The new year is off to a start with two potential nurse strikes as negotiations drag on at both The Queen’s Health System on Oahu and Wilcox Medical Center on Kauai.

The Hawaii Nurses’ Association announced enough votes over the New Year’s holiday to authorize strikes among union nurses — first at The Queen’s Health System and its two campuses in downtown Honolulu and in West Oahu, then at Wilcox Medical Center on Kauai.

Though no dates for the strikes have been set yet, the union wants to send a strong message of its frustration with management, according to HNA President Rosalee Agas-Yuu.

Both looming strikes are over what the union says are unfair labor practices during the course of negotiations, which have been ongoing with Queen’s since mid-April and with Wilcox since early May.

A key sticking point with both hospital systems remains over safer nurse-to-patient ratios, according to Agas-Yuu, just as it was during negotiations with the Kapi‘olani Medical Center for Women &Children.

This is a pivotal issue across the state and U.S., she said, and will be as overburdened nurses continue to leave the profession or go elsewhere.

“We’ve talked about this many times,” she said. “Since COVID there were a lot of changes, and nurses have been working really hard to make things work. Now they’re getting burned out and people are leaving. We’re saying, ‘Hey, we need to stop this and try to keep our local nurses in Hawaii.’”

It’s about ratios that allow nurses to give patients quality care as if they were family members, she said, rather than “just barely care.”

Hospital management has pushed back against the concept of fixed ratios, saying they do not effectively address staffing shortages or allow for the flexibility needed to address patients’ changing needs, and could result in unintended consequences.

Agas-Yuu said talks at Queen’s broke down when the union’s proposal for safer staffing ratios seemingly made progress the past few weeks and were then abruptly reversed.

HNA is filing a charge of regressive bargaining at Queen’s, along with failure to take the nurses’ proposals seriously.

Queen’s responded that despite 43 bargaining sessions with HNA, “we still do not have clarity on what the union truly wants” and that “unfortunately, it feels like HNA has set its sights on a strike, steering its members in that direction.”

“We deeply regret the uncertainty this situation creates for our community,” said Queen’s Chief Nursing Executive Linda Puu in a written statement. “Queen’s serves the sickest and most vulnerable patients in Hawaii. We take this responsibility seriously and find it disheartening that our nurses are being led down a path that could negatively impact them, their families, this prestigious institution, our patients, and the mission of our Founders, King Kamehameha IV and Queen Emma.”

According to Puu, Queen’s offer to HNA would make their nurses the highest paid in the state and among the highest paid in the nation.

Queen’s is offering pay raises of 13% over three years, and a nurse with five years of service would earn more than $144,000 annually for a three-day workweek.

Additionally, Puu said safe staffing has always been a priority at Queen’s and that it proposed staffing templates similar to what was offered at Kapi‘olani but that HNA “downplayed this offer.”

Agas-Yuu, however, said this was not the case.

She said HNA has made it clear from the start that staffing ratios are a priority — having published a white paper on the subject as well as holding a joint informational picket at both Queen’s and Kapiolani last summer.

At Wilcox, which is operated by Hawaii Pacific Health, nurses are particularly concerned about ratios in the medical-surgical unit, which treats patients with a wide range of conditions.

“There’s this new trend where they put step-down patients (recovering from ICU) or higher-acuity patients in med-surg, and unfortunately, they also want the nurses there to take on more,” said Agas-Yuu.

The union represents 159 nurses at Wilcox, one of the major hospitals serving Kauai with an emergency department certified as a level 3 trauma center.

She said HPH has “the capacity and resources to fix this problem, as they did for the patients at Kapi‘olani.” Instead, management has been barring off-duty nurses from their worksite to speak with fellow union members.

Wilcox President and CEO Jen Chahanovich expressed disappointment with HNA’s decision but said it remained “committed to reaching an agreement for our nurses, our medical center and our community.”

Agas-Yuu said under the new contract at Kapi‘olani, management is making an effort to maintain agreed-upon staffing standards. While it is still a “work in progress,” she said, nurses there seem happier.

Whereas the union represented about 600 nurses at Kapi‘olani, it represents nearly 2,000 at Queen’s, which is the only level 1 trauma center in the state.

“No one wants a strike,” she said, but many of the nurses felt it was the only way to be heard.

Puu of Queen’s said, “We don’t view this as a win-or-lose situation. A strike jeopardizes the health and safety of our community unnecessarily, especially when our offer already addresses safe staffing and places our nurses among the best compensated in the nation.”

The union’s next bargaining sessions are set to resume with Queen’s on Tuesday and with Wilcox on Thursday and Jan. 10.