Nurse managers continued to fill in for strikers at the 162-bed facility, said hospital spokesman Richard Aea.

Aea said the hospital postponed elective surgery, but its emergency room, labor and delivery facilities, and outpatient services such as X-ray, rehab and laboratory work ran smoothly, he said.

The hospital's long-term-care unit is not affected by the strike because no registered nurses work there.

Hospital administrators and the Hawai'i Nurses Association last met with a federal mediator on Wednesday, but the negotiations ended when the hospital rejected a proposal from the union.

About 30 nurses walked picket lines at the hospital's three entrances this morning, said Randy Pisani, the hospital's recovery room nurse and one of the negotiators.

"We're still upbeat," she said. "We are still unified. We would love to be back at the bargaining table. We are available at any time of day or night to go back to the bargaining table."

In December, nearly 1,400 nurses at three major Honolulu hospitals went on strike for nearly six weeks.

For those nurses at The Queen's, Kuakini and St. Francis medical centers, the dispute focused on working conditions that included staffing issues, mandatory overtime and sick leave/paid time off benefits.

At Wahiawa, the union said the key issue is a proposed cut in benefits that would undermine a proposed pay increase. The union said the proposed wage increase would be offset if the union accepts a management proposal to have nurses pay a bigger share of their medical costs.

But management said employees would still receive an overall increase in compensation.

Insurance rates already went up sharply in March. But the nurses are upset at what the hospital is proposing to pay: 90 percent of coverage for single people, 80 percent of full-time family coverage and 70 percent of part-time family coverage.

Aea said the employee share of co-payments would increase by $4 to $13 a month.