Hundreds of unionized nurses Tuesday morning held signs in front of three hospitals across Oahu, eliciting honks from passing cars, as they called for safer staffing levels.

The informational picket was held simultaneously in front of The Queen’s Medical Center on Punchbowl Street, The Queen’s Medical Center-West Oahu campus, and Kapi‘iolani Medical Center for Women & Children to demonstrate unity as nego­tiations for their contracts continue.

The No. 1 issue?

Safer staff-to-patient ratios, according to Hawaii Nurses’ Association President Rose Agas-Yuu, which are critical for patient safety.

When nurses are assigned to care for too many patients, they are less likely to detect critical changes in a patient’s condition, she said, compromising quality of care. Hospitals need to ensure this does not happen.

“As you know, from Kapi‘o­lani, that’s been our priority through this whole negotiation process,” said Agas-Yuu. “Interestingly enough, (nurses at) Queen’s feel the same way. Wilcox is also negotiating at this time, and it’s also a forefront issue. It’s turning out to be a statewide issue.”

HNA represents about 600 nurses at Kapi‘olani, which held a weeklong strike in January before returning to the bargaining table.

The contract for nurses at Kapi‘olani expired Dec. 1, and negotiations with parent company Hawaii Pacific Health have been ongoing since mid-­September. The contract for close to 2,000 nurses at Queen’s expired June 30, with negotiations having commenced in mid-April.

Nationwide, other nurses unions are also pushing for better ratios, with some success. Many hospitals, however, are pushing back, saying that mandated ratios can strain health care systems and potentially delay care or result in turning away patients.

Queen’s picket

At Queen’s downtown, nurses dressed in yellow union shirts lined Punchbowl Street, holding signs that said, “Safe Staffing for All” and “Make Bedside Nursing Great Again.”

Paul Silva, a registered nurse at Queen’s cardiac ICU, said patients benefit from nurses who are well rested instead of overwhelmed, and who have a reasonable number of patients to care for at one time.

“I came from a hospital in California where we had patient ratios, and it’s a lot safer for patients,” he said. “Not only that, but nurses would actually take their breaks.”

Nurses often end up going without breaks due to staffing shortages, he said, or working beyond their 12-hour shifts.

Emily Siebeneck, a registered nurse at Queen’s Emergency Department, held a sign that said, “Unsafe Nurses Equals Unsafe Patients.”

“We are fearing for our patients so greatly because we’re overwhelmed,” she said. “It doesn’t matter how many patients we have in the ED. We can have 85, we can have 50, we can have 40 — we’re going to have the same number of nurses, so we are spread so thin taking care of critical patients.”

In the emergency department, she said, safe levels of staffing are crucial for the unpredictable, constantly changing care nurses there provide.

She has seen colleagues burn out and leave the state to pursue better opportunities.

Both say the situation was challenging when the COVID-­19 pandemic began and that staffing shortages and working conditions seem to have only gotten worse.

Queen’s issued a statement saying its top priority is to be the best place to give and get care.

“We are so proud of and grateful for all of our patient care staff, including our valued nurses and we are working constructively with the HNA to reach an agreement that upholds our commitment to promote the safety, well-being and profession of our nurses,” said Linda Puu, Queen’s senior vice president and system chief nursing officer, in a statement.

“We respect our nurses’ right to participate in lawful protected activities such as their scheduled informational picket,” she continued. “Our pledge throughout these negotiations has been to bargain in good faith to reach a mutually acceptable agreement that provides wage increases and other improvements that support our nurses and their profession.”

To date, she said, the two parties have reached agreements on 19 areas of the contract.

Meetings continue

Staff-to-patient ratios have continued to be a sticking point between HNA and Kapi‘olani.

HNA is not backing down from its push for limits on the number of patients nurses care for during a shift.

HPH hospital administrators, however, have said previously that these ratios are a one-size-fits-all approach that take away the flexibility to adjust to changing needs and are ultimately not the answer to easing health care workforce shortages.

Gidget Ruscetta, chief operating officer at Kapi‘olani Medical Center, said the hospital administration has held 27 bargaining sessions with the union to date.

The next meeting is scheduled for Thursday.

“We continue to listen to our nurses and are open to discussions in our negotiations,” said Ruscetta in a statement. “We are committed to reaching an agreement as soon as possible so our nurses can benefit from the improvements our offer would provide. While this has been a long process, we appreciate that our nurses and our entire health care team continue to work together at Kapi‘olani Medical Center for Women & Children for our patients and community.”

Agas-Yuu, a veteran nurse at Kapi‘olani, said safe staffing also means being provided with the training to care for patients nurses are assigned to, and she looks forward to discussing this further with hospital management.

The nurses at Queen’s have picketed alongside their colleagues at Kapi‘o­lani and are watching to see what happens. At Queen’s they are also pushing for pay that matches Hawaii’s high cost of living.

The pay needs to be compared with the rest of the U.S. market, they said, citing a recent WalletHub survey that ranked Hawaii last out of all 50 states in annual nursing salary when adjusted for cost of living.

With better working conditions and pay, more nurses will stay in Hawaii hospitals, they said.

Victoria Ogasawara, a registered nurse at Queen’s with 37 years of experience under her belt, said she is grateful to be retiring in another year or two.

Situations were more manageable in earlier years, she said, but for a young nurse starting out today, staffing ratios are very poor, putting them and patients in a dangerous position.

“We don’t want pizzas, we don’t want meal tickets,” she said. “We want to be respected for evidence-based practice, and we want to have safe ratios for patients and staff. When they talk about burnout, it’s very real.”