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Rich Pedroncelli, Associated Press
More than 100 registered nurses and supporters picket outside a Kaiser Permanente facility in Sacramento, Calif., Tuesday Nov. 11, 2014. As many as 18,000 nurses are participating in a statewide two-day strike to call attention to what they say is an erosion in patient care and lack of preparation for treating Ebola at Kaiser facilities.

SAN FRANCISCO — As many as 18,000 nurses, who are in the midst of contract negotiations, have walked off the job and are picketing in front of Kaiser Permanente facilities in Northern California to express their concerns about patient-care standards and Ebola.

With nurses holding red and yellow "strike for health and safety" picket signs, the two-day walk off started Tuesday morning and will last until 7 a.m. Thursday. It will affect at least 21 Kaiser hospitals and 35 clinics.

Kaiser will remain open during the strike, though some elective procedures and routine appointments may be rescheduled, company officials said. Replacement nurses are in place, union officials said.

A California Nurses Association union official said nurses are striking over claims there has been an erosion of patient-care standards in Kaiser facilities for months and that the company has failed to adopt optimal safeguards for Ebola

But California Hospital Association spokeswoman Jan Emerson-Shea said the nurses' union, which has been in contract talks since July, is using the crisis to further its own agenda. The association represents and advocates for California hospitals, patients and communities.

"The union is in contact negotiations with the hospitals they are striking. They are using Ebola as a ruse," she said Monday.

The association is working with federal, state and local agencies to assure the public that universal precautions are in place to screen and identify infectious diseases, Emerson-Shea said.

There are no confirmed cases of Ebola in California.

Kaiser has remained mum on the strike, but it ran an advertisement Monday in Northern California newspapers calling the unions' tactics "baffling."

Kaiser said calling a strike now, "just as we are entering flu season, and when the nation and our members are concerned about the risk of Ebola, seems particularly irresponsible."