Hundreds of nurses and health care workers from Maui Health returned to work Thursday morning after holding a three-day strike protesting unfair labor practices.

They marched back to work in unison at 7 a.m., the start of their work shift at Maui Memorial Medical Center in Wailuku. The strike also took place at Maui Health’s Kula Hospital and Lanai Community Hospital.

The United Nurses and Health Care Employees of Hawaii, which represents more than 900 workers, moved forward with the strike after talks broke down Nov. 1 over safe staffing ratios.

“The primary issues remain safe staffing and wages that can retain staff in Maui to care for Maui residents,” said the union in a news release. “The UNHCEH bargaining team have proposed the same staffing ratios that Kaiser agreed to in its contract with RNs in California.”

Over three days, starting at 7 a.m. Monday, the workers walked, chanted and danced on picket lines, calling for what they call fair wages and safe staffing at all three facilities.

They held printed signs that said, “United for Our Patients,” and handmade signs that said, “Safe Staffin, We’re Not Laughin” and “Burnout Caused This Turnout.”

UNHCEH spokesperson Jeff Rogers called the strike “tremendously successful” in terms of member participation and enthusiasm, with support from the community and fellow unions.

Maui Health, meanwhile, kept its hospitals, emergency departments and clinics open during the strike with a temporary workforce.

Maui Health said in a statement that its current offer is strong and highly competitive, with across-the-board wage increases of 18% over four years.

It also offers differentials, or additional compensation, at seven and 15 years, and for nurses earning a bachelor’s or master’s in nursing as financial incentive for continued education.

“We are disappointed the Union chose not to meet for bargaining as scheduled on Sunday; however, we remain available and ready to continue bargaining in good faith, for as long as needed, to reach a fair and equitable agreement,” said Maui Health in a statement. “We urge the union to come back to the table with a willingness to engage and reach an agreement that benefits everyone involved.”

Maui Health said the two bargaining teams have so far made significant progress after meeting 22 times in 15 weeks, with tentative agreements on seniority, hours of work and overtime.

The nurse-to-patient ratios, however, appear to to be what broke down talks Nov. 1.

While a boost in wages was offered, the two parties appear to disagree on nurse-to-patient ratios, which have become a flashpoint between nurses unions and hospital administrations across the nation.

Maui Health said most staffing guidelines the union is suggesting are already in place and that it was working collaboratively on a staffing model that includes them, in addition to putting together a “robust” nurse staffing committee.

“The model gives nurses and nurse leadership authority over managing staffing on a daily basis, and allows adjustments based on the needs of our patients and staff,” said Maui Health. “This flexibility is necessary to ensure all patients will be able to receive safe, quality and timely care.”

Flexibility is necessary, Maui Health said, rather than a “rigid mandate” dictated solely by numbers that the union is asking for.

The union, energized by support from the community during the strike, said safe staffing must be on the table in order for meaningful progress to continue in contract negotiations.

Talks have been ongoing since July. The union’s contract ended Sept. 30.

The union says Kaiser Permanente took over management of Maui Health in 2017, along with promises to elevate care standards, but “has not kept its promises to Maui and Lanai residents.”

Workers at Maui Memorial are covered by separate contracts from other KP health care workers in Hawaii and the rest of the U.S., the union said, and are not only getting lower wages and benefits, but working under lower care standards, resulting in high turnover and chronic staffing shortages.

Maui Health, which describes itself as a not-for-profit organization, said it — not Kaiser — is wholly and financially responsible for employees’ payroll and cost of benefits.

“As a community hospital system, Maui Health employee compensation is market-based, and is governed by the economics of the revenues and expenses of Maui Health in this market,” said Maui Health in a statement. “Kaiser Permanente is a different organization, with its own structure and staffing.”

The union represents more than 900 workers, including registered nurses, physical therapists, pharmacists, imaging techs, admitting clerks, receptionists and more.

The two parties are scheduled to return to the bargaining table virtually Thursday, followed by in-person meetings Dec. 11 and 12.