Wilcox nurses rally behind new state report about need for, benefits of safe staffing

When the nurses of Wilcox Medical Center in Līhu‘e went on strike in January to protest unfair labor practices, they hoped to raise awareness about the need for safe staffing ratios at the Hawai‘i Pacific Health hospital and the health inequities faced by Kaua‘i’s residents.

Wilcox nurses began negotiations May 6, 2024, with hospital administration and still have no agreement in sight, with safe staffing ratios continuing to be the major point of disagreement.

A new Hawai‘i Legislative Research Bureau report — “Time for Triage: A Summary of Best Practices, State Requirements and Successful Efforts to Reduce Nurse Staffing Shortages” — documents the need and benefits of safe staffing, and the nurses at Wilcox are rallying behind its findings.

The report dives into existing nursing staffing standards and regulations in other states, includes a literature review of best practices for staffing and workforce development and discusses successful efforts by other states to address the nursing workforce shortage.

Input was received from a spectrum of stakeholders such as Hawai‘i Nurses Association, Hawai‘i Center for Nursing, Hawai‘i Department of Health, Hawai‘i Government Employees Association and University of Hawai‘i at Mānoa Nancy Atmospera-Walch School of Nursing.

The bureau also reached out to the Healthcare Association of Hawai‘i, which testified against legislation mandating safe staffing for nurses.

It’s noted in the report’s executive summary: “There appears to be a consensus that nurses who are assigned to fewer patients have better patient outcomes and experience preferable employment conditions.”

“It really doesn’t make sense to us,” said Amy Steward, a Wilcox nurse for more than 17 years and member of the Hawai‘i Nurses Association Wilcox bargaining team, adding the hospital’s administration hasn’t given nurses any reasons why they won’t agree to a lower nurse-to-patient ratio in the Med-Surg Department. “We have shared the research that lower ratios literally save lives. Hawai‘i Pacific Health has lower nurse-to-patient ratios in all their O‘ahu hospitals. It’s baffling why they won’t agree to well-researched health policy.”

In addition to helping patients, safer staffing ratios also benefit nurses.

Retention issues, burnout and high turnover rates are leading contributors to national nurse shortages. Attrition rates are especially high among newly licensed nurses.

A 2012 study found roughly 30% of new nurses left their jobs within the first year; up to 57% left within the second year. They reported experiencing low job satisfaction based primarily on heavy workloads and an inability to ensure patient safety.

Other states have taken a variety of approaches to achieving safer staffing ratios:

• Nurse staffing ratios established by law.
• Staffing committees to establish nurse staffing ratios.
• Requirements to have at least one nurse on duty.
• Public reporting of nurse staffing levels.
• Team nursing strategies.
• Prohibitions or restrictions on nurse overtime.

The report also noted there is no clear evidence that one approach or particular combination of approaches is the most effective. However, it sheds light on how critical better nurse staffing ratios can be.

Studies have demonstrated outcomes improve when nurses are assigned to attend to fewer patients, and the report adds when nurse staffing ratios are higher, patients generally experience shorter hospital stays, fewer complications, fewer readmissions and less risk of death.

“No one on Kaua‘i or anywhere else in our state should be left behind when it comes to the standard of care they receive when they go to the hospital,” said Hawai‘i Nurses Association president Rosalee Agas-Yuu. “Safe staffing is about safeguarding the health of everyone in Hawai‘i and no one should receive a lower standard of care just because of their ZIP code.”