Kuakini management and the Hawai'i Nurses Association, which is representing Kuakini's nurses, met with a federal mediator Monday. The association wanted Kuakini to consider changes to the hospital's "best and final offer" that came just before the Dec. 2 walkout.

"It seems like both sides are trying to do something," said Donda Spiker, Kuakini spokeswoman. "The increases and changes to the best and final offer are being considered. What will happen, I don't know. We are not speculating."

In the meantime, striking nurses from Queen's, where negotiations broke down early yesterday morning, have taken their case directly to the hospital's board of directors. Four nurses drove to the homes of most of the board's 38 members to deliver a letter, said Queen's nurse Elizabeth Clavin.

"I wrote the letter myself," Clavin said. "The intention was to open up a line of communication directly from the staff nurses to the board. It occurred to me that they are only relying on the hospital administration for their information and that may be incomplete."

Clavin said nearly 300 nurses signed the letter. The letter talks about working conditions and the commitment nurses have to patients.

"It is a statement of how we identify ourselves and what our mission is as nurses," she said. "Our mission is patient care, patient safety and patient advocacy."

Nearly 1,400 nurses remain off the job at Kuakini, Queen's and St. Francis Medical Center as the strike over staffing levels, paid time off, retirement benefits and salary slogged through its third week.

At St. Francis, a Hawai'i man is "doing fine" after receiving a kidney transplant yesterday from his daughter in an operation assisted by three striking nurses.

The three nurses agreed to help in the transplant operation under a "patients first" agreement between the hospital and the nurses association. It was the first transplant operation at the hospital since the strike began.

The kidney recipient was a man in his 60s; the donor was in her 30s, Jarrett said. Both are recovering in the hospital, she said.

Talks at Queen's, where 800 nurses walked off the job Dec. 3, broke off after the medical center refused to accept a new wage increase proposal put forward by the nurses, said Gail Tiwanak, vice president of marketing and communications.

Queen's has offered a 21 percent wage hike over three years and other improved benefits, Tiwanak said.

"HNA's final proposal on the table last night requested a wage increase, which was clearly an unwelcome turn," she said.