Nurses unions, legislators, others join forces to ensure safe patient care standards in Hawai‘i

A coalition of the state’s 3 nursing unions, representing more than 5,000 nurses, along with state lawmakers as well as labor and community leaders joined forces and locked arms Thursday at the state Capitol in Honolulu in support of critical legislation aimed at ensuring safer hospital staffing and patient care.

They made sure their voice was united, loud and clear, rallying around a core message that there is an urgent need for reform to improve patient care and strengthen the state’s health care system.

“In recent months, all of us as separate unions have taken on fights for safe staffing, and today, for the first time, we are uniting to make history in Hawai‘i,” said Hawai‘i Nurses Association Rosalee President and registered nurse Agas-Yuu. “This is what it’s about — safe staffing for all, not just one union or one hospital. We are a united front, fighting for every resident and every patient in the state of Hawai‘i to have safer care.”

Patients also shared personal stories, only underscoring the importance of nurses having manageable workloads so their patients receive the dedicated care they need and deserve.

Registered nurse and president of Hawai’i Nurses and Healthcare Professionals Terilyn Carvalho said staffing challenges directly impact the quality of care patients receive.

“Safe patient-to-nurse ratios save lives and empower nurses to advocate for what’s best for their patients,” said Carvalho. “Nurses are at the forefront of patient care, spending more time with patients than anyone else on the health care team.”

Agas-Yuu’s, Carvalho’s and other coalition members’ rally cries rang out while 159 nurses at Wilcox Medical Center spent their final day on the picket line as part of a 3-day strike.

The walkout came after the latest round of negotiations between Hawai‘i Nurses Association, which represents the nurses, and management at Wilcox, a Hawai‘i Pacific Health hospital and the largest medical center on Kaua‘i, failed to reach an agreement regarding better patient-to-nurse staffing ratios.

Many states mandate patient-to-nurse ratios.

Hawai‘i health care workers continue to face systemic challenges that compromise patient outcomes, and the unions urge lawmakers to prioritize safe staffing laws during their 2025 legislative session, which began Wednesday.

Studies have shown every patient added to a nurse’s workload increases patient mortality rates by 7%.

Legislation proposed by state House Majority Leader Rep. Sean Quinlan of O‘ahu, called the Hawai‘i Safe Staffing Proposal, would enhance patient safety and quality of care by establishing enforceable patient-to-nurse ratios, ensuring transparency and improving accountability in hospital staffing practices.

“By addressing the root causes of burnout and staffing shortages, we are ensuring that every patient receives the care and attention they deserve,” said Agas-Yuu. “After years of fighting for change, we are finally seeing progress that puts patients at the center of health care reform.”

Key provisions in Quinlan’s proposed measure include minimum staffing ratios tailored to hospital units, mandatory nurse-led staffing committees and oversight by the Hawai‘i Department of Labor and Industrial Relations to enforce compliance and address violations.

Supporters say it will save lives, lead to improved nurse retention and reduce nurse burnout, with flexibility for emergencies to maintain care standards.

They also say the legislation would make the statement that Hawai‘i prioritizes a patient-centered health care system.

“My support for this legislation goes beyond my duties as a representative,” said Quinlan. “As a father and a community member, I believe that every patient in Hawai‘i deserves the same standard of care. That is why I am sponsoring this legislation to create a safer and more supportive environment in our health care system.”

There was no legislation called the “Hawai‘i Safe Staffing Proposal” or referencing patient-to-nurse ratios introduced by Quinlan as of Thursday night, according to a list of bills introduced on the Hawai‘i Legislature website.

There was, however, a bipartisan House measure relating to nurse staffing at the state’s health care facilities regarding nurse-to-patient ratios.

House Bill 62 was prefiled Jan. 13. It was introduced Thursday by O‘ahu Republican Rep. Kanani Souza, O‘ahu Democrat and House Majority Whip Rep. Amy Perruso as well as Moloka‘i/Lāna‘i/Kaho‘olawe/East Maui Democrat Rep. Mahina Poepoe.

The bill also passed first reading Thursday.

HB 62 would implement a minimum number of registered nurses a facility must staff at all times during every shift based on the number of patients laid out under various circumstances, including at least 1-to-1 patient-to-nurse care in critical or intensive care and operating room settings.

The bill also calls for the Hawai‘i Department of Health to make sure health care facilities would be complying with staffing ratios.

“When our keiki or kūpuna enter a hospital, we shouldn’t have to worry whether a nurse will be available to give them the attention they need for their recovery or to identify symptoms that require immediate intervention,” said University of Hawai‘i Professional Assembly AFT Local 6625 Executive Director Christian Fern during Thursday’s rally. “That’s what we pay for.”

Registered nurse and president of United Nurses and Health Care Employees of Hawai‘i Charmaine Morales said with safe staffing practices such as enforceable ratios and safety committees in place, Hawai’i would ensure every patient got the time, attention and care to which they are entitled.

“Patients are at the heart of everything we do,” said Morales about the state’s nurses. “Our nurses are here for every patient, every time.”

News reporter Nathan Christophel contributed to this story.