Most of the facility's 62 nurses were at the small community hospital when the strike began at 7 a.m., said Sue Scheider, collective bargaining director for the Hawai'i Nurses' Association. Three nurses crossed the picket line, she said.

The two sides last met with a federal mediator Wednesday, but the negotiations ended when the hospital rejected a proposal from the union. Nurses had hoped management would resume talks yesterday.

"When the phone didn't ring before yesterday afternoon, we got the message that they weren't interested," Scheider said today.

Because of safety issues, strikers only will walk picket lines from 7 a.m. to 7 p.m., she said.

No immediate talks were scheduled, said Richard Aea, hospital spokesman. Nurse managers were told to fill in for strikers but Aea could not say how much effect the walkout was having.

He would not say how many patients the hospital had in its 30-bed acute care area, the only area affected by the strike.

"Since receiving the notice from HNA on their intent to strike, the hospital has had to make reasonable adjustments to its services in anticipation of not having any registered nurses," Aea said. "We did scale back."

But the emergency room, outpatient services and its long-term care unit "will operate as usual," he said. Elective surgeries were deferred and patient transfers were being discussed.

"We are hoping for a resolution to the strike," Aea said. "However, we are prepared, if it is necessary, for a long strike."

Mainland nurses will not be used ­ at least not yet, he said.

City ambulances still planned to use the Wahiawa emergency room, said Donnie Gates, assistant chief for the city's Emergency Medical Services.

"We will communicate with them when we are going there," Gates said. "We don't anticipate any problems at this point."

The 162-bed facility is the only 24-hour primary and emergency care medical facility between 'Ewa and Kahuku.

The two sides are not that far apart on wages, the union has said. But there are sticking points in the benefit package, including health insurance, longevity steps and access to retiree benefits.

Wahiawa nurses are paid about $28.60 an hour and any proposed wage increases have been offset by management plans to increase nurses' share of healthcare costs, the union has said.

Nurses walking three picket lines were enthusiastic.

Their union had taken a "straw poll" yesterday to gauge the current level of support and the result overwhelmingly favored a strike.

"We are a unified group," said Ella Siroskey, a nurse in the hospital's intensive care unit. "We were hoping they would come back to the table before this but they didn't."

Drivers passing the strikers leaned on their horns in support, prompting cheers from the picket line.

"It's all the community," Siroskey said. "It is really amazing. They are screaming out of their cars."