Hundreds of unionized health care workers at Maui Memorial Medical Center walked off the job Monday morning, the first day of a planned, three-day strike.

The United Nurses and Health Care Employees of Hawaii, representing more than 900 workers at Maui Health, said talks with their employer broke down Friday evening over safe staffing ratios.

The two parties did not resume talks scheduled for Saturday and Sunday.

“This is historic,” said UNHCEH Chair Matt Pelc of the 7 a.m. showing Monday. “Maui has never had 900 walk off the job before, and nurses have never gone on strike before at this hospital.”

Hundreds gathered in front of Maui Memorial in Kahului for a Hawaiian blessing, then picketed along the sidewalk, wielding signs that said “ULP (Unfair Labor Practice) Strike” and “Safe Staffing Now!”

They had been preparing to strike, mainly over better wages and benefits, wage equality with other Kaiser facilities, and safe staffing.

Safe staffing must be on the table, the union said, in order for meaningful progress to continue with contract negotiations, which have been ongoing since July. Their contract ended Sept. 30.

Pelc said safe staffing has been a No. 1 priority for the union since “Day 1” but that management flat-out refused to discuss it.

“We told them Friday if we don’t move on staffing, we aren’t going to talk until the strike is over,” he said. “They’re being told from someone up top that they don’t want staffing in the contract. If they refuse to put it in the contract, that’s a no-go.”

Without addressing it, he said, departures will only continue, and the burnout rate is “through the roof.”

“This (Maui Memorial) is the only acute-care facility on the island,” said Pelc, who works as a CT tech. “The people who come here, they’re our friends and our family. We want to provide the best care for our people, and if the CEO doesn’t want to provide that care, we’re going to fight until we get the care we deserve.”

Strikes at Maui Memorial, Kula Hospital and Lanai Community Hospital are scheduled to continue until 7 a.m. Thursday.

Maui Health, meanwhile, assured patients that its hospitals, emergency departments and clinics remain open to serve patients and will remain open for the duration of the strike.

“We have comprehensive plans in place to ensure the best care for our patients, residents, and the communities we serve on Maui and Lanai,” said Maui Health in a statement posted online, “including a temporary workforce of experienced nurses and health care professionals who will work with the rest of our health care team, for as long as needed. Patients should not let strike activity deter them from seeking care.”

Maui Health said the two parties had successfully reached over 25 tentative agreements and that the current offers on the table are strong and highly competitive.

The current offer includes across-the-board wage increases of 18% over four years, in addition to other base wage rate and step increases for individual job classifications.

Maui Health said it is also offering a differential, or a higher pay rate, for all union members at seven and 15 years. A differential is also being offered to nurses earning a bachelor’s or master’s in nursing as financial incentive for continued education.

But union members said safe staffing and patient care come first and that higher pay, while certainly welcome, does not address this underlying issue.

UNHCEH contends that it simply wants the same ratios that have already been granted to workers in the Kaiser California contract, such as 1-to-1 for emergency trauma and 1-to-2 for critical care.

Melissa Robinson, union co-chair, said she was particularly disappointed because a breakout group of union nurses and nurse managers, plus the chief nursing executive, actually had ironed out an agreement based on types of patients.

“Over several days and many hours, we sat and we hashed out safe staffing ratios,” said Robinson, a registered nurse. “In the end we were all in agreement.”

But when those ratios were included in the union’s proposal, management returned it with that entire section crossed out.

At Maui Memorial’s emergency room, nurses continue taking on more patients, she said, without as much support staff, so hospitals can save money.

“This is about our community, ultimately, and our community deserves to get nurses that are not spread too thin,” she said. “Nurses will miss things if they have too many patients. This is a protection for the community as well as the staff. It’s very important.”

Staffing ratios remain a flashpoint of controversy between nurses and hospital administrations across the U.S.

Hospital management argues that mandated nurse staffing standards remove “real-time clinical judgment” and the flexibility needed to determine the level of care for individual patients.

Many say the mandates come with unintended consequences that could result in closures or patients being turned away.

National Nurses United says bedside nurses face moral distress and job dissatisfaction because hospital employers fail to protect them on the job and provide them with staff and resources needed to give safe care.

Many leave bedside nursing or the profession altogether to protect themselves, their licenses and their patients, NNU said, while hospital profit margins continue to grow.

The Hawaii Nurses’ Association also advocated for safer nurse-to-patient ratios as a top priority during its negotiations with Kapi‘olani Medical Center, which lasted for more than a year.

The conflict resulted in two strikes, a lockout by management and the arrest of 10 community activists for alleged obstruction of the hospital entrance. With the help of federal mediators, a settlement was reached in October.

HNA also represents nurses at Wilcox Medical Center on Kauai and at The Queen’s Health System on Oahu who are pushing for safer staff ratios in their new contracts.

“We have left the door open,” said Pelc. “When they’re ready to address staffing, we’ll be there.”

Additional bargaining sessions are scheduled for mid-November through December.