Union nurses at Wilcox Medical Center on Kauai walked off the job for a second day today in protest of unfair labor practices by their employer.

The Hawaii Nurses’ Association, which represents 159 members at Wilcox, continues to clash with management primarily over nurse-to-patient ratios in the hospital’s medical-surgical unit.

The nurses are asking for a 1-to-5 ratio — or one nurse to five patients in the unit — which they said is the standard on Oahu.

In a news release, HNA members shared their frustration with management for bringing in replacement nurses during the strike that are working with better ratios than they are asking for.

Stacy Matsuyama, a medical-surgical nurse, called it a “slap in the face” that the traveling nurses are working with a 1-to-2 ratio when longtime nurses such as herself usually get a workload of 1-to 6.

Greg Schumacher, an ICU nurse, said, “We’ve heard that the hospital is full right now,” with holds in the emergency department and a packed ICU, prompting Wilcox to reopen an overflow unit to accommodate more patients.

But Wilcox President and CEO Jen Chahanovich said in a statement that, “Wilcox Medical Center continues to care for the patients of Kauai, providing the high-quality care our community expects from us.”

“We are fully staffed and operating as we always have,” she said. “Our Wilcox medical teams are prepared to serve our community with no interruptions to services. There is no change in our ability to accept and care for patients.”

Chahanovich said the hospital and union have agreed on staffing levels for every nursing area except for the medical-surgical unit, which treats a range of patients of all ages.

“Our offer includes staffing guidelines that are based on how sick a patient is and the level of care needed, which can vary throughout the day,” she said. “Since staffing adjustments will be based on individual needs, we are proposing that our medical-surgical nurses each care for up to five or six patients. This aligns very closely with what our nurses are asking for.”

The strike is expected to continue on Thursday. The nurses, who have been working without a contract since Aug. 31, are scheduled to return to work Friday morning.

Both parties are working with a federal mediator, the union said, and have agreed to return to the bargaining table after this week.

Chahanovich said, “We value our nurses, and our goal is to reacha n agreement.”