ANALYSIS
Dispute reflects healthcare crisis

By Dan Nakaso
Advertiser Staff Writer

The rising tension between Hawai'i's nurses and hospitals that has led to the largest nurses' strike in the state in nearly three decades has grown through a series of events including a global nursing shortage, poor communication and a new union leader who brought in an aggressive attitude that caught hospital officials off guard.

Talks between the Hawai'i Nurses Association and the so-called Big Five hospitals began Oct. 16 and quickly fell apart, with union leaders calling for strike authorization votes just a month into the talks.

The speed of the authorization votes stunned hospital officials. Since then, two hospitals have reached tentative deals with the union. But yesterday, nearly 600 nurses at Kuakini and St. Francis went on strike. And more than 800 nurses at Queen's were to go on strike today.

As leaders on both sides adjusted to the situation yesterday, many said the issues that led to this point reflect a growing global healthcare crisis and longstanding local pressures that have now come to the forefront.

Some of the issues are universal to healthcare, such as cutbacks in state and federal reimbursements that Hawai'i hospitals project will cost them $2 billion from 1998 to 2003. And while nurses with the right skills are in high demand everywhere, many of them are complaining about mandatory overtime, staffing levels, working conditions, health care benefits and pensions.

"The issues the Hawai'i nurses are dealing with ... are very big and very much the same everywhere," said Suzanne Martin, spokeswoman for the United American Nurses, AFL-CIO, in Washington, D.C. "Nurses everywhere are really trying to address and improve their conditions."

Hospitals across the country, at the same time, face rising costs for everything from blood to liability insurance, an aging population and a projected shortage of 800,000 nurses by 2020.

The industry got a little help in August when President Bush signed the Nurse Reinvestment Act that offers financial assistance for nursing students. But in the meantime, one-third of hospitals are losing money, according to Richard Coorsh of the Federation of American Hospitals, and "another third have a very thin profit margin. The other third are getting by."

In Hawai'i's nurses talks, hospital officials have argued with union leaders that not all of the nurses' issues apply to all five hospitals, which negotiate separately for three-year contracts.

"You can raise all of these issues that are being advocated on a national basis," said Kaiser Medical Center spokesman Chris Pablo, "but you have to look at each institution about how they're dealing with them rather than blanket every institution."

Twelve years ago, Hawai'i hospitals dealt with their nursing shortage by flying in Mainland nurses at a cost of $6 million per year, said Rich Meiers, president and chief executive of the Healthcare Association of Hawai'i.

But hospitals no longer can afford to do that, Meiers said.

Hawai'i hospitals and nursing homes are projected to lose approximately $440 million this year because of increasing demands for medical services and falling federal and state reimbursements, according to a report commissioned by the Healthcare Association of Hawai'i.

So the nursing shortage continues today with Hawai'i's programs graduating 120 fewer nurses than are needed to keep up with the annual losses. Many stay while others leave for higher pay, better benefits and even signing bonuses.

Nursing contracts vary widely around the country — depending on region, salary levels and other variables — but Martin said raises generally have averaged 4 percent to 5 percent per year.

Unlike the Mainland, though, Hawai'i's economy struggled during the last decade. And workers have grown weary of hearing "we can't afford it," said William Puette, director of the Center for Labor Education and Research at the University of Hawai'i-West O'ahu. "The economy has been difficult and especially in the last five, six years. After a certain point, saying, 'Not now, not now' isn't going to work anymore, especially if your employer is making money."

But negotiator Sue Scheider pushed the issue too far, Meiers said. Scheider, who arrived in January, opened some of her negotiations by calling for wage and benefits packages that ranged from 40 percent to 70 percent increases over the life of the three-year contracts, Meiers said.

"That's absolutely ludicrous," he said. "The economy can't handle something like that. There's no question our nurses need raises. They're the hardest working people in our hospitals. They do deserve a raise, but that's ridiculous."

Officials at Kaiser and Kapi'olani declined to reveal the increased cost of the salaries and benefits offered to their nurses, since the contract offers have yet to be ratified.

Scott Foster, a spokesman for the union, said: "Sue didn't come in here and stir up all this sentiment. It's here and it's been here. It's like a head of steam and at some point the safety valve's going to blow. ... Sue just happened to come in at a certain time and had the chutzpa to stand up and fully articulate the nurses' concerns."

Scheider's predecessor, Hawaii Nurses' Association director Marian Marsh, was "like your favorite great aunt," Foster said. "When I met Sue, in my own mind I went, 'This is a horse of a different color in personality.' "

Gail Lerch, vice president of human resources at Kapi'olani, is relieved that her hospital reached a tentative agreement with nurses, just as Kaiser did. But there were plenty of things that hospital officials could have done sooner and better, she said.

"The main thing is the hospitals have not done enough to tell our story — what the real status of hospitals and healthcare is in Hawai'i," Lerch said.

Each of the hospitals need to do more of that kind of thinking in the future, Lerch said.

They also need to work with Hawai'i's nursing programs more, talk to students directly and work to train more people for critical nursing skills. "If we do that," Lerch said, "I'm just hoping that we're not going to be in the same situation in three years."

Reach Dan Nakaso at dnakaso@honoluluadvertiser.com or 525-8085.