The Kauai County Council unanimously passed a resolution “urging the Hawaii State Legislature to Implement Safe Nurse-to-Patient Staffing Requirements for Hospitals” during its Kauai County Council meeting on Wednesday.
“The council passed the resolution unanimously,” a nurse from the group of nurses at the Wilcox Medical Center said following a morning where testimony on both sides of the patient-ratio issue were presented. “That is the main sticking point in our contract negotiations. It’s not wages. We’ve been working without a contract for nine months now.”
The resolution authored by Councilmembers Fern Holland and Bernard Carvalho aligns the council with the Hawaii Nurses’ Association, OPEIU Local 50 in endorsing passing legislation to require safe patient-to-nurse ratios in Hawaii’s acute care hospitals, according to a HNA flier that was being circulated at the meeting.
“Hawaii Nurses’ Association supports a state-wide standardization of nurse staffing by requiring all of our acute care hospitals to follow maximum patient-to-nurse ratios,” the flier stated. “Patient-to-nurse ratios are proven to improve quality of care, reduce negative health outcomes and readmissions for patients, and improve job satisfaction for nurses.”
Michelle Gonsalves has been a Registered Nurse at Wilcox Hospital for 30 years, having worked as a “Med Surg nurse, a Labor and Delivery nurse, and currently a Same Day Surgery recovery nurse.” She said her sister is also a nurse at Wilcox.
“I take care of my family and my friends every single day I work,” Gonsalves said. “On any given day, a member of my family is being cared for at Wilcox. I hope for safe staffing at Wilcox Hospital for my family, my nursing family, and for my entire community. It matters to me. I ask for our County Council, and our entire Kauai community to stand with us nurses as we ask for safe staffing ratios to be made into law in the state of Hawaii.”
“We have pled with Wilcox Hospital and Hawaii Pacific Health for safe staffing ratios,” the nurse said. “They have not listened to our pleas. Now, we are pleading with you, and pleading with our law makers, with our legislators, for the safety of our loved ones. We need someone to listen to our pleas.”
Gonsalves said there are repeated studies that show that safe staffing ratios of 1-to-4 reduce mortality, ensure less complications, improve outcomes, and up patient satisfaction. She said safe staffing ratios increase nurse recruitment, and nurse retention.
“HPH claims that Wilcox does not need safe staffing ratios because ‘patients on Kauai aren’t as sick as patients on Oahu,’” she said. “We, as nurses at Wilcox, have to continue to care for our patients; sometimes as we wait for life flight. We are caring for patients in critical condition waiting for life flight as we still care for five other patients.”
A spokesperson for Hawaii Pacific Health said the contract negotiating teams from both sides continue to have meetings with a mediator.
“Wilcox understands the intent of the Resolution, as we also truly value our nurses and the vital role they serve as part of our care team” said Jen Chahanovich, the CEO of Wilcox Medical Center in written testimony. “We care for our nurses and acknowledge that the statewide housing crisis and rising cost of living have added to the difficulty of making ends meet in Hawaii not only for our nurses but for all workers across our islands. This is why Wilcox has presented an offer to our nurses that includes across-the-board wage increases that would bring nurses’ base salaries to $138,000 to $161,000 for a 3-day work week by the end of the contract. In addition to this base salary, we are offering pay incentives and a generous benefits package. The rates we are offering would make our nurses amongst the highest paid in the nation. Our offer also includes a flexible staffing matrix based on national standards, and an opportunity for our nurses to have an ongoing role and voice in determining staffing adjustments for ever-evolving patient needs.”
“Mandated, fixed nurse staffing ratios are an ineffective approach in that it assumes all patients are the same and require the same level of care,” Chahanovich said. “Considering Wilcox’s patient population, we need to be flexible to ensure access to quality health care. We also need the ability to adjust staffing to care for patients awaiting transport to Oahu for services not available on-island or for a higher level of care, since we are dependent on an external flight service which is also responsible for providing air transport for the entire state.”
After going through the drawbacks of fixed staffing ratios established by statue, Chahanovich said, “What we believe is needed are ratios that are clinically informed in collaboration with nurse staffing councils that tailor staffing to specific care settings and patient acuity as well as refer to guidance by comparable national standards at every unit level.”
“We are already demonstrating our ability to work directly with our nurses to develop care plans with medically informed nurse staffing standards that are specific to all units and the needs of our patients through our collective bargaining agreements,” Chahanovich said. “We have already deployed efforts around many of the recommendations in the Legislative Reference Bureau study authorized by HCR No. 87 SD1 entitled ‘Time for Triage: A Summary of Best Practices, State Requirements, And Successful Efforts to Reduce Nurse Staffing Shortages (2024).’
“We also believe that ensuring safe nurse staffing will be best introduced through workplace innovations to advance nursing practice and relieve workforce burden that were also recommended from the LRB study,” Chahanovich said. “We are looking forward toward introducing innovations such as virtual staffing support options, changes in the health care team models, novel evidence based innovative solutions including decreasing the documentation burden on nurses, as a means of addressing the challenge of shortages in health care professionals.”
“However, none of these collaborative improvements can be done in the face of a law requiring a certain number and type of staff regardless of the circumstances of care and acuity of patients,” Chahanovich said. “A one-size-fits-all approach would do more harm than good as it removes the needed flexibility to operate, which will negatively impact care.”
“As Wilcox is currently in the process of negotiating its labor contract, the introduction of statutory provisions during these negotiations would establish an inappropriate precedent that would have far-reaching implications across the continuum of care in our state,” she said.
As a former employee who experienced an injury that was directly related to showery staffing, I am extremely disappointed in HPH and Jen Chahanovich’s response to safe staffing ratios. While HPH stresses a “3 day work week”, what they don’t say is that their RNs are working 12.5-14 hour days, often with out adequate breaks. While they stress flexible staffing and incentives, they don’t say that flexible staffing. Means working short when I’ll calls occur, or a labor delivery Rn being forced to care foe post op or med surge patients while caring for newborns and their mothers. Or, where a med surge nurse already caring for high acuity patients are being forced to take on the care of new borns and mom. When the “overflow” floor is opened, it is often staffed with one nurse and a PCA (if available) . Those 2 staff people are on their own, with no back up, no breaks.
A staff ratio of 6:1 vs 5:1 can be a matter of life and death. So, let me put this question to MS. Chahanovich; Where are you when your RNs are short staffed? Do you actually assist the nursing staff? Are you walking through the units to assess the well being of staff and patients? If you or your loved ones were a patient at Wilcox, would you have more confidence knowing your RN had 4other patients, or was caring for 5 other patients. Knowing that you would probably only have your RNs full focus for 10 minutes each hour? With a staff ratio of 6:1, you would be allotted 120 minutes of care out of 720 minutes on a 12 hour shift. Do the nursing staff stop caring for you or your family when you have met your allotted 120 minutes? Of course not.! However, this seems to be how you and other HPH management look at the situation. Another point; we all knew/know that when HCAPS and patient satisfaction scores decrease, the blame is placed on the RNs and PCAs. Never management for cutting staff.
Wilcox hospital has some of the most skilled and highly sought after nurses in the U.S.A. Why wouldn’t Wilcox management and HPH seek to keep them and maintain safe staffing ratios? It is not a matter of money, (Kauai has higher cost of living than other islands) this is about patient safety and the well being of the citizens of Kauai.
So, if this is about money, HPH should take a look executive salaries and bonuses, reshuffle and cut at the top, to provide for a more stable base which is their medical staff and RNs.
No matter what the outcome, Wilcox RNs are going to strive to provide the best care possible.