Nurses, technicians in Machias strike over staffing and retention issues

Heading into their seventh month working under an expired contract, about 50 registered nurses and technicians at Down East Community Hospital in Machias began a two-day strike on Tuesday over compensation and staffing they say is inadequate and jeopardizing patient care. 

“In order to recruit and retain our staff, we need to have competitive wages that will bring people to our rural area,” said Berta Alley, a registered nurse in the infusion clinic and chief negotiator for the Maine State Nurses Association (MSNA), the union representing the nurses and technicians. “And also, bring people back to our hospital that are out in the community.” 

Alley has seen colleagues leave the profession in recent years and those who remain take on second jobs to make ends meet, which she said demonstrates a need for cost-of-living wage increases. 

Despite failure of patient ratio bill, Maine nurses union celebrates progress in staffing fight

The nurses and technicians announced their plan to strike on April 19. They’ve been bargaining for a new contract since September 2023, before their contract expired on Oct. 18. Down East Community Hospital, a 25-bed acute care facility that also offers primary care, is the only hospital in a roughly 50 mile radius. 

“This is about prioritizing our community and our patients,” Joelle Jackson, a medical lab technician and union steward, said of the strike. “Unfortunately, that’s just not what we see happening.”

Some staff left last year after their responsibilities doubled from the hospital merging its medical surgery and obstetrics departments, which at the time CEO Steve Lail said he saw as a move vital to the hospital’s long-term financial health and recovery from the continuing fallout of the COVID-19 pandemic, as reported by the Machias Valley News Observer. 

Julie Hixson, director of marketing and communications for Down East Community Hospital, said a significant number of workers left before then, in 2021, because of the COVID-19 vaccine requirement, which led the hospital to rely on travel nurses to keep services in operation. In May 2023, the hospital had 23 traveling personnel throughout unionized departments, and as of this month, there are now 12, Hixson said. 

Hixson cited declining financial performance linked to depleted pandemic relief funds as to why the hospital is unable to meet the union’s demands. Audited financial statements show the hospital had a surplus due to federal COVID relief but is now operating at a loss.  

“All relief funds have been expended as required by law, and the hospital is left to address significant compensation, benefits, and supply cost increases driven by inflation with no additional support thus resulting in operating losses since 2022 that continue in present day,” Hixson said.  

​​In contrast, the union cited Form 990s from 2020 to 2022, the latest year available, that show net asset gains and increasing salaries for Lail, the CEO, and Chief Financial Officer Lynette Parr.

Currently, the hospital is offering higher wages as needed during the strike to per diem nurses who set their own schedules, which the union nurses say should instead go toward the recruitment and retention of permanent staff. Hixson said the hospital offered the bonus to ensure care could be provided and that union staff have been offered such bonuses to cover vacant shifts in lieu of using travelers.

In addition to an inability to reach agreement on compensation, another issue nurses have raised is over what they call safe staffing ratios. 

There are currently no nurse-to-patient ratios mandated by law, though lawmakers attempted, ultimately unsuccessfully, to create such requirements through legislation this session. 

Throughout consideration of that bill, and in response to the current strike, nurses have cited studies that show patients are at higher risk of preventable medical errors and avoidable complications when nurses have to care for too many patients at one time. An analysis of multiple data sources found that each additional patient the average nurse is responsible for raises the odds of patient mortality. 

Further, nurses said that inadequate staffing also has negative effects on their wellbeing, including mental health issues such as stress, anxiety and depression.

The protest in Machias is a pocket of outcry from the union’s broader membership of about 4,000 nurses and caregivers across the state, who have spoken to similar challenges with unmanageable nurse-to-patient ratios hampering patient safety in other hospitals. 

“We’re having to skip things and be really task-oriented instead of having the ability to use the nursing process to catch subtle changes in patient conditions that could lead to something terrible,” Kelli Brennan, a nurse at Maine Medical Center in Portland, told Maine Morning Star in early March. 

In the absence of a state law, these ratios are set for unionized workers in contracts with their respective hospitals. In general, staffing levels vary based on patient needs, explained MSNA president and registered nurse Cokie Giles. Most patients in acute care settings are in medical-surgical units where the minimum nurse-to-patient ratio is 1:4, Giles said, but patients in the ICU may need a one nurse dedicated to one patient, or sometimes two nurses per one critical patient.  

Down East Community Hospital does not have an ICU, and per the expired union contract, medical-surgical nurses have a one nurse for five patients ratio, according to MSNA.  

“The important thing is that every patient receives the nursing care they need,” Giles said, adding that the legislation that did not come to fruition this session would have ensured that hospitals couldn’t implement a blanket mandate treating all patients and nurses the same.

Known as the Maine Quality Care Act, LD 1639 would have created mandated nurse-to-patient ratios in certain health care settings, authorized the Maine Department of Health and Human Services to enforce those limits and protected nurse whistleblowers who speak out about unsafe assignments.

Sponsored by Sen. Stacy Brenner (D-Cumberland) and co-sponsored by Democratic leadership of both chambers, among others, the bill passed the Senate 22-13 but never received votes in the House, which tabled the measure in March. Mary Kate O’Sullivan, a nurse and member of MSNA, previously told Maine Morning Star the proposal didn’t have the votes needed to pass the other chamber.

For now, those efforts continue in Machias. The strike began at 7 a.m. Tuesday and is slated to last until 6:59 a.m. on Thursday. Hixson, the hospital spokesperson, said the strike would have minimal impact on patient care but that the hospital would be moving some scheduled services to non-strike days as well as closing its obstetric unit from 7 a.m. Monday through 7 a.m. Thursday.