There's a surge in complaints from nurses about operations at North Hawaii Community Hospital in Waimea.
The grievances include fear of retaliation, layoffs, staffing levels and patient safety.
"They fear for their jobs and they fear for retaliation," said Sue Gingrich, a former North Hawaii Community Hospital nurse, who left in 2005.
Queen's Health Systems took over North Hawaii Community Hospital in a historic affiliation agreement in January 2014.
Queen's CEO Art Ushijima said change is hard, and that there will be some bumps along the way.
"You make the operation more efficient, you provide services where they are needed the most, but we cannot continue to function in the way that we have," said Ushijima.
On Tuesday, the leaders of the Queen's Health Systems, which runs the 315-employee hospital, addressed a packed crowd at Waimea Elementary. They talked about the realities of keeping the facility thriving and touched on what they're doing to expand services.
Waimea resident M. Kalani Souza, who suffers from a rare auto-immune disease, said North Hawaii Community Hospital saved his life.
"We are not lacking! Those girls (nurses), they're doing a great job," said Souza, to a round of applause. "Finding a way to make community work with institutions. This is not an option. This is a must."
Behind the scenes, though, nurses say they are afraid after a handful of layoffs.
The community supports the Queen's affiliation. But the Hawaii Nurses Association, which represents 80 nurses at the hospital, says nurses have filed more grievances and unfair labor practices within the first quarter of this year, then in the combined four years. Overall, there are about 20 complaints.
"It's not fair to the community to have staff, whether they are nurses to housekeeping or kitchen, that are fearful of saying this is incorrect. I'm not giving the best patient care because I'm understaffed," said Skye Bergan, a former Hawaii Community Hospital nurse, who left four years ago.
"We are committed to patients first and we are also committed to employees' engagement and working with us," said Cindy Kamikawa, President of North Hawaii Community Hospital.
Maureen Meehan-Golonka, president of the Hawaii Nurses Association, said the union "really does encourage management to reach out to the staff to help solve those problems."
Hospital leadership says before the Queen's affiliation, the hospital was in danger of shutting down, suffering from rising costs and low reimbursements from Medicare and Medicaid. Queen's invested $30 million, is expanding the emergency room and increasing services in ICU telemedicine and cancer care.
Dr. Howard Wong, chief of staff, added that rural hospitals nationwide are facing closures or struggling financially.