Five hospitals: What's at issue

Research by Dan Nakaso
Advertiser Staff Writer

More than 1,400 nurses are striking at three of Honolulu's so-called Big Five hospitals — the Queen's, Kuakini and St. Francis medical centers — and nurses at Kaiser and Kapi'olani medical centers are voting to ratify contracts. The Hawai'i Nurses Association negotiates separately with each hospital, but the contracts historically have run for three years and expire at the same time. Some of the top issues in contract talks:

Queen's Medical Center

• Wages: The hospital's proposal would increase nurses' job rate with two years' experience from the current $60,549 a year to $74,173 at the end of the three-year contract. Salaries for nurses' job rate plus 15 years of experience would increase from $62,629 to $80,413 at the end of three years.

Nurses say that the only wage progression improvement is a $1-per-hour increase for nurses at the 15-year mark.

• Paid Time Off: Queen's officials want to institute a program that combines sick, holiday and vacation programs. Nurses would accrue up to five extra vacation days for not using sick days and could "sell back" up to 80 hours of unused paid time off each year and donate hours to fellow employees. Nurses would not lose any sick leave they currently have. Nurses want to tie acceptance of paid time off to their concerns on sick leave and mandatory overtime.

• Mandatory overtime: Hospital officials say nurses at Queen's average 95 hours of overtime per year — one-third less than the national average. Nurses say mandatory overtime is worsening.

• Medical Retirement: Queen's proposed a subsidy toward medical, drug or dental coverage for retirees of $8 per month per year of service for the first two years of the contract. In the third year of the contract, coverage would increase to $11 per month per year of service. Queen's officials also proposed increasing the employer contribution to the 401(k) plan from 3 percent to 4.5 percent. Nurses say the hospital proposed a total revision of retirement benefits.

Kuakini Medical Center

Hospital officials would not comment on contract issues.

• Mandatory overtime: Nurses say they want to reduce mandatory overtime, which they say the hospital routinely uses to staff units.

• Nurse-to-patient ratio: Union leaders are seeking a patient-acuity system that would require the hospital to staff according to the amount of care necessary for the patient's medical condition. The union says the hospital currently determines staffing only by the number of patients in a unit.

• Work shifts: The union says some 88 nurses work a 36/48-hour shift pattern. This means that in one week, they work three 12-hour shifts and then work four 12-hour shifts the following week. In the week with 48 hours, they get eight hours of overtime. The nurses say the hospital wants all of them to go to either 36- or 40-hour weeks, which would eliminate overtime. The union argues that the 40-hour combination does not work for 12-hour shifts (unless nurses work an odd four-hour shift); the 36-hour week would cut nurses' annual income. Nurses say the change would lose more than 2,000 hours of nursing care in a hospital they say is already short-handed.

• Retiree medical benefits: Union leaders say they want a new medical plan, with drug coverage and a significant hospital contribution toward premiums. They say the hospital's best offer was for access to medical plans in a group separate from active employees, which would have led to expensive premiums.

St. Francis Medical Center

• Wages: St. Francis would not divulge offer. Union leaders say the hospital is proposing a 4 percent wage increase, and decreases to the employer's share of medical insurance premiums.

• Length of contract: The hospital offered a one-year contract with a "reopener" after the first year. Nurses want another three-year contract.

• Medical benefits: St. Francis is proposing to pay 90 percent of single coverage and 90 percent of family coverage. Nurses want St. Francis to pay 100 percent of the cost of single coverage and 90 percent of family coverage.

• Care Managers: The hospital is proposing to eliminate "Care Manager" positions but is offering the registered nurses to remain in day shift positions with their current differential. The union says the hospital wants to eliminate Care Manager positions without replacing those nurses who perform direct patient care and other duties.

• Working conditions: Nurses say they work long hours and care for more patients than they feel they can handle safely. They say nursing units are chronically understaffed and vacant positions go unfilled.

Kaiser Medical Center
(Tentative agreement reached)

Hospital officials would not comment on contract issues.

• Wages: Under the tentative agreement, the union says wages would rise 21 percent over the three-year life of the contact. Experienced nurses would see additional improvements in the second and third years. Nurses with seven years of experience would get $1 more per hour in the second year of the contract. Those with 15 years at Kaiser would be paid an additional $1 per hour beyond that, beginning with the third year. About 75 percent of clinic nurses would have wage parity with hospital nurses and the remaining clinic nurses could opt to assume additional duties to reach the higher rates.

• Working conditions: The tentative agreement includes new health and safety language.

• Safe staffing: The tentative agreement offers new staffing language, including a process for developing what the union says are "realistic" patient classification and acuity systems, incorporates staff nurse and union input, and references American Nurses Association staffing guidelines.

• Retiree medical benefits: Nurses sought fully-paid retiree medical coverage, including a drug plan. The tentative agreement does not include fully-paid coverage but offers improved benefits and two options for retiring nurses.

Kapi'olani Medical Center for Women and Children
(Tentative agreement reached)

Hospital officials would not comment on contract issues.

• Wages/Benefits: The tentative agreement gives a 22 percent wage increase over three years, maintaining the increase of $1 per hour for nurses with seven years' experience and adding a 15-year increase of another $1 in the third year of the contract. The tentative agreement also offers full-time benefits for nurses who work 36 hours per week, increased differentials, and a new level of health benefits for the employee plus one family member.

• Staffing: Because Kapi'olani's staffing needs change on a regular basis because it has so many specialized areas, hospital and union officials agreed to "float" nurses by designated units and provide a differential for those nurses who float.

• Retiree medical benefits: The tentative agreement provides a partial contribution to retirees between ages 62 to 70. Only nurses who will be age 45 by April 1, 2003, are eligible for the benefit and only if they retire with 20 years of service. To get the benefit, union leaders said they agreed to revamp overall retirement benefits and switch the emphasis of employer contributions from a defined benefit pension plan to the 403(b) tax-deferred savings plan.