Nurses strike continues at Wilcox Medical Center with staffing ratios as sticking point

The 159 nurses now on strike at Wilcox Medical Center, the largest medical center on Kaua‘i, say five minutes of delayed care can be a matter of life and death.

That is why they are striking, after the latest round of negotiations between the Hawai‘I Nurses’ Association and Wilcox management failed to reach an agreement regarding better staffing ratios of nurses to patients.

The three-day strike began at 7 a.m. Tuesday and is set to conclude early Friday morning.

Wilcox Medical Center and the Hawai‘i Nurses’ Association agree on staffing levels for every nursing area except the medical-surgical unit, according to Jen Chahanovich, the hospital’s president and CEO.

Staffing within the Wilcox medical-surgical unit is indeed the greatest issue at stake, said Jonathan Leibowitz, director of field services for the union. He described the status quo as “significantly worse” than staffing ratios found at hospitals on O‘ahu.

Issues the Hawai’i Nurses’ Association believe would improve nurse retainment and recruitment also remain on the negotiating table, he said.

But some aspects of the negotiations have been agreed upon, including wage increases that are similar to those in the agreement reached last October between nurses and the administration at Kapiʻolani Medical Center in Honolulu, Leibowitz said.

That agreement gave Kapiʻolani nurses an average 3.5% annual raise for four years, with longevity pay increases for registered nurses with 5, 10 and 15 years experience at the facility, according to Spectrum News.

At Wilcox, nurses are especially concerned about staffing of the medical-surgical unit, which contains 45 beds divided between two floors. Its personnel treat a range of patients of all ages. Cases include pediatric patients, individuals undergoing cardiac monitoring and others recovering from a variety of surgeries or illnesses.

Nurses in Wilcox’s medical-surgical unit now are responsible for six patients at a time, meaning each patient receives about 10 minutes of care per hour. The nurses say this staffing ratio is unsafe, and must be reduced to ensure patients receive an appropriate level of treatment.

But Chahanovich countered Wednesday in a written statement: “Our offer includes staffing guidelines that are based on how sick a patient is and the level of care needed, which can vary throughout the day.

“Since staffing adjustments will be based on individual needs, we are proposing that our medical-surgical nurses each care for up to five or six patients. This aligns very closely with what our nurses are asking for.”

The Hawai‘i Nurses’ Association says it is seeking a ratio of four to five Wilcox patients per nurse. The change would provide patients with an additional two to five minutes of care an hour.

“To put it into perspective, one round of CPR is two minutes,” nurse Steph Cuyo said. “In the two minutes I’m trying to save someone’s life, I have five other people I still have to keep in the back of my mind.”

Cuyo completed her nursing degree at the University of Hawai‘i at Mānoa 15 years ago and has worked at Wilcox ever since. She joined scores of coworkers Wednesday to picket outside the hospital’s main entrance on Kūhiō Highway in Līhu‘e.

“In the two extra minutes that I could have possibly had with that patient, maybe I could have avoided having to do CPR,” Cuyo added.

Others nurses stated two minutes feels much longer to patients who need pain medication or their bedpan changed. It’s also enough time for a patient to slip from a relatively healthy to critical condition.

Wilcox Medical Center is one of four hospitals belonging to Hawai‘i Pacific Health, the state’s largest health care network. More than 4,000 nurses belong to the Hawai‘i Nurses’ Association. The majority of hospitals in Hawai‘i are unionized.

The two entities have been at loggerheads since May.

The new three-year contract with nurses at Kapi‘olani Medical Center, one of three Hawai‘i Pacific Health hospitals in or near Honolulu, was reportedly the first in the state to include enforceable staffing ratios.

A three-day strike at The Queen’s Medical Center in Honolulu was averted early Monday morning, when the Hawai‘i Nurses’ Association and hospital management reached a tentative agreement that also focused on enforceable nurse-to-patient staffing ratios. The agreement at Queen’s, which is not affiliated with Hawai‘i Pacific Health, also included a nearly 17% wage increase over a three-year period.

At Wilcox, no services have been interrupted as a result of the ongoing strike due to a temporary pool of nurses that will keep the hospital fully staffed until striking nurses resume work Friday. A posting for the temporary positions, shown to Kaua‘i Now on Wednesday, advertised occupancy at a luxury beach resort and free tours of waterfalls and beaches.

The union will continue to bargain even after its nurses return to work Friday. Both parties have agreed to connect through a federal mediator for the next few days before meeting in person.

Most nurses at Wilcox work three 12-hour shifts per week while on call, as well. Others maintain five 8-hour workdays. A nurse may work at the hospital for 24 hours at a time.

Nurses assigned to one floor may be assigned patients on other floors. While that’s typical in a rural hospital, according to Cuyo, someone in the labor and delivery unit may lack the training or certifications desired in the medical-surgical unit.

Sonya Balian-Grande, a nurse on the Wilcox bargaining committee, said when nurses are assigned more than four patients, risks of death, readmission or an extended length of stay are increased.

“It’s not that we’re asking for less work to do,” Balian-Grande said. “We’re asking for this in order to save people’s lives.”

Some states have mandated certain staffing ratios at hospitals. A similar bill will come before the Hawai‘i State Legislature this session.

Shelby Banach was born in 1993 at Wilcox Medical Center. Her mother had been studying to become a nurse when she died.

Banach decided to also go into nursing and after earning her degree in 2022, she went to work at Wilcox to care for the community in which she was born and raised.

“I came here to take care of our patients, and we can only give them a small percentage of our time per shift,” Banach said.

She continued with a catch in her voice: “It really is disheartening, and we can get really emotional about it.”

Nurses at Wilcox see in their patients ʻohana, a word that means family: Aunties, uncles, grandparents and children.

“We’ve made it work for so long, because we are resilient, and that’s just how we are on Kaua‘i,” Banach said. “But enough is enough, and we need to make changes.”