Over the year, it’s been talked back-and-forth up to the last day or two. Even the accountability — that language was so important — and we finally got agreement.”

Nurses are expected to return to work Sunday and look forward to returning to their patients, she said.

Agas-Yuu said the agreement includes the first contractually enforceable nurse-to-patient ratios in Hawaii history, and thanked the community and fellow unions for their support.

“We identified what we feel is important for each unit to work with,” she said. “We don’t expect it to be perfect from day one. It’s going to take time, and we’ll make sure everybody’s aware.”

She said HNA would be happy to release more details on the agreed-upon matrix after the ratification.

Kapi‘olani Chief Operating Officer Gidget Ruscetta said both parties agreed on “flexible staffing levels” — and not fixed ratios.

A staffing council made up of Kapi‘olani nurses and nurse leaders will meet monthly to address staffing issues and review the staffing matrix annually.

“We are pleased our nurses voted in favor of this contract,” said Ruscetta in a news release. “Fixed ratios are not the answer. As a result of our collaborative efforts in negotiations, our nurses will now be a part of the staffing process so we can all work together to adjust to our patients’ needs. With these agreed upon flexible staffing levels, we can focus on our patients and the ever-changing needs in our medical center.”

The agreement includes across-the-board raises that average out to 3.5% annually over nearly four years, plus longevity pay increases for registered nurses who have five, 10, and 15 years of experience at Kapi‘olani.

In addition, Kapi‘olani said it would use an innovative tool to determine scheduling needs for each unit and remain committed to ongoing nurse recruitment and retention programs.

“This has been an emotional process for all of us at Kapi‘olani, and we are ready to move forward, together,” she said in the release.

Both sides credited federal mediators for helping to move the negotiations forward.

Ruscetta said, “Federal mediation played an instrumental role in the final steps of reaching this agreement. We were always a proponent of having a neutral third party involved. We encouraged it early in our talks and again in the last few weeks of negotiations.”

“We were very lucky to have two federal mediators,” said Agas-Yuu. “I believe they did make a really big difference.”

Tensions between the two parties had escalated to a new high on Sept. 23, when Honolulu police arrested 10 union supporters for alleged obstruction of a public passageway after they blocked charter buses with traveling nurses from entering the hospital’s driveway.

Those cited and arrested outside the hospital included recently elected state Rep. Kim Coco Iwamoto and Democratic candidate for state House Ikaika Hussey.

Hussey on Wednesday congratulated the Kapi‘olani nurses on the new agreement.

“Their victory is good for workers and for all of us who value high-quality health care,” he said in a written statement. “In the long-term, we need to address the basic economic model of health care in our islands. The drive to turn key elements of our island life — health care, energy, food, housing — into Wall Street-friendly enterprises is contrary to our local values, and drives up the cost of living here in our home. Mahalo to the workers at Kapi‘olani for standing up for us all.”

The push for safer staffing ratios, meanwhile, continues to be part of negotiations for other hospital union employees in Hawaii.

HNA also represents about 2,000 nurses at The Queen’s Health Systems who are negotiating a new contract, with safe staffing ratios being a top concern. Their contract expired June 30.

The United Nurses and Health Care Employees of Hawaii continues negotiations today with Maui Health for a new contract covering about 1,000 registered nurses, physical therapists and others that work at Maui Memorial Medical Center and other clinics.

Their contract expired on Monday, and negotiations have been ongoing since July.

Nearly all union members voted weeks ago to authorize a strike, according to Greg Wilson, a negotiator for UNHCE.

The nurses are advocating for safer nurse-to-patient ratios similar to ones at Kaiser Permanente hospitals elsewhere and equitable wages and benefits across the system.

“We’re going to do everything we can to avoid having to go on strike,” Wilson said. “But our members have a key role, and one of the key roles is (to be) patient advocates rather than just health care workers. If we are not able to advocate for our patients, if they don’t listen to us at the bargaining table, then we’re going to be forced to have them listen to us by other means.”