Nurses at nine Appalachian hospitals will remain on strike after voting 455 to five to reject a contract offer.
Nurses working for Appalachian Regional Healthcare in Kentucky and West Virginia walked out Oct. 1.
Chief Union Negotiator Pat Tanner says the company's offer was not enough to win approval from the nurses the night of Dec. 4.
An ARH spokeswoman says the company is disappointed in the outcome of the vote.
Tanner has estimated that about 500 of the 750 registered nurses at ARH hospitals are still striking.
No further meetings have been scheduled.