CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
Striking registered nurses at Queen's Medical Center urged motorists yesterday to honk to show their support. The nurses went on strike yesterday morning.
Care continues As nurses at Queen's, Kuakini and St. Francis medical centers continued picketing their employers today, their counterparts at Kapiolani Medical Center began voting on a new contract.
despite strike,
Queen’s says
No new talks are scheduled between
What it means for the public
the nurses union and 3 hospitals
Dialysis, transplant concerns
By Lyn Danninger
ldanninger@starbulletin.comEarlier this week, nurses at Kaiser Medical Center and Kapiolani reached tentative agreements with the hospitals. A vote and informational meeting was scheduled to last until 5:30 p.m. at Kapiolani. Kaiser nurses are scheduled to vote all day Saturday and Sunday, with results expected early Monday morning, according to Hawaii Nurses Association spokesman Scott Foster.
Turnout for the Kapiolani vote, which began at 8:30 this morning, was good, according to Joanne Kealoha, a labor relations specialist with the union.
"Nurses are coming in on breaks. Some stayed over from the night shift," she said.
Kealoha was on hand to address concerns at the informational briefing, taking place alongside the vote. "The questions coming in are good," she said. "It's a very informed group of nurses."
Among the biggest issues were staffing guarantees in the existing contract that management initially wanted removed. "We fought hard to get that in 1999," said Kealoha, and nurses have been pleased that they were retained.
"The whole thing was very well organized this year," said Kapiolani nurse Lisa Calhoun. But despite feeling like she had all her questions answered, she was planning to think a little longer before voting later in the day.
Jennifer Hoang-Nghiem, a registered nurse for 15 years, with 10 years at Kapiolani, had made up her mind to support the deal.
"It's OK. I think the majority of us are satisfied," she said.
Meanwhile, none of the three hospitals being picketed has contacted the union to resume talks, according to Foster of the HNA.
"The ball is in their court," he said.
Officials at Queen's Medical Center, which has more than 800 nurses on strike, sought to reassure patients and the public yesterday that it was business as usual at the state's largest medical center.
Queen's Chief of Staff Dr. Peter Halford described the transition at 7 a.m. yesterday to contract nurses, Queen's nurse managers and other support staff as "seamless."
"Patient care data was transferred to nurse managers, who passed it on to the (contract) nurses," he said.
Halford said two patient emergencies that occurred earlier in the morning also turned out well.
"We had a trauma case at 7:05 a.m. and a cardiopulmonary resuscitation that went flawlessly," he said.
Registered nurses at Queen's began picketing yesterday morning after members of the Hawaii Nurses Association rejected the hospital's contract offer Monday.
Union members at Kuakini Medical Center and St. Francis Medical Center began striking Monday morning.
Queen's has already received some patients transferred from St. Francis, said Dr. Richard Friedman, vice president for medical affairs at Queen's.
So far, the hospital is running at almost full capacity, he said.
But Friedman said the hospital is still waiting to see if it will receive a larger-than-normal influx of patients to its emergency room or intensive care unit because of transfers from Kuakini and St. Francis.
Halford said he was not sure how many contract nurses, brought in from the mainland, are now working at the hospital to replace Queen's staff of about 800 registered nurses.
"I'm not privy to the exact numbers, but I think it's about 200 to 300," he said.
Both Halford and Friedman said that despite the smaller number of nurses on site, the hospital was able to maintain the same staff-to-patient ratios by using nurse managers and scheduling 12-hour shifts.
"Staff ratios are where they have always been," Halford said yesterday. "As of this morning, we've actually overstaffed and had more nurses here physically."
The hospital can operate for the near future with the current number of contract nurses, he said, but cannot go on indefinitely.
The hospital has asked doctors to postpone elective surgeries.
"We've asked the MDs not to do any electives unless absolutely necessary," Friedman said.
"But we'll review it again tomorrow, and it's our hope to go back to a regular schedule."
At St. Francis, spokeswoman Maggie Jarrett said the organization continues to reduce the number of in-house patients.
"As of this morning, St. Francis still had 113 patients," Jarrett said. "We expect 10 more discharges by the end of the day."
On Dec. 12, Circuit Judge Dexter Del Rosario will hear a request by St. Francis to declare RNs who care for organ transplant, hospice and kidney dialysis patients essential so they can be called back to work.
St. Francis laid off 126 support staff this week in response to fewer patients. The support staff included secretaries, clerical and housekeeping personnel, food service and maintenance workers, and information services staff, Jarrett said.
At Kuakini Medical Center, spokeswoman Donda Spiker said full outpatient and inpatient services continue, although the hospital is reviewing all patients to see who can be safely sent home or discharged to another facility.
Like Queen's, Kuakini made arrangements for contract nurses to replace striking RNs. So far, 20 replacement RNs have been brought in. More will be phased in as needed, Spiker said.
St. Francis Healthcare System
Queen's Medical Center
Kuakini Health System
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Strike Q&A
Nurses at St. Francis Medical Center in Liliha, Kuakini Medical Center and Queen's Medical Center are on strike. Here's a rundown on what the strike means for the public:Question: Are the hospitals' emergency rooms still operating?
Answer: At Queen's: Yes, the emergency room is operating as usual.
At St. Francis: Although it is open, the hospital has asked the city to divert ambulances to other hospitals. If individuals seeking emergency care arrive, they will be treated and released, or will be stabilized and transferred to another hospital. (St. Francis Medical Center-West is fully operational because its nurses are not on strike. However, it has been experiencing an increase in the number of surgeries due to transfers from Liliha.)
At Kuakini: Yes. Contract nurses are working alongside other staff in the emergency room.
Q: Are scheduled medical procedures, such as elective surgeries, still being done at the three hospitals?
A: Queen's: The hospital has asked physicians not to do elective surgery through today, unless necessary, and have asked them to postpone the ones that can be put off. The hospital is screening such procedures and will reassess the situation tomorrow.
St. Francis: No elective surgeries are being performed.
Kuakini: The hospital has not canceled elective surgeries. It has asked physicians to assess the need for their patients to be hospitalized.
Q: Who is taking care of patients already in the hospitals?
A: Queen's: The hospital has brought in 200 to 300 registered nurses from the mainland. All regular hospital staff, except registered nurses on strike, are continuing their duties. Those who normally serve in other capacities but are registered nurses have been substituting where needed.
St. Francis: A number of nonunion registered nurses, who are managers or who work in other positions, are now at bedsides. Other care givers, such as licensed practical nurses, nurse assistants and hemodialysis technicians, are on their jobs as usual. (St. Francis laid off 126 employees Monday throughout the medical center, including maintenance, clerical, food service and informational services personnel due to the drop in patients. No direct patient care givers were laid off.)
Kuakini: About 20 registered nurses have been contracted by the hospital, but more will be phased in as needed.
The hospital has a "team care" approach with other care-giver staff, such as licensed practical nurses, health care technicians, dietitians, therapists and medical social workers, working with the contract nurses.
In-house patients are being monitored to see who can be safely discharged home or to another facility, making beds available for those who need its services.
Q: Are doctors who have offices at the hospitals still seeing patients?
A: Queen's: Yes, doctors at the Queen's Physician's Office Buildings are seeing patients as usual.
St. Francis: Yes. Outpatient services are operating as normal, such as radiology, laboratory and ultrasound.
Kuakini: Yes. Patients seeing their doctors will be affected only by a possible traffic slowdown because of strikers.
Q: What numbers can be called for more information?
A: Queen's: Patients can call 537-7117 from 7:30 a.m. to 4 p.m. to speak to someone. After hours, the number will have a daily updated message.
St. Francis: Patients may call the community information line at 547-6337 for prerecorded messages of the services that are open. Anyone who wishes to receive a response must leave a name and phone number, and will receive an answer as promptly as possible.
Kuakini: All patients who are scheduled for an appointment are being called daily. If patients have any questions, they should call their physicians if they have a procedure scheduled, or the respective departments where they are scheduled, such as radiology or admitting.
St. Francis Healthcare System
Queen's Medical Center
Kuakini Health System
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CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
The Hawaii Nurses Association strike at St. Francis Medical Center has raised concerns about how the hospital should handle kidney dialysis patients and transplant surgeries. Registered nurses picketed outside the hospital on Monday.
The Hawaii Nurses Association strike at St. Francis Medical Center has raised public concern about dialysis for kidney-failure patients and transplant surgery if an organ becomes available. Most St. Francis dialysis
centers still openTransplant organs will go
according to a list, the hospital saysBy Helen Altonn
haltonn@starbulletin.comSt. Francis is the only hospital in Hawaii that does transplant surgery, and it operates dialysis facilities statewide for about 1,000 patients with kidney failure.
"We've had many phone calls from patients who are very concerned," said Maggie Jarrett, hospital spokeswoman.
She said St. Francis is waiting for a Circuit Court ruling on a request for a court order to allow essential nurses to continue providing care for renal dialysis, organ transplant and hospice patients. Judge Dexter Del Rosario will hear the request at 9 a.m. Dec. 12.
Meanwhile, St. Francis can't accept any more patients with its current staffing, she said.
What happens if an organ donation becomes available before the issues are resolved?
"If we're not able to do a transplant locally, the organ will go to the next person on the list on the mainland," said Robyn Kaufman, Organ Donor Center of Hawaii executive director.
"The overriding factor in this is we follow the list. Often, there are reasons why we can't transplant someone," she said, explaining a patient might be sick or out of town. "But someone will get the transplant. The organ won't be wasted."
All of St. Francis' dialysis clinics remain open for visits three times a week by patients, except those in West Kauai and Kahana, Maui.
Newly diagnosed kidney patients requiring dialysis are being referred to the Fresenius Medical Center, which has six dialysis units on Oahu and a small clinic on Lanai, said Alvin Cecil, regional manager.
He said Fresenius has about 780 patients in its clinics and about 100 being treated at home. With the purchase of St. Francis' Pearlridge dialysis facility in July, Fresenius has a capacity for about 1,100 patients, he said.
An international company, Fresenius manufacturers dialysis machines and other products, in addition to providing dialysis services, Cecil said.
Its headquarters are in Germany and Lexington, Mass.
The company's contract with the nurses association won't expire until January 2004, Cecil said.
At St. Francis-Liliha, the dialysis procedure, which usually lasts several hours at a time, is being reduced by about 30 minutes.
"In the short term, there will not be a significant impact on the patient," Jarrett said. "Most are doing very well following their new dialysis times and limiting diets according to instructions."
Those experiencing any problems should contact their physician or dialysis caregiver, she said, noting the majority of caregivers involved with dialysis are not registered nurses.
Dialysis patients last week were instructed to go on an emergency diet that involves limiting fluid intake, minimizing weight gains between treatments and limiting foods high in potassium, she said.
Patients weigh themselves when they go in for dialysis and the length of treatment depends on their weight, she said.
The National Kidney Foundation of Hawaii has urged dialysis patients to remain calm and follow dietary restrictions.
A free emergency planning guide is available at the foundation, including a three-day meal plan if a dialysis treatment must be missed. It can be obtained by calling the foundation's patient hotline at 589-5945.
St. Francis Healthcare System
Queen's Medical Center
Kuakini Health System
