Holding a strike is never an easy decision. The nearly 600 nurses of Kapiolani Medical Center for Women and Children would prefer to be at the bedside, providing the care our patients need.

But a strike is necessary to create the change the hospital sorely needs. The pending crisis could be averted, if hospital management adopts new solutions.

Our decision to strike was the result of bad-faith bargaining and unfair labor practices.

However, these are symptoms of an underlying issue: the failure of Kapiolani Medical Center’s leadership to keep pace with the changes occurring in the national health care landscape to ensure the successful delivery of care.

The primary concern of the Kapiolani nurses is the nurse-to-patient ratio. Being responsible for the care of too many patients in a shift is dangerous for patients. Nurses cannot realistically and sustainably provide the care and attention each patient deserves. It’s a lose-lose situation for the nurses and patients.

While we recognize assigning nurses to multiple patients keeps costs down and makes for a healthier hospital bottom line, this compromises the care and health of our patients. If provided the right working conditions, more nurses would be willing to work for Kapiolani and this would address the critically important nurse-to-patient ratio issue.

Many have bought into the notion that there is “nursing shortage,” but the facts do not support this. According to the National Council of State Boards of Nursing, there are 4.6 million actively licensed registered nurses in the United States, based on May 2023 data. However, the U.S. Bureau of Labor data shows there are about 3 million nurses who are not currently employed, leaving a net difference of about a million qualified nurses.

The perceived shortage is the result of registered nurses leaving the profession altogether or leaving hospitals and contemplating work in outpatient clinics or doctors’ offices.

Despite the retention challenges, the pipeline is full. The number of nursing school graduates who have passed their licensure exam is steadily growing. Those who have been monitoring nursing trends project that over the next decade, the national registered nurse workforce will not only replace the expected 500,000 retiring registered nurses, but also expand the workforce by nearly 1 million registered nurses.

In a recent full-page print ad, Kapiolani Medical Center proudly noted it hired more than 100 new nurses last year. However, disclosing the attrition rate would provide a candid state of the hospital.

Kapiolani can look to California for innovative solutions. Employment of nurses grew significantly faster in California compared to other states after its nurse-to-patient minimum ratio law was implemented.

Nurses within the state returned to the bedside, and California’s ratios also attracted nurses from across the country, including those from Kapiolani, to practice nursing in a safe working environment.

Without being stretched to care for too many patients, job dissatisfaction and burnout correspondingly decreased. With fewer patients entrusted to their care, nurses can detect changes in patient conditions earlier, improving care. A win-win situation.

Academic research confirms California’s ratios law has improved the quality of health care outcomes for patients, including a decrease in patient mortality. The nurses hope Kapiolani Medical Center’s leaders are open to new solutions. And moms from all over the Pacific facing high-risk pregnancies and babies starting their lives are also counting on them to do the right thing.

The hospital has offered to meet with the nurses on Jan. 31 and Feb. 1, but nurses are willing and available to bargain before the planned strike and ensure these mothers and their children have access to ongoing care.