Maui hospital workers union mulls strike over concerns about safe staffing levels

CAT scan technician Mathew Pelc almost quit last year due to short-staffing at Maui’s only acute-care hospital.

He ultimately decided to stay at Maui Memorial Medical Center because he loved the community. But he says plenty of other workers have left in frustration over pay and “unsafe” staffing levels that are pushing his union to consider a strike. 

“Nobody in there wants to go on strike,” said Pelc, chair of the United Nurses and Health Care Employees of Hawai‘i. “It’s not good for the community. It’s not good for our own personal lives. … But we’re not sure management is taking us seriously right now.”

Last month, 495 of the union’s 930 members participated in a call-to-action vote, with 98% voting to authorize taking actions that included a strike if necessary. On Monday night, their contract expired. 

The union’s members make up a large portion of the more than 1,650 employees who work for Maui Health. The Kaiser affiliate took over operations at Maui Memorial Medical Center, Kula Hospital and Lānaʻi Community Hospital from the state in July 2017. 

“Our employees are the very heart of how we provide high-quality and compassionate care,” Maui Health CEO Lynn Fulton, who took over on Jan. 1, said via email on Tuesday. “We value and respect all of our employees and are committed to bargaining in good faith to reach an agreement that honors them and ensures we can continue to provide the care and service our community needs and deserves.”

But hospital employees say changes to staffing policies are burning out workers and putting patients at risk. 

Most of the union’s 930 members work at Maui Memorial, with a few in Kula and on Lānaʻi. The wide-ranging membership includes registered nurses; social workers; physical and occupational therapists; speech/language pathologists; MRI, imaging and mammography technicians; financial counselors; admitting clerks; and receptionists. 

Melissa Robinson, a registered nurse at Maui Memorial and union co-chair, said the hospital’s Emergency Department recently changed the ratios that determine the number of patients a nurse can care for safely. It went from three nurses to a pod — about seven or eight patients — to only two nurses.

After that happened, a critical patient came into the ER who required one-on-one care, leaving the other nurse to take care of six or seven other patients. 

Maui Memorial has one rapid response nurse who can be deployed to the ER or another unit for a critical patient, but once that nurse gets pulled, the duty falls to the ICU charge nurse, who now has to manage their staff as well as answer calls for help in other units, Robinson said.

She works in the ambulatory care center and the post-anesthesia care unit where nurses can have up to two patients. But nurses remain one-on-one with a patient until their airway is stable.

For about three months last year, Pelc said he was the only CAT scan technician available to do every in-patient, out-patient and emergency scan. That meant he had to move fast. If a stroke patient came in while Pelc was scanning another patient by himself, he had about a 15-minute window to finish up and get the stroke patient into the scanner before the loss of more brain tissue. 

“It’s delaying patient care one way or another, whether it’s the previous patient or the code stroke,” said Pelc, who said the work was “overwhelming” to the point where he’d even written up his letter of resignation. 

Fulton said nurse-to-patient ratios are based on nursing teams’ review of the census and current patient and staffing mix, including patient acuity and volume. Then, appropriate staffing is tailored to meet the needs of each unit.

“This happens around the clock every day to ensure the highest level of care for our patients as well as patient and clinician safety,” Fulton said.

Robinson said she’s “never received a good explanation of why the change, except for ‘this is the way that many other hospitals in the country do their staffing.’”

But Maui, she points out, has only one acute-care hospital. 

“So when you run your staff so thin, like they do here, and something catastrophic happens, like the fires in Lahaina, and you need all hands on deck, you don’t have many hands, because people are tired of running short,” Robinson said. 

Statewide, Hawai’i is hurting for health care workers. A 2022 report by the Healthcare Association of Hawai’i and sponsored by Maui Health and other providers found 3,873 unfilled health care positions, not including physicians, with the largest percentage of openings on Lānaʻi (48%) and Maui (36%).

Access to health care is especially tough on Neighbor Islands where patients often have to fly to Oʻahu or the Mainland for major procedures. A Hawai‘i State Rural Health Association survey of more than 2,000 Maui County residents after the fire found that the lack of health care professionals, the cost of care and the quality of care were top concerns, with 68% reporting delays in receiving care.

To incentivize health workers to stay, the union also is pushing for an across-the-board wage increase of $10 per hour, saying some of the lower-paid staff in their union make about $20 an hour and can’t afford to live on Maui.

Some in the union are juggling multiple jobs to make ends meet. Some lost their homes in last year’s wildfires and are struggling to find affordable housing. 

Fulton said that the “bargaining teams have exchanged several economic proposals and we continue to work towards reaching an agreement as soon as possible.”

“Our goal is to reach an agreement that provides excellent compensation and benefits to our employees while ensuring we can continue to provide our community access to the high-quality health care they need and deserve,” Fulton said. 

In response to the union’s wage increase request, Fulton added that Maui Health has “provided counter proposals that include professional development programs that provide additional compensation and career growth opportunities.” 

Bargaining has continued since July 22, with another round of talks planned for Thursday. After the union’s vote, Pelc said the ball is in Maui Health’s court. 

Last year, the United Public Workers union that represents about 500 Maui Health workers went on strike for two months in a dispute over competitive wages and long shifts. 

Multiple hospitals across the state, including Queen’s Medical Center, have been stuck in contract talks, with safe staffing levels at the heart of the dispute. Last month, Kapi‘olani locked out about 600 striking nurses until their union agreed to accept its contract offer — the two sides finally reached a tentative contract on Tuesday.   

Robinson said there are few other places for Maui health care providers to work, “and I feel like the hospital plays on that a little bit.”

“I feel like they don’t have to give us what we’re asking for because where else are we going to go?” Robinson said. “They’re the only show in town. … And now is when we’re standing up for what we believe we deserve.”