Hundreds of union nurses at Kapi‘olani Medical Center for Women &Children are holding a one-day strike starting this morning after talks failed to yield a new contract.

The Hawaii Nurses’ Association and Kapi‘olani management Thursday held another round of negotiations in a last-ditch effort to avert the strike and a subsequent lockout but could not reach a resolution.

Tensions between the union, which represents 600 nurses, and Kapi‘olani had been mounting in past weeks as they upped the stakes for a new contract.

HNA OPEIU Local 50 notified Kapi‘olani on Sept. 3 that it intended to hold a one-day strike, and hospital executives responded the following day by saying they were prepared to impose a lockout, meaning all HNA- represented registered nurses with contracts that expired Nov. 30, 2023, would not be allowed to return to work until their offer was accepted.

HNA President Rosalee Agas-Yuu called Thursday a sad day for Hawaii.

“Kapi‘olani Medical Center for Women &Children know they are the only specialty hospital for women and children and play a crucial role in our state and the Pacific,” she said in a news release. “They know children and families count on their services, yet the hospital’s leaders have chosen to lock out the nurses for advocating for safe staffing standards to improve patient care.”

Kapi‘olani Chief Operating Officer Gidget Ruscetta said the union ended talks early, at 3 p.m. Thursday, even though its negotiation team was prepared to stay as long as possible to reach a deal to benefit the nurses.

“Unfortunately, after less than three hours, HNA ended negotiations for the day,” she said in an emailed statement. “We want to reassure everyone that Kapi‘olani has secured a highly skilled temporary workforce and will be fully staffed in order to provide uninterrupted care.”

The two parties continued to disagree primarily over nurse-to-patient ratios and work conditions.

HNA said today’s strike is an “unfair labor strike” due to nurses feeling retaliated against for filling out safe- staffing forms.

These forms are available to nurses to document situations in which they had safety concerns — whether it was due to understaffing or inadequate training. They also can indicate whether they missed breaks or meals, and if they worked overtime involuntarily.

Last week HNA filed an injunction with the National Labor Relations Board to stop the lockout, calling it an act of retaliation for the strike. The board’s decision is pending, according to Agas-Yuu.

Ruscetta responded at an earlier news conference there has been no retaliation at Kapi‘olani, which has a strict policy against it.

“Repeated strikes are far too disruptive for our patients that depend on us,” she said at the news conference. “We are dedicated to providing the highest-­quality care to our community 24 hours a day, seven days a week.”

The temporary workforce will ensure uninterrupted care at Kapi‘olani, she said, but she declined to say how many would be brought in and at what cost.

This the second strike HNA is holding this year, after a weeklong strike in late January.

Agas-Yuu said the nurses opted for a one-day strike this time because they understood it was difficult for everyone involved, including the patients and the community.

She said Hawaii Pacific Health, which operates Kapi‘olani, has enough assets to increase nurse staffing levels but has chosen instead to spend its resources on travel nurses, who do not have the same level of experience or cultural competence as Kapi‘o­lani nurses.

“We cannot remain silent and agree to a contract that skirts the core issue of patient safety,” she said in a release. “Unfortunately, Hawaii’s patients have become innocent bystanders in this battle being waged against the nurses.”

HNA also represents about 2,000 nurses at The Queen’s Health System, who are also negotiating a new contract. Queen’s nurses are standing in solidarity with nurses at Kapi‘olani and say, they too want safer staffing ratios.

The push for safer staffing, meanwhile, continues to gain momentum among unions nationwide as hospitals grapple with an exodus of burned-out health care workers.

California has mandated nurse-to-patient ratios for more than 20 years, while Massachusetts requires 1-to-1 ratios for ICUs. Oregon recently enacted a Safe Staffing Law, establishing nurse-to-patient ratios and other requirements, but nurses there struck over the summer due to hospitals’ refusal to enact them.

Hospital executives are pushing back, saying fixed ratios are not the answer to staffing shortages and that they result in less flexibility and unforeseen consequences, such as having to turn away patients or closures.

A Senate bill introduced at the state Legislature earlier this year seeking nurse-to-patient ratios, with specific numbers for the emergency room, ICU and other departments, did not survive.