Nurses form a crucial foundation for the healing industry of health care. And now that industry, in one or more Hawaii hospitals, is itself in need of healing.

About 600 members of the Hawaii Nurses Association and their employer, Kapi‘olani Medical Center for Women &Children, last week settled their long-running standoff with its unionized nurses, who overwhelmingly voted to ratify the three-year pact.

They headed back to work Sunday, ending a turbulent period that included picketers obstructing a hospital entry point and hospital management imposing a lockout starting Sept. 14.

The long-awaited truce was testament to the importance of federal mediation in finding the path to a workable compromise. Among those pressing for intervention by a mediator was Gov. Josh Green.

That nudge proved useful. The Federal Mediation and Conciliation Service, according to its website, can make inroads because the mediator adopts a neutral stance. Others credit its maintenance of private discussions for successes, avoiding publicity that can be counterproductive.

Whatever the reason for the outcome, the hope is that other collective bargaining and management units in health care across this state come away with a balanced understanding.

Yes, the agreement is likely to ripple outward to other entities in the industry, with labor hoping for a similar accord. About 2,000 HNA nurses at The Queen’s Health System are now negotiating a new contract and pushing for nurse-to-patient ratios. At Maui Memorial Medical center, a collective — 1,000-strong, comprising registered nurses, pharmacists, imaging techs and others — is surely contemplating the Kapi‘olani outcome in ongoing contract negotiations there.

But the other takeaway, just as important, should be that ultimately neither side will get exactly what it wants, at least not in the first go-around. Progress has to be incremental, especially because the health-care sector of the economy faces enormous cost pressures.

The Kapi‘olani contract, ratified by 98% of members of HNA voting members, makes some significant strides. Across the board, average raises amount to a 3.5% annual boost in pay over nearly four years.

Perhaps the preeminent complaint is the nurse-patient ratio, and there’s been some movement in the right direction there. A staffing council that assembles nurses and leadership has been instituted to address staffing issues and will review monthly the hospital’s staffing matrix that includes flexible staffing levels.

Management has committed to a more innovative way to determine each unit’s scheduling needs; how exactly that will work is unclear, but this is certainly a conversation that needs to happen on a routine basis.

The matter of adequate staffing is a national one, and the exploration of solutions has only begun. In 2021, the journal Medical Care published what it noted was the first national study to assess alternative policy approaches to increasing hospital nurse staffing.

The study found that a mandated staffing ratio, not surprisingly, had a more significant effect than either establishing a staffing committee or publicly reporting staffing levels, with the idea that better staffing would draw more patients.

That does not mean, however, that the heavy hammer of mandates is the right move. The study also showed that keeping staffing levels at a mandated level also can lead to cutbacks elsewhere in staff, as the hospital works to contain costs.

Health care costs in the U.S. are very high compared to the rest of the developed world, and it is a complex challenge to overcome. Chief Operating Officer Gidget Ruscetta described Kapi‘olani’s specific case as a “journey of healing,” with a commitment to “moving forward with our nurses.” That is, at least, a solid starting point.