Nurses in red union shirts carried signs and chanted slogans outside dozens of Northern and Central California hospitals into the night Thursday as part of a one-day strike over benefit cuts and other concessions sought by hospital management.
The California Nurses Association, the union organizing the strike, expected nearly 23,000 nurses to participate although hospital officials reported that many nurses had crossed the picket line.
Union officials could not provide an estimate of how many nurses took part in the strike, but Charles Idelson, a spokesman for the California Nurses Association, described it as "overwhelming participation."
Striking nurses were planning to return to work at 7 a.m. Friday, but Idelson said he expected lockouts at some of the hospitals.
The strike affected 33 not-for-profit hospitals run by Kaiser Permanente and Sutter Health, and the independent Children's Hospital Oakland, said Idelson.
Hospital officials said they had made preparations to minimize any possible patient disruptions. Replacement nurses were on hand at some of the eight Sutter Health hospitals affected by the walk-out, the hospital said.
"Surgeries are continuing, babies are continuing to be born," hospital spokeswoman Karen Garner said.
A strike involving 23,000 nurses would be large, particularly in recent years when the strength of organized labor has declined, said John-Paul Ferguson, assistant professor of organizational labor at Stanford University.
"It's rare for us to have these days in the United States that many people on a coordinated strike," Ferguson said.
The eight hospitals employ about 4,500 nurses who are members of the union, according to Garner. At least at two of the hospitals, a majority of unionized nurses who were scheduled to work reported for duty, Garner said.
"Many of our nurses recognize that our hospitals provide competitive wages, competitive benefits and a rewarding working environment, and they've chosen to report to work to care for our patients," she said.
Children's Hospital Oakland was also expected to bring in replacement nurses. The hospital had rescheduled elective surgeries as well, according to Erin Goldsmith, a hospital spokeswoman.
Kaiser officials said many nurses had crossed the picket line and their hospitals were "fully staffed."
The focus of the strike was Sutter Health, where union officials say nurses in contract negotiations are being asked to accept thousands of dollars in higher costs for their health care.
Sutter's proposed concessions would also reduce the ability of certain nurses to advocate for patients, cut pay for newly hired nurses, and slash vacations and holiday pay, according to the union.
At Alta Bates Summit Medical Center in Oakland _ a Sutter Health-affiliated hospital _ nurses held signs that read, "Community Care, Not Corporate Profits," and "Some Cuts Don't Heal."
"We're not just here for money," said Vicki Theocharis, a nurse in the hospital's oncology unit. "We want to take care of the patients, and it almost feels like we're being penalized for doing it."
Millicent Borland, 65, a nurse on the union bargaining team at Summit Medical Center, said the cuts management has proposed would set a dangerous precedent in the health care industry.
"It would set a precedent that all other management will think about and pass it down to other workers," she said.
Garner has said the hospital has an obligation to keep health care costs down for patients.
Union members at Children's Hospital, who have been without a contract for more than a year, have objected to a proposed increase in the cost of a health care plan the hospital offers.
At Kaiser Permanente, 17,000 nurses were expected to walk-off the job to show solidarity with the National Union of Healthcare Workers. The union is in contract talks with Kaiser and facing demands for cuts in health and retirement benefits, Idelson said.
Thursday's action was among the largest nurses' strikes in recent years, according to the Bureau of Labor Statistics. In two strikes in March and May, up to 2,500 health care workers, including 2,100 nurses, held one-day walkouts at Kaiser Permanente's flagship Los Angeles Medical Center as part of a contract dispute.
The last largest nurses' strike, according to the BLS, was in June 2010, when a dispute over nurse-patient ratios led to a one-day walkout of 12,000 nurses working at 14 Minneapolis-area hospitals.
Kaiser Permanente has said it is bargaining in good faith.
The strike is scheduled for one day, but Sutter Health and Children's Hospital officials said nurses will not be able to immediately return to work because the hospitals' contracts with replacement agencies require a minimum number of days of service.
At Sutter Health, that ranges from three to five days, Garner said. At Children's Hospital, it is five days, according to Goldsmith.
Associated Press writer Terence Chea in Oakland and Jennifer Farrar of the Associated Press News Research Center contributed to this report.