It was strike day for hundreds of union nurses Friday.

The nurses hit the picket lines at Kapi‘olani Medical Center for Women &Children for a planned one-day strike as hospital management vowed to lock them out from returning to work today unless they accepted the latest contract offer.

In a show of unity, the nurses lined up along Punahou Street in front of the hospital and around the corner, donning yellow T-shirts and holding signs that said, “Safe Staffing for All” and “ULP Strike,” standing for unfair labor practice strike.

They chanted, “When we fight, we win!” while clanging bells and eliciting honks of support from drivers passing by.

It was their second strike this year, following a weeklong strike in January. The nurses have been working without a contract since December.

Friday also marked one year since negotiations began between Kapi‘olani and the Hawaii Nurses’ Association, which represents 600, with no apparent resolution yet on new contract terms, primarily over nurse-to-patient ratios.

HNA President Rosalee Agas-Yuu said Friday’s strike was held to protest management’s retaliation against nurses who were filling out safe-staffing forms. It was also to push back against management’s alleged bullying tactics.

Nurses use the forms to document safety concerns due to understaffing or inadequate training, as well as whether they missed breaks, meals, or worked overtime involuntarily.

The strike on Friday went forward after the two parties failed to reach an agreement at two bargaining sessions held earlier in the week.

The stakes for reaching one had grown, as HNA notified Kapi‘olani on Sept. 3 that it intended to hold a one-day strike, and hospital executives responded the next day by announcing plans to impose a lockout the following day.

Effective at 7 a.m. today, Kapi‘olani will lock out all HNA-represented registered nurses with contracts that expired Nov. 30, forbidding them to return to their shifts unless the latest offer is unconditionally accepted.

From her office on the first floor, Gidget Ruscetta, Kapiolani’s chief operating officer, said the strike was disappointing.

“It’s very emotional, as you can see,” she said. “There’s noise up and down the sidewalk, and we didn’t want it to come to this. We have been negotiating with the nurses union for a year. We have met over 30 times, and we had the federal mediator involved.”

She said a lot of progress was made at the bargaining session Monday but that Thursday’s meeting was cut short at 3 p.m. by the union.

HNA’s Agas-Yuu said talks ended because a key person managing the Neonatal Intensive Care Unit was not present to discuss staffing ratios. Ruscetta, however, said her core negotiating team made up of managers and directors was present, and was qualified to speak for NICU.

Kapi‘olani’s team was prepared to negotiate all night to avoid the strike and subsequent lockout.

“We were disappointed because our focus, our goal was to reach an agreement for our nurses,” she said. “We have a generous package that is on the table for our nurses. We want them to benefit from it, and it’s disappointing because they’re on the sidewalk and not inside the hospital taking care of our patients.”

In the third year Kapi‘olani’s contract is offering registered nurses a base salary of $133,000 to $160,000, in addition to bonuses and incentive pay.

To address nurse-to-patient issues, Kapi‘olani is offering a “staffing matrix” that adjusts levels based on the needs of patients and a staffing council that brings nurses and nurse leaders together to enforce it.

A temporary workforce of nurses, most of which have had prior experience working at Kapi‘olani, filled in Friday morning.

“We have been entrusted by this community to provide excellent, safe care for our patients, and we need to do that seamlessly,” said Ruscetta. “We will not allow a labor dispute to prevent us from providing care.”

Nurses outside, meanwhile, said staffing issues remain a concern, and they want adequate time to care for patients properly and a workplace without retaliation.

Kassie Tanabe, a Kapi‘olani transport nurse who used to work in the NICU, said babies there require intervention and close monitoring.

“You can’t just rush through it,” she said. “When you rush through it, you end up making mistakes.”

The ratio for the NICU should be 1-to-1 for a baby on a ventilator, she said, and can be 1-to-2 or 1-to-3, at most, but not 1-to-4. With four there is not enough time to offer proper care, she said.

Alyssa Morgan, a former Kapi‘olani nurse who was at the strike in January, now works at Lucile Packard Children’s Hospital Stanford in California.

She is happy with the move to Stanford, she said, where there is a 1-to-1 ratio for intubated patients, and dedicated “break nurses” who work during nurse’s breaks to ensure they get their breaks, plus other incentives.

Morgan says she misses the isles and her family in Hawaii but is happy with her new employer.

In addition to being locked out, the union nurses are poised to lose their health care coverage in October. If they do not return to work by then, they would have to apply for coverage under the federal Continuation of Health Coverage, or COBRA, plan.

Despite all this, Agas-Yuu says HNA nurses had voted to take a stand Friday. This morning, dozens of nurses plan to show up for work at Kapi‘olani, she said.

HNA has filed an injunction with the National Labor Relations Board to stop the lockout, calling it an act of retaliation for the strike, but a decision by NLRB is still pending.

The nurses got support on the picket line from fellow nurses at The Queen’s Medical Center, who are also negotiating a new contract, along with members of other unions, including UNITE HERE Local 5, which recently held its own strike.

John Witeck, founder of the Hawaii Worker Center, said to his knowledge the threat of a lockout has not been used in Hawaii in decades, and he thinks it’s an unfair labor practice that makes the situation worse.

“It’s not a regular management tactic,” said Witeck on his way to the picket line. “They may have a legal right to do it, but in this situation I think it’s a terrible practice.”

The University of Hawaii Professional Assembly posted an online statement blasting Kapi‘olani’s lockout move as “pilau,” or filthy, and “a very hardball, mainland style of bargaining.”

U.S. Rep. Jill Tokuda also showed up to show her support.

“I stand in solidarity with the nurses,” she said, saying it was personal. “They’ve taken care of me throughout my life. Our youngest son was in the NICU. We’ve seen the kind of care and intensity that’s required in there, and that’s where staffing ratios absolutely save lives.”

Tokuda said she supports legislation to ensure nurses are not overworked.