Changing Hawaii

By Diane Yukihiro Chang

Monday, October 25, 1999

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A pep talk for
Hawaii nurses

LAST Friday, as union and management reps were preparing for tense weekend negotiations to avoid a dockworkers' strike, another group of island professionals was getting a pep talk/leadership lesson of its own. They were members of the Hawaii Nurses Association, whose contracts at the state's five largest hospitals -- affecting 2,500 registered nurses -- are due to expire Nov. 30.

In a keynote address to the HNA's annual meeting at the Hawaiian Regent hotel, Boston-based author Suzanne Gordon energized the dozens of RNs in attendance. She urged them to fight for their profession and their patients because, she said, "patients can't fight for themselves."

The author of "Life Support" (Little, Brown and Co., 1997) revved up the crowd of nurses by relating some information that they ALL seemed to relate to:

The health-care system needs restructuring, because the big bucks are being made at the top of the corporate pyramid and aren't trickling down to the bedside. It starts when employers want lower premiums, which means hospitals need to cut costs. They bring in high-priced consultants who suggest changing the skill mix -- meaning putting fewer registered nurses and more lower-paid nursing assistants on the floor.

Hospitalized patients deserve excellent nurses and nursing care. But how can this happen when patient loads and the number of non-RNs reporting to registered nurses are increasing? At the same time, RNs are being held accountable for what happens to their patients while relying on those with less training. This is unfair, stressful and dangerous, says Gordon.

The public must be made aware of the importance of having RNs on duty, since their "educated eyes" can recognize problems with patients and they can intervene quickly. After all, doctors are present only during their rounds, while nurses are on the hospital floor around the clock. In fact, according to patient satisfaction surveys, the key indicator is the quality of nursing care received, with any other factor a distant second.

What does it say about a society that pays the people who actually take care of the ailing much less than physicians, hospital administrators, and insurance company presidents? Is it significant that most nurses are women, and that female-dominated industries like nursing and teaching are notoriously underpaid? Or that health maintenance organizations push for early release of patients so that they can go home, perhaps prematurely, to be cared for by other females like mothers, wives and sisters?

WHEN the nurses filed out after Gordon's speech last Friday morning at the Hawaiian Regent, they were smiling and upbeat. For them, Nov. 30 can't come soon enough. Bring on those contract negotiations!

Meanwhile, on the other end of Waikiki, at ILWU headquarters on Atkinson Drive, the faces of union leadership were grim as their own negotiators prepared to hammer out demands with management.

There's at least one thing that dockworkers and nurses have in common, though. While they are both making good salaries, at least in comparison to other Hawaii wage earners, they believe that those at the top of their businesses are making huge profits while the ones on the bottom aren't sharing in that wealth.

And, in the final analysis, it's the consumers and/or patients who pay for it, one way or another.

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Diane Yukihiro Chang's column runs Monday and Friday.
She can be reached by phone at 525-8607, via e-mail at
dchang@starbulletin.com, or by fax at 523-7863.