Nurses at Kapiolani Medical Center for Women & Children have voted to authorize a strike about six months into bargaining for a new contract in the midst of the COVID-19 pandemic.

The Hawai‘i Nurses’ Association OPEIU Local 50, which represents the hospital’s nurses, said in a statement today that 93% of the nurses voted to authorize a strike, which they characterize as a show of the “high level of frustration among the nurses.”

The union said an unprecedented 96% of the hospital’s 725 nurses showed up to vote over the three-day voting period, which ended at midnight Saturday.

The union said nurses are now making plans for a strike, with more details expected later this week.

“The nurses have spoken. It is very clear they feel the hospital has left them no choice but to take this action to protest Kapiolani management’s disregard for our concerns and the hospital’s continued unfair labor practices,” said Daniel Ross, president of the Hawai’i Nurses’ Association. “We hope this serves as a wake-up call to Kapiolani’s management.”

While it’s clear from the union vote that Kapiolani nurses are not satisfied with the hospital’s latest contract offer, a ratified strike vote does not necessarily mean that a strike will happen. Unions often use strike votes as negotiating tools to demonstrate the seriousness of their requests, especially at pivotal negotiating points.

The vote to authorize a strike comes in advance of Wednesday’s scheduled meeting of the union, the hospital and a federal negotiator.

The hospital already has presented “a last, best, final offer.”

HNA, which represents 4,000 nurses in Hawaii’s major health care providers throughout the state, said that Kapiolani Medical Center “has been demanding its nurses pay a higher percentage of their health care premiums and be satisfied with zero to below-average wage increases.”

The union said other issues not addressed in the management’s “last, best, final offer” are nurses having to intermingle with both COVID-19 and non-COVID-19 patients during their same shift; and nurses being required to reuse N95 masks, even though Hawaii Pacific Health, the parent of Kapiolani Medical Center, is the only hospital system that reuses N95 masks instead of discarding them after a single use.

“Kapiolani has continued to generate significant revenue even during this pandemic — on the backs of the nurses, respiratory therapists and other healthcare professionals,” Ross said in a statement. “The management has attempted to diminish our voice and dismiss our concerns by making this all about money, but from the outset of our negotiations, we have said our concerns are much more than about fair compensation, and safety for ourselves and our patients.”

Kapiolani Medical Center CEO Martha Smith refuted the characterization portrayed by Ross.

“For months now, Kapiolani has been dedicated to reaching a collective bargaining agreement with HNA that addresses our nurses’ concerns and is fair to all parties,” Smith said in a statement today. ” We reject any assertion that our team is bargaining in bad faith and remain committed to reaching an equitable and responsible labor agreement in a timely manner.”

Smith said Kapiolani has experienced major declines in patient census numbers since the beginning of the pandemic.

“The loss in volume and patient activity has had a significant financial impact, which is estimated at $21 million for the period from March through October 2020,” she said. “Despite this challenging economic landscape, we presented a fair offer that includes wage increases totaling 5% over the three-year contract, the continued payment of 100% of healthcare premium costs for nurses with single coverage, and many other benefits.”

Previously, Smith told the Star-Advertiser that the hospital’s registered nurses are paid on average $124,000 ($168,480 with benefits), and its recent settlement offer includes wage increases totaling 5% over the three-year contract in addition to paid time off enhancements and the continued payment of 100% of health care costs for nurses with single coverage, among many other benefits.

She also disputed “any suggestion that our PPE practices are unsafe is misleading.”

“We are concerned about the fragility of the supply chain in light of surging COVID-19 case counts across the mainland and the recent rise in cases here in Hawaii,” Smith said. “Our practice to disinfect and reuse N95 masks complies with CDC and manufacturer guidelines, and we know it is effective because we haven’t had any Kapiolani employees test positive for COVID-19 due to an exposure from a patient when these practices have been followed.”

Smith said as a women’s and children’s hospital, Kapiolani has generally not had patients with severe COVID-19 illness like other acute care hospitals in Hawaii.

“Those patients who have been identified with COVID-19 at Kapiolani are typically asymptomatic and released after only a couple of days. We are fortunate that our case numbers have been very low since the start of the pandemic,” she said. “As an example, Kapiolani had only two positive COVID-19 patients in December.”

In the “unfortunate event of a strike,” Smith said the hospital “will take all of the appropriate steps to ensure that patient care at Kapiolani will not be affected and access to quality care will continue without disruption for our patients and the community in the unfortunate event of a strike.”