Kapi'olani Nurses Show Up to Defy Lockout, Are Turned Away

CRAIG T. KOJIMA / CKOJIMA @STARADVERTISER.COM Nurses held signs Saturday morning outside Kapi ‘olani Women’s and Children’s Medical Center after receiving a lockout notice.

1 /2 CRAIG T. KOJIMA / CKOJIMA @STARADVERTISER.COM Nurses held signs Saturday morning outside Kapi ‘olani Women’s and Children’s Medical Center after receiving a lockout notice.

CRAIG T. KOJIMA / CKOJIMA @STARADVERTISER.COM Union nurses were barred after arriving at Kapi ‘olani Women and Children’s Medical Center at 7 a.m. Saturday. Hawaii Nurses Association President Rosalee Agas-Yuu, at the center, and the nurses were told by hospital officials they could not enter.

2 /2 CRAIG T. KOJIMA / CKOJIMA @STARADVERTISER.COM Union nurses were barred after arriving at Kapi ‘olani Women and Children’s Medical Center at 7 a.m. Saturday. Hawaii Nurses Association President Rosalee Agas-Yuu, at the center, and the nurses were told by hospital officials that they could not enter.

CRAIG T. KOJIMA / CKOJIMA @STARADVERTISER.COM Nurses held signs Saturday morning outside Kapi ‘olani Women’s and Children’s Medical Center after receiving a lockout notice.

RELATED PHOTO GALLERY Hundreds of unionized nurses who showed up at the entrance to Kapi ‘olani Women’s and Children’s Medical Center Saturday morning to defy management’s lockout were turned away as planned.

Shortly before 7 a.m., the nurses, some in full scrubs, gathered on the lawn and marched in procession toward the gates to return to work the next day, but were met halfway by Troy Branstetter, Kapi ‘olani’s vice president of general services, informing them they could not enter due to the lockout.

There were no skirmishes or confrontations, and Honolulu police were present but did not disrupt the procession.

“We’re ready to work,” said Rosalee Agas-Yuu, president of the Hawaii Nurses Association. “We want to go there for our patients, but if Kapi ‘olani says they don’t want us to go there, we want to hear it from you personally, because these nurses are dedicated to their patients. They’re dedicated to this hospital.”

Agas-Yuu continued: “I want you to tell us to our faces and say, ‘Thank you very much,’ that you don’t want us to be here to take care of our patients who need us, who we know need us right now.”

She was referring to a letter emailed Friday night by Kapi’olani CEO David Underriner, reiterating that the lockout would occur at 7 a.m. Saturday unless HNA unconditionally accepted the contract offer presented Monday.

This has been communicated repeatedly over the past nine days, he wrote, adding that any directive from HNA asking nurses to report to work “would be misleading, intentionally disruptive and serve no legitimate purpose.”

Agas-Yuu thanked security for not bringing him down, stressing that the attempt was “against people” and that nurses are not violent.

The nurses then returned to the streets to hold what the union called a protest, a rally to wave signs, most of which read “Illegal Lockout.”

Some nurses were visibly moved and in tears as they marched. Some used their smartphones to record and share the historic moment on social media.

Kapi ‘olani Chief Operating Officer Gidget Ruscetta said the hospital reached out to the union early this morning, before the lockout, to reiterate its willingness and availability to meet.

“This is a difficult situation for all of us here at the medical center,” she said. “We want our nurses back at the bedside of their patients. We always have. Again, the union has the power to end this lockout and it’s in their hands.”

She said the union had not yet responded.

Friday’s one-day strike marked the second time this year that about 600 Kapi’ Olani nurses represented by HNA walked off the job. In January, they staged a.

The January strike was the first at Kapi ‘Olani in nearly 50 years, and nurses were allowed to return to work from morning to night. The lockout, unions say, is an unusual move and the first of its kind in Hawaii’s history.

Agas-Yuu acknowledged that the dispute has evolved into what she called a “different battle,” potentially impacting all union workers in Hawaii.

“It’s not just about the nurses at Kapi ‘olani anymore,” she told the Star-Advertiser. “It’s about the workers in Hawaii. Every worker who goes through negotiations now raises the question of whether this is acceptable.”

Friday’s strike was called to protest an unfair labour practice, she said, that was management’s retaliation against nurses who filled out safe staffing forms. It was also meant to counter alleged management intimidation tactics, she added.

Management denies any retaliation or intimidation.

Since the strike was called to protest an unfair labor practice, HNA claims the lockout is illegal and has filed a complaint with the National Labor Relations Board. The board’s decision, however, is still pending.

In addition, the union denounced the imposition of an indefinite lockout – in effect an ultimatum – until a contract is accepted unconditionally, particularly when it denounces dangerous nursing practices.

The nurses were also told that their employer’s health coverage would end if they did not return to work by October.

In a pep talk to union nurses after being denied entry, Agas-Yuu said there is strength in numbers and that “money will not win, hearts will win.”

Last Friday marked one year since negotiations began between Kapi ‘olani and HNA. The union has been working without a contract since December, and the lockout applies to all registered nurses represented by HNA whose contracts expired on November 30.

Kapi ‘Olani leaders said that during the lockdown, a temporary team of trained nurses will keep the hospital running at full capacity.

Staff-to-patient ratios The union and hospital management continue to disagree over proposed nurse-to-patient ratios, with the former saying there must be limits on the number of patients assigned to nurses at one time, particularly in intensive care units.

The conflict is playing out across the United States, with nurses’ unions demanding the limits, saying they are overburdened and the measures are necessary for patient safety.

The chronic nursing shortage has worsened across the country due to the exodus caused by the COVID-19 pandemic. By some estimates, America will run out of full-time registered nurses by 2025.

Hospital leaders have responded by saying fixed ratios have failed to address staffing shortages, do not allow managers to adapt to the changing dynamics of patient needs and lead to unintended consequences such as closures.

Hospitals are absolutely committed to patient safety, said Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, a nonprofit trade group.

Nursing managers already make decisions about patient-to-staff ratios every day, he said. Those decisions are based on the severity of patients’ illnesses, staff availability and experience and many other criteria. A “fixed ratio” doesn’t adjust for all of those variable factors.

“There are a wide variety of factors,” he said. “You can’t just look at the number of patients and say it’s ‘x,’ and then it’s ‘y.’ That’s not how hospitals and care work.”

Paul Silva, a registered nurse in the cardiac intensive care unit at Queen’s, disagrees.

Silva, who joined the protest Saturday to support the Kapi ‘Olani nurses, said he has seen their effectiveness in California, where they are mandatory.

“We also negotiated on patient ratios,” said Silva, who is part of HNA’s negotiating team for Queen’s, which represents about 2,000 members. “We want to see that in our contract, but Queen’s doesn’t want that.”

Nurses are overworked with too many patients at once, he said, and they are demanding dedicated break nurses so they can actually take their breaks without passing patients to their colleagues. Breaks are often skipped.

“Unfortunately, Queen’s management is very similar to Kapi’olani,” he said. “They don’t give in. We want to take care of our patients safely. That’s all.”

Negotiations have been ongoing since mid-April. HNA’s contract expired on June 30.

More states are adopting hospital staffing laws in an effort to improve patient safety and reduce nurse burnout, according to Chartis, a health care consulting firm.

At least three states — California, Massachusetts and Oregon — have mandated nurse-to-patient ratios, and a handful of other states are considering them as well.

About 15 states, including Washington, have adopted staffing requirements laws, ranging from the creation of a nurse-led staffing committee to public reporting requirements for staffing. Some hospitals may also have nurse-to-patient ratios.

A bill introduced in the state Legislature this year, with specific numbers for emergency rooms, intensive care and other services, did not survive.