Nurses at Stanford and Lucile Packard Children's hospitals have soundly rejected a contract the hospitals have called their "last, best and final" offer.

Ninety percent of the 2,300 voting nurses rejected the contract Wednesday evening, with 10 percent in support, according to Peter Nussbaum, lead attorney for the Committee for Recognition of Nursing Achievements (CRONA), a union representing 2,700 nurses.

"It is by far the greatest number of nurses to ever vote in such a referendum," he said.

The contract included a 4-percent raise in the first year of a two-year contract but also changed the requirements for nurses seeking promotions in two top categories of their profession. Union officials have said that change would demote many nurses and make it impossible for others to advance.

During the nurses' strike in June 2000, the same two top issues were sticking points: advancement policies for nurses and paid time off/health benefits, Nussbaum said. That strike lasted seven weeks and required a federal mediator to help broker a deal. Nurses also went on strike in 1974.

But there are other issues that have angered the nurses this time around, according to Nussbaum.

"The hospital is trying to seriously weaken CRONA and the nurses are upset about that," he said.

Stanford also sent managers and officials into the hospital "24 hours a day" in the last days before the vote in attempts to get nurses to accept the contract, he said. "There was a tremendous push and to scare the nurses," he said.

Despite the hospital's efforts the contract rejection was "extraordinary," Nussbaum said.

The union is not at the striking point yet, he said. The CRONA bargaining team will meet this afternoon (Thursday) to discuss the next steps. The union and hospitals are "very far apart," in the contract, he added.

"The hospital is insisting on a proposal that was at the beginning of the negotiations. There really wasn't any bargaining. There was no give and take," he said.

Sarah Staley, Lucile Packard spokeswoman, said hospital officials are disappointed the contract was rejected.

"The ball's really in their court. It's unfortunate. We think the offers reflect the high regard we have for our nursing staff," she said.

"We think this is a fantastic package for our nurses and one we're proud of. We hope that the nurses will reconsider."

The majority of the hospital's nurses are of the highest level -- Staff Nurse IV -- and receive between $50.90 and $67.11 per hour, according to Staley. They make more than $100,000 a year and would have between 26 and 39 days of paid time off per year under the contract, she said.

Additional wage increases for subsequent years along with a $3,000 signing bonus if no strike notice is given are also in the package, she said.

"The offer includes a nursing development program that rewards and recognizes merits in professional nursing and represents national standards for nursing excellence.

We can't understand why CRONA is not willing for the nurses to be held to the same standards as those at other prominent hospitals and major academic medical centers," she said.

In the event of a strike the hospitals have contingency plans to continue deliver quality care to patients and families, Staley said.

"Both hospitals are committed to the responsibility of ensuring patient safety. Identifying replacement nurses is part of the contingency planning and is a responsible, precautionary step," she said.