The 640 nurses at Kapi'olani accepted the contract with some anger and many reservations, said Cindy Burgess, a Hawai'i Nurses Association member who served on the negotiating committee with Kapi'olani.

"The vote was very close," she said. "Many people are still not happy that the management did not address all the issues we felt were important." The exact vote total was not released.

The contract gives nurses a substantial pay increase, but does not fully deal with nurses concerns about safe staffing levels, nurse retention, and medical coverage for retirees, Burgess said.

"The management made us feel like we are nothing," she said. "Even those who voted to ratify the contract have serious reservations about it."

The contract, which becomes effective Dec. 8, gives nurses pay increases of 8 percent, 7 percent and 7 percent, respectively, for the next three years. In addition, nurses with seven years experience will get $1 more per hour starting in the second year. Those with 15 years experience will get an additional $1 per hour beyond that beginning in the third year. The current salary for nurses with at least two years experience is $28.60 per hour.

The new contract far from satisfies nurses concerns in other areas, Burgess said. "It's everything from staffing to retirement," she said.

The contract does not include the fully-paid medical coverage for retirees that nurses sought. Instead, it provides partial coverage for retirees only between the ages of 62 to 70. Only nurses who will be age 45 by April 1, 2003 are eligible for the benefit and only if they retire with 20 years of service.

In order to get the benefit, union leaders had to agree to revamp the overall retirement benefit package and change the emphasis of employer contributions from a defined benefit pension plan to a 403(b) tax deferred savings plan, which shifts more investment risk to employees.

Kapi'olani needs to address many of the nurses concerns in both the near future and in the next contract negotiations, Burgess said.

"There's a lot of things they can do now to improve the situation," she said.

Gail Lerch, vice president of human resources and marketing for the medical center's parent company, Hawai'i Pacific Health, said tonight that the hospital would try to work with nurses on those issues in coming months.

"We're willing to look at their concerns," Lerch said. "We can do that in a number of ways, including our labor-management committee and through employee forums."

The agreement places nursing salaries at Kapi'olani at competitive levels with national rates and is a sincere effort to deal with staffing concerns. Because staffing needs in different Kapi'olani units change from day to day, the contract calls for nurses to receive a pay differential when they "float" from unit to unit.

Meanwhile, nurses at Queen's, St. Francis and Kuakini medical centers remained on strike tonight. No new talks were scheduled.

"We told the federal mediator that we're ready to go back to bargaining any time, but so far there's been no response from management," Sue Scheider, director of collective bargaining for Hawai'i Nurses Association, said tonight.

Since the issues dividing nurses and management vary from hospital to hospital, it was unclear tonight if the contract approval at Kapi'olani would have much impact on other negotiations.

"It's very difficult to judge because the issues are so different," Lerch said. "Although we are happy to have a new three-year contract in place, we remain concerned and emphathetic for patients and staff at Queen's, Kuakini and St. Francis."

The three medical centers reported no major problems today as they continued to deal with the strike by using replacement nurses and other staff adjustments and, in some cases, downsizing medical operations.

St. Francis yesterday had 99 patients, about 50 percent of its normal occupancy, said spokeswoman Maggie Jarrett. Kuakini reported a lower-than-usual patient census, but said most of its outpatient services were open and busy. Queen's said it was resuming all scheduling of elective surgeries starting Friday, and all other medical work was proceeding "beautifully."

St. Francis, however, asked some of its nurses to return to work, invoking a "patients first" agreement made with nursing association last month. Jarret said the agreement called for some nurses to come back under certain circumstances to treat patients in the intensive care unit and to help with organ transplants. The hospital needs 16 nurses to work in its acute and chronic care units and up to seven nurses during organ transplant operations, she said.

Scott Foster, a spokesman for the nurses association, said some St. Francis nurses would come back once all conditions of the agreement are met. "Obviously, the hospital would not have asked it it was not a critical situation," he said.

While no major incidents were reported on the picket lines today, tempers flared briefly last night when someone on a picket line at Queen's threw a plastic water bottle at a bus full of replacement nurses, said Yoshimi Ott, a Queen's nurse for 30 years and a picket line captain. There were no arrests.

"There are going to be hard feelings on both sides," Ott said. "That's to be expected."

Some replacement nurses also made obscene gestures today as their bus crossed the picket line, said striking nurse Linda Briggs.

"And they were taking pictures of us like we were some sort of Hawaiian tourist attraction," she said.