Kaiser management, nurses confirm plan to restructure

HONOLULU (HawaiiNewsNow) - The Hawaii Nurses Association and Kaiser Permanente Hawaii confirm they have been in talks to plan a restructuring of Kaiser care that could mean new assignments and some layoffs.

Sources say there is a fairly complete plan on the table, which protects most current nursing assignments and gives a full year of paid employment to others while they find new assignments.

Discussions were held away from the public spotlight, as is standard for labor negotiations, but the HMO and the union confirmed the talks, and sources revealed new details of the plan, after worried nurses began mentioning the talks to media and patients.

"I don't know if I'll still have a job then," a nurse told a patient who was scheduling an appointment in six months' time and remarked that she would see the nurse then.

She probably will. What her union has been discussing with Kaiser management, sources say, is a plan under which any nurse who gets a layoff notice would actually be transferred to a nursing pool while the nurse seeks a new assignment and, in some cases, acquires new training or certification.

Proposals put on the table in labor negotiations don't necessarily remain there at the end, but in this case the proposal accords with national Kaiser policy when operations are reconfigured.

Kaiser Hawaii has roughly 900 nurses of whom 100 could eventually be faced with seeking a different assignment, sources said.

Management confirms it will close the Honolulu Urgent Care Center, which typically treats only 30 patients a day. Patients will instead be treated upstairs by the other doctors and nurses at the clinic. Sources said there is also a plan to develop a unit that specializes in caring for patients with diabetes.

An internal memo obtained by Kristen Consillio of the Honolulu Star-Advertiser referred to 47 pending job cuts among registered nurses in Kaiser clinics across the state. Kaiser has been leaving some openings unfilled, and already has enough to absorb most of the nurses who lose existing assignments.

Medical clinics across the country, struggling to control the rise cost of health care, have found that it saves money to stop using registered nurses for work that can be done by licensed practical nurses and medical assistants. A registered nurse can make twice what they do.

Registered nurses say their greater education provides a safety benefit, but management sources at Kaiser and in two other local medical organizations say there are other ways to ensure safety that are more affordable.

Health care costs have been rising several times faster than overall inflation for many years. But there is a complicating addition factor for labor and management alike: the Affordable Care Act, better known as Obamacare, is changing the rules for health service billing, and compensation for acute care clinic operations could be reduced. Neither side can be sure of the impact since the federal government is under enormous pressure to reduce spending and all expenditures are being revisited.

Kaiser management and the nurses association are having daily communications on the plan.