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As about 600 unionized nurses remained locked out from the Kapiolani Medical Center for Women and Children for a second week, Gov. Josh Green on Tuesday called on the two sides to use federal mediators to resolve their prolonged contract negotiations.

The statement came a day after tensions spiked with the arrest of 10 protesters who police said were blocking the driveway of the hospital and refused to leave despite warnings. The nurses were locked out after they staged a strike on Sept. 13 over what they say are unsafe working conditions.

It was the second strike since contract negotiations began last September. Federal mediators have been used , according to Hawaii Pacific Health, which oversees the facility. But that was before the dispute escalated with the arrests on Monday. All those arrested were , according to the Honolulu Police Department.

The strike earlier this month occurred despite the hospital’s warning about the lockout, a drastic move that aims to put to approve the current offer, which would give nurses a base salary of between $133,000 and $160,000 by the third year of its implementation. 

Beyond the raise, the contract would address the desire for more workable patient-to-staff ratios by making a matrix to help adjust staffing where needed.

The Hawaii Nurses Association called on Green to step in and help resolve the impasse, with collecting over 7,000 signatures.

In a statement last week, Green said the governor can’t legally get involved with private negotiations unless both parties formally request his assistance.

Now, Green is calling for both parties to bring in federal mediators again. 

“During this phase of the negotiation, with a federal mediator, I would ask that both parties ensure that no services are interrupted at Kapi‘olani and that the nurses continue to receive their health benefits. These gestures of good faith should help the parties move forward,” he said Tuesday.

Kapiolani Medical Center said it supports the idea and would extend nurses’ health benefits past the planned contract expiration date of Sept. 30 if the nurses’ union also agrees to mediation. Rosalee Agas-Yuu, the Hawaii Nurses Association president, did not respond to a request for comment. 

Perhaps the nurses’ biggest complaint is having too few nurses to treat patients, leading to overwork and burnout. Patients tend to have better health outcomes – shorter hospital stays and lower mortality rates – when the ratio of nurses to patients is higher, according to from 87 acute care hospitals in Illinois.

The Hawaii Nurses Association wants minimum staffing ratios included in new employment contracts with Kapiolani Medical Center. 

Hawaii Pacific Health, which oversees Kapiolani Medical Center, said that its most recent proposal includes a staffing matrix to help achieve something like this. That matrix would be more flexible than minimum staffing ratios, and would be based on factors that nurse managers already consider.

Hawaii’s nurse shortage has been an issue for years. 

To fix the problem, state lawmakers have considered by joining an interstate nurse licensure compact .

But the union , saying that more nurses might leave Hawaii than enter the state, and that an interstate compact ignores that different states have different standards.