The union representing health care workers, including nurses at Maui Memorial Medical Center, has ratified a new, four-year contract with Maui Health.

The United Nurses and Health Care Employees of Hawaii, which represents more than 900 workers at Maui Health, said Monday its members voted overwhelmingly to ratify the contract.

UNHCEH said the new contract, which covers Maui Memorial Medical Center, Kula Hospital and Lanai Community Hospital, makes “historic gains” toward goals set out from the start of negotiations — with significant raises for the lowest- paid workers, including clerical staff and receptionists.

Negotiations began July 22, with agreement reached after 26 bargaining sessions between the two parties.

According to the union, the contract offers lowest- paid workers raises of between 27% and nearly 50% over four years.

All union members’ wages will increase at a minimum of 21% up to 97.5% over the life of the agreement, with the highest increases going to per diem workers who also will be offered a differential.

Maui Health said the new contract includes an across-the-board increase of 21% over four years, and a one-time bonus for all union members, plus additional wage adjustments for individual job classifications, longevity pay, preceptor, educational and other pay differentials.

“I want to recognize the tremendous work of both bargaining teams to bring this to fruition and reach an agreement that affords competitive compensation to all job classifications represented across the bargaining unit,” said Lynn Fulton, Maui Health CEO, in a statement. “Our nurses and nurse leaders will continue to collaborate on staffing plans that are dynamic and flexible, ensuring that we can continue to provide exceptional health care to our community.”

The union says it agreed to a comprehensive plan with enforceable staffing ratios, while Maui Health said it agreed to a staffing matrix with guidelines that are aligned with national organizations but that will still be flexible based on patients’ needs.

“Our members fought hard, with a lot of public support, and we won a historic contract,” said Matt Pelc, UNHCEH chair, in a news release. “We won a comprehensive plan to develop staffing ratios and have them enforceable through our contract, a system specific to our hospital that will make Maui Health a safe place to be a patient.”

Pelc, a CT technician at Maui Memorial, added, “We also won lifechanging money for our lowest paid members, so they’ll no longer have to work a second job, will have more time with their families, and we can keep families together here on Maui.”

According to the union, which had been prepared to call for a second strike, the two parties reached a tentative agreement Dec. 20, before the holidays.

Union members had been voting electronically since Thursday — and the majority voted Monday to ratify the contract.

The agreement comes after a historic three-day strike by the union workers in early November, followed by the passage of a Maui County Council resolution later that month urging Maui Health to settle the negotiations.

Maui Health, an affiliate of Kaiser Permanente, had said in previous statements that it was committed to collaborating on a flexible staffing model while being responsive to fluctuating patients’ needs at Maui Memorial, the only acute care hospital serving three islands.

Melissa Robinson, union co-chair and a registered nurse, said a committee of nurses and nurse managers will work together to review ratios for every department based on national guidelines set by entities such as the Emergency Nurses Association and the Association of periOperative Registered Nurses.

The committee, which was already in place, also will address staffing- concern forms on a regular basis, she said, instead of just keeping them on file.

While no fixed ratios are written into the contract, Robinson said there are now guidelines and that grievances can be filed if they are not followed.

“It gives us a benchmark, basically, to be able to say, ‘Wow, we need to stop and take a look at this,’” she said. “This does not mean patients are not going to be taken care of. This just means maybe the hospital needs to hire more staff, maybe the hospital needs to look at the acuity of patients and give us more support staff.”

Robinson added, “For us, it’s about being able to take care of the community and our patients.”

The hope, according to Pelc, is that the higher pay and policies will help more of the lowest-paid workers stay at Maui Health, and improve recruitment and retention.

“We think we’ll have an easier time hiring people now that wages have increased,” he said.

The contract runs retroactively from Oct. 1 to Sept. 30, 2028.