Staffing issues spur strike

By Robbie Dingeman
Advertiser Health Writer

Nurses walking the picket lines at three O'ahu hospitals point to staffing issues — mandatory overtime, vacation and sick leave — as the main motivating factors that sent them out on strike this week.

The hospitals look at staffing levels, working conditions and generous pay raises that have been offered and see a reasonable overall package.

Because both sides are standing firm, the strikes could drag on. No new negotiations have been scheduled.

Strikes began for some 600 nurses at St. Francis Medical Center and Kuakini Medical Center on Monday morning and on Tuesday for more than 800 nurses at The Queen's Medical Center, the state's largest private hospital and trauma center. Nurses voted to accept a contract at Kapi'olani Medical Center yesterday, and a vote on a settlement agreement with Kaiser Permanente is scheduled later this week.

While the Hawai'i Nurses Association is negotiating separate contracts with issues unique to each hospital, staffing issues overall are a growing concern in the industry.

Queen's neurology nurse Aleli Daligdig said a big issue for her is a proposal to combine sick leave and vacation into one pot called "paid time off," or PTO. She sees that as meaning, "every time you call in sick, you're using your vacation," Daligdig said.

But nurses would only tap their vacation in certain circumstances. Under the proposal, nurses who use no sick leave in a year would receive five additional days of vacation, and nurses who call in sick fewer than five days a year also end up with additional time off. Nurses out for one or two days at a time would be charged vacation leave, but those out sick for three days or more would be charged sick leave. Someone sick for a series of one- or two-day absences would continue to eat into vacation days.

If the goal is to discourage the potential abuse of sick leave, Daligdig believes fewer nurses would call in sick if hospitals had more nurses on duty. "If we have enough staffing and we're not burned out, people would not be calling in sick so much," she said.

But managers say that having the PTO system can help to reduce so-called mandatory overtime because it means that there are fewer unscheduled absences that have to be covered. Many hospitals require employees to work overtime to ensure patient safety, but that is another staffing issue that many debate.

Queen's has uniformly been at or above staffing levels set by the American Nurses' Association, said Dr. Peter Halford, Queen's chief of staff. Queen's officials say that the staff nurse vacancy rate is at 5 percent, compared with 15 percent in California and a national average of 13 percent.

Halford, who isn't part of the hospital's negotiating team, doesn't see management giving up on the PTO issue and fears the strike will drag on. "They're never going to let that go. It's too important to them. They are sick and tired of people calling in sick randomly," he said.

Because the hospital is now operating with traveling nurses, managers and non-union employees, and not paying the striking nurses, those costs are saved for the time being. And that takes pressure off of management to agree to conditions that they don't like.

Halford said he has a hard time understanding how a pay package regarded as generous by both sides was rejected. "The pay hike is considerable, that's why we were awestruck," he said.

Queen's management has described the pay package that was voted down as including raises that averaged about 25 percent over three years. And Halford is wondering how the expense of paying the temporary nurses as much as a reported $1 million a week will affect any pay package the nurses could eventually receive. "This is going to be so costly," he said.

Kerry Lineham, a nurse for Kuakini for the past 10 years, said "It's not about money," but about benefits and working conditions.

"We actually said that we would take less money if they would address the other issues," he said.

Lineham said Kuakini nurses want a medical retirement plan that the employer would pay a share of, "like a yearly stipend." And they want to reduce the amount of mandatory overtime and have suggested ways to do that, including giving voluntary overtime first, calling people who volunteer to be on-call, and/or hiring agency nurses.

The overtime policy now means that after 12-hour shifts, the hospital can require nurses to work an extra four hours. "And you get pretty tired nurses after 16 hours," Lineham said.

At Kapi'olani, mandatory overtime was a big issue three years ago in negotiations, but both labor and management suggested changes that seem to work there.

Gail Lerch, vice president of human resources and marketing for the medical center's parent company, Hawai'i Pacific Health, said both sides worked together to help reduce the forced overtime. And they did it using exactly the alternatives Lineham cited.

"We have a standby program and we have on-call so we certainly ask for volunteers first," Lerch said, noting however that each hospital has different issues and different priorities. "Each side comes with issues that are very important to them," Lerch said. "And then it becomes a trade-off at the table as to the give and take of what either party will give in exchange for dropping something else."

Lerch thinks both sides appear committed to their issues, prolonging the stalemate.

At Kapi'olani, nurses being required to "float" among different units was a key issue, Lerch said. To respond, management agreed to limit the number of units people are required to report to and are trying to refine the process.

At St. Francis, Blaine Southward has worked as a nurse for eight years, where he helps care for kidney patients who need dialysis treatments.

Southward sees the labor dispute as prompted more by issues such as nurse-patient ratios than by salary. "I think it's a general dissatisfaction with management practices," he said.

He sees people concerned primarily about nurse-patient ratios and medical retirement benefits. He said retirement is an important means to retaining experienced workers.

Southward wants to see an increase in staffing "so the nurse-patient ratio would be at safer level." Generally, he believes the union members made the right choice to not compromise on certain issues.