Patient Care at Eastern Maine Medical Center

Patient Care at Eastern Maine
Medical Center
… a nurse priority
… a community concern
A report by the Worker Rights Board of Eastern Maine on
patient care and quality healthcare outcomes from the
perspective of those who do the work.
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Worker Rights Board of Eastern Maine
20 Ivers Street, Brewer, Maine 04412 ● (207) 989-5860
Steering Committee
Dr. Bjorn Claeson
Rev. Dr. Mark Doty
Hon. Adam Goode
Julie Grab
Eric Mehnert, Esq.
Bill Murphy
Members
Dr. Doug Allen
Dr. Francois Amar
Margaret Baillie
Dr. Tony Brinkley
Lisa Butler, Esq.
Hon. Emily Cain
Dr. Valerie Carter
Dennis Chinoy
The mission of the Worker Rights
Board of Eastern Maine is to
provide a community forum to
legitimize workers' voices and to
help remedy workplace injustices.
Rev. Dr. Susan Davies
John Diefenbacher-Krall
Jon Falk
Father Tom Farley
Dr. Nathan Godfried
Hon. Geoff Gratwick, M.D.
For more information, please go to
www.foodandmedicine.org/worker-rights-board
or call 989-5860.
Rev. Becky Gunn
Dr. Mike Howard
Rabbi Darah Lerner
Clyde MacDonald
Dr. Beth McKillen
Hon. Mike Michaud
Suzanne Moulton
Joe Perry
Ilze Petersons
Hon. Elizabeth Schneider
Paul Volckhausen
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Patient Care at EMMC
Table of Contents:
Executive Summary
4
The Worker Rights Board of Eastern Maine (WRB)
5
Background to the Crisis
5
Preliminary Conclusions
8
Nurse and Patient Testimonials
10
Conclusion
20
Acknowledgements
23
Appendices:
A: WRB invitation to Corporators
24
B: WRB Op Ed
26
C: WRB letter to Deborah Carey Johnson
28
D: Deborah Carey Johnson letter to WRB
29
E: Bangor Daily News coverage of Forum
30
F: Eastern Maine Healthcare Systems (EMHS) Directory
31
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Executive Summary
The nurses and management at Eastern Maine Medical Center (EMMC), a non-profit
community hospital, just settled the second contentious contract negotiation in two years.
However, the issues of nurse staffing and patient care promise to remain critical issues in the
times ahead. Further, severe budget cuts proposed by the LePage administration threaten
funding to Maine’s regional healthcare providers. EMMC management recently announced the
sale of its dialysis services to a for-profit, Fortune 500 dialysis company, Colorado-based
DaVita, further raising concerns about the management of our community-directed, non-profit
hospital.
Most of EMMC’s revenue comes from tax dollars through Medicare, Medicaid,
Mainecare and public insurance pools. EMMC also benefits from the forgiveness of income
taxes and other corporate taxes, including property taxes. This is particularly significant for
Bangor and Brewer, where property tax rates are relatively high. EMMC’s costs are also passed
on to the public through health insurance premiums, which rise when healthcare costs go up.
Given the situation, this report will
Explore developments and issues underlying the factious relationship between
EMMC management and its workers.
Provide the perspectives of EMMC employees and former patients.
Explore the roles and responsibilities of:
Nurses and their unions.
Management at our non-profit, community hospital.
Corporators and board members of EMMC.
Local elected leaders.
The Worker Rights Board of Eastern Maine (WRB) sees these issues as absolutely essential to
worker rights, the care of patients, and the long-term viability of the Eastern Maine Medical
Center as a crucial asset to our community. The questions we attempt to answer in this report
are:
Have conditions for patient care improved at EMMC?
To what degree does EMMC management look after the greater good?
Has EMMC management become more forthcoming and accountable to our
community?
What can be done to help resolve worker-management issues at EMMC and to
improve healthcare services for the local community?
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Worker Rights Board of Eastern Maine
In early 2009, members of the Bangor community, concerned about injustice in the
workplace and the weakened voice of both organized and unorganized workers, began to put
together a worker rights board. This board is a project of Food AND Medicine and Jobs with
Justice. Since 1993, Jobs with Justice worker rights boards have brought together respected
members of communities to address the lack of an adequate legal framework to listen to
workers’ stories and to advocate for just solutions to violations of workers’ rights.
As members of local boards in more than 25 cities and a National Workers’ Rights
Board, religious leaders, academics and elected officials respond to worker and community
concerns in a variety of public forums.
In January 2010, the Worker Rights Board of Eastern Maine (WRB) introduced itself to
the community. This board, made up of over 30 faith leaders, farmers, elected officials, legal
and judicial representatives, academics and various members of non-profit groups, fulfills two
essential functions: it provides a community forum to legitimize workers’ voices, and helps
remedy workplace injustices. The WRB helps workers to make changes that will benefit their
lives and the surrounding community. Worker rights boards use a variety of tactics, the most
powerful being listening to workers in a formal “hearing.” In the fall of 2010, nurses who were
negotiating their new contract with the Eastern Maine Medical Center (EMMC) felt their voices
were not being heard. Through their union, the Maine State Nurses Association/National Nurses
United (MSNA), they approached the WRB for assistance.
Background to the Crisis
How did we get to this point?
One dark and rainy night in the autumn of 2010, State Street in Bangor was lit up with
hundreds and hundreds of candles held by working professionals at Eastern Maine Medical
Center (EMMC), who were calling attention to staffing issues and patient safety at their
workplace. The National Institute of Health estimates that 98,000 patients die each year in US
hospitals due to avoidable error and staff shortages. Registered nurses intercept 86% of all
medication errors, but they must be present, on duty, with manageable loads and have time to
utilize their skills in patient assessment in order to catch errors effectively. The nurses wanted the
public to know that these issues are interrelated.
A few weeks later—one week before Thanksgiving—EMMC administrators did what no
other hospital in Maine has done before. They locked out over 800 nurses for two days after a
one-day strike by the nurses’ union. The nurses reached out to the community to broaden the
conversation about patient care. They met with legislators, non-profit institutions, and the
Worker Rights Board of Eastern Maine.
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Is this solely an issue between labor and management, or does it concern the entire
community?
The steering committee of the WRB met regularly to discuss the issues brought by the
nurses, research the problems, and make contact with all parties involved. At the same time, the
EMMC began a series of advertisements about the contract questions, bringing the staffing issue
directly to the community. The WRB steering committee offered to meet with the EMMC
administration both in person and by letter (See Appendix A), but were repeatedly rebuffed.
Nurse staffing: a critical issue in our community
After a number of meetings with nurses, the WRB steering committee realized that nurseto-patient staffing ratios affect nurses and are a concern to the entire community. Although there
have been staffing concerns since the 1970’s regarding both nurse-to-patient ratios and
schedules, this has become a larger issue since 2009, in part because EMMC has eliminated
nearly 100 nursing positions. The Medical Center administration has insisted on leaving
vacancies unfilled, despite nurse opposition. The loss of 10% of the work force has resulted in
increased patient assignments for staff nurses, especially during the 7pm-11 pm period in the
Towers (the main building at EMMC), where a second shift was virtually eliminated. Due to the
critical role nurses play, patient care has suffered. As one nurse stated, “This isn’t about not
wanting to work hard, it is about the simple impossibility of being two or more places at once.”
The nurses were quite clear, inadequate staffing had reached a crisis point for patient care.
EMMC response to nurses
EMMC management either ignored or rejected nurse staffing as an issue for contract
negotiations, and instead repeatedly attacked the union. EMMC hired a Portland law firm that
specializes in union busting as a negotiator, spent well over $60,000 on newspaper
advertisements disparaging nurses and their union, and spent more than $900,000 on salaries,
meals, and travel for 215 replacement nurses for a lockout. The nurses believed management
had little intention of negotiating in good faith. Even in its ads to the whole community, EMMC
said it “cannot compromise with a national nurses union on staffing ratios, transfer language and
health insurance offerings.” (See page 7)
EMMC response to the WRB
After initial investigation of the negotiation issues, the WRB steering committee invited
EMMC management to meet with them. The management declined to meet with the steering
committee, offering to talk only with Adam Goode, a state legislator and steering committee
member. During the continued negotiations and mediation of their contract, nurses told the WRB
steering committee that they felt an atmosphere of intimidation beginning to arise, in which
nurses who questioned or challenged the EMMC were threatened by management.
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Bangor Daily News 11/16/10 p B3
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Preliminary Conclusions
By March 2011, after several meetings with nurses and union negotiators and an extensive
investigation of the issues involved, the WRB came to several conclusions:
1. There needs to be far more transparency in hospital operations as they relate to patient
care. Also, the hospital should publicly disclose staffing levels and rates of hospital
acquired infections and medical errors.
2. EMMC Board of Directors meetings need to be open to the public. Further the Board of
Directors should include members representing low and mid-level employees of the
hospital and former patients.
3. The workload and stress caused by inadequate staffing and resulting job requirements are
having a critical effect on the quality of care, which poses dangers to members of the
community.
4. EMMC management’s reprisals against nurses who speak up for their rights and the
climate of fear this causes must end.
Therefore, the WRB declared the need for a public forum where positions in the contract
negotiations could be heard and concerns could be voiced. The nurses, the EMMC management,
and the public were all invited to participate in the forum, held on April 25, 2011. Nurse
testimonials and patient testimonials follow. The EMMC management chose not to participate.
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Bangor Daily News 2/9/11 p A3
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Nurse and Patient Testimonials
The Worker Rights Board of Eastern Maine (WRB) hosted a forum at the Bangor Public
Library on Monday, April 25th, 2011 entitled Staffing and Quality Healthcare Outcomes at
Eastern Maine Medical Center. Prior to the forum, the WRB invited EMMC Board members,
Corporators, nurses and the community to attend. Michelle Hood, EMHS President and CEO
wrote ominously in e-mail to EMHS Corporators that, “a person who attends and expresses an
opinion at odds with the union’s viewpoint should be prepared for the possibility of being treated
disrespectfully.” (See page 13).
The public hearing, which was widely reported by the local media, featured numerous
testimonies by workers and patients who cared about improving patient care. Within three days,
management at EMMC did in fact “compromise with a national nurses union on staffing ratios,
transfer language and health insurance offerings,” and the nurses won a contract.
Members of the Worker Rights Board of Eastern Maine listen to Nurses and community members
speaking about health care at Eastern Maine Medical Center.
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Dawn Caron
Caron has been a RN at EMMC for fourteen years. At present, she is a labor and delivery
nurse on level 7 at EMMC. Because of staff needs in the Emergency Room (ER), she
volunteered to float there when they are in crisis mode. Recently, she has been cross training to
the ER department so that when she goes to the ER she can be of more use to them.
“Being a nurse is as much a part of me as breathing,” she says. “The current situation
surrounding negotiations pains me deeply and voting to strike was the hardest thing I have ever
done professionally.”
She said, “The ER feels like a disaster zone. I feel called to help ER staff.” Along with
drug-related emergencies, psychiatric admissions, and trauma patients, Dawn noted, violence and
rage find their way into the hospital. She is concerned for the safety of employees. She
described an incident where a nurse was grabbed by a patient and her head was slammed against
the wall. She said that on the way into the ER, she passed beds in the hallway with patients who
still had not been seen. She has had to prepare trauma patients for the operating room, a task that
she had not previously done for many years. She described another incident in which a patient
who was actively bleeding in the waiting room had to receive initial treatment in full view of
patients and visitors, including children. According to Caron, the ER has a patient load that
requires more staff, but the administration keeps saying there is no problem.
“EMMC has said we’ve blindly
followed in step with a national agenda,”
continued Caron. “Yes, in step but not
blind. We should be able to have the
same level of competent, compassionate
and adequately staffed care for ourselves
and loved ones whether we are in
California or in Maine.” When asked
about floating staff, she said that nurses
sometimes asked to move but are not
comfortable in the new sites, in part
because they might not have the
experience needed for care.
“Being a patient advocate is our
highest calling,” declared Caron. “I do
not understand how the administration of
EMMC can say there is no problem with
staffing and refuse to negotiate on this
matter.”
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Jessie Mellott addressing the Worker Rights Board Forum
Jessie Mellott
Although she has worked at EMMC for ten years, Mellott has only been a nurse there for
one year. She works a 12-hour shift, which she said can stretch to 13 hours or occasionally
longer. She said that her priority is to do what is needed medically, but it is not always possible.
In addition, Mellott said, “There are a lot of tasks that are proven to help patients heal faster, but
when I am assigned 7 or 8 or more patients in a 12-hour shift, those simple tasks don’t get done,
like helping patients to eat, encouraging them to do deep breathing, talking and listening to them,
helping them walk or sit up in a chair.” She said, “I want to work harder, I want to have the time
to do more for my patients.”
She said that people are even asked to work an extra four hours, making a 16-hour shift
total, and that “a lot on [her] floor would go back to eights [eight hour shifts] in a second.”
Additionally, proper break time presents an issue. She said, “I’ve been told we’re supposed to get
two fifteens and a half hour. I usually get a chance to stuff some food in a couple times a day.
You’re having a good day if you get a lunch break!” She misses a break “Every day. Every day.”
Cindy Kekacs
Cindy is an RN who works on the
cardiac floor. She said, “I like my job. I
honor the trust of patients and families who
allow me and expect me to keep them safe,
help them get well and to provide accurate
and reliable information about their illness
and treatment.” Kekacs said that when she
started nursing, she would have 3 to 5
patients on an 8-hour shift. “I had time to
talk to patients and listen to them,” she
P a g e | 13
said. Circumstances have changed with 12-hour shifts. At night, she said, patients are “scattered
in a big triangle…hard to get to through distance and keep an eye on them.” She mentioned this
to the Charge Nurse, who simply said everybody has a heavy load. One night Kekacs said to a
Charge Nurse, “Somebody’s going to fall tonight.” 90 minutes later, one patient fell. “I take
responsibility very seriously. I felt I had let him down and more than just myself at fault,”
Kekacs recalled from that night. “More than that, the system was at fault. I still had six patients,
despite objections to the Charge Nurse. Fortunately, no broken bones, but that’s not the point. I
don’t want to work in circumstances where when I finish a shift it’s ‘phew, nobody got hurt
today.’ The thing now is fewer staff with more patients.”
She agreed with Mellott about good things falling by the wayside. “I went into nursing to
give patient care, not give pills. I don’t feel I have the time. Yes, it’s more stressful. I liked
working under the old system.”
Steven Akerley
Steve is a thirty-year employee of
EMMC, 20 of them as an RN. He is a steward
and also works on the Professional Practice
Committee. He said, “EMMC has grown, the
economy is in the tank, health care is a mess,
patients are sicker, and they require so much
care. Support from the hospital is not there.”
He said that nurses work long hours with little
or no back up and on top of this must do hours
of work on the computer. The committee gets
letters from nurses who are mentally and
physically tired and can’t give patients the care
they deserve. He said that nurses are also
patient advocates. “Let’s get Eastern Maine
Medical Center back into the patient care
business and out of the profit business.”
Akerley said that “patients wait longer
to come in” than they did in the past. “There
are more patients with multiple morbidities,
and it takes a lot of care,” Akerley continued.
“We used to have a nursing pool and techs to back up. The system balanced out better.” When
questioned about techs, he said that one floor technician could have fifteen patients.
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Rachel Maidlow
Maidlow has been a nurse for 29 years at
EMMC and is now in the ICU. She said that she
has seen drastic changes in how nurses are used.
“I came to make a difference in lives. I don’t feel I
can do that anymore,” Maidlow said. She said
there are two patients to one nurse in ICU, but
there are patients who require more than one nurse.
Maidlow feels that nurses are taking on larger
loads to make up for the removal of adequate
support staff. “The Charge Nurse may not be
available for assistance..things happen; we no
longer have a safety net to catch bad things,” she
said. She explained how, due to staff shortages
elsewhere in the hospital, every day there are
patients waiting in the ICU to get moved to other
floors.
Lori Trundy
Trundy testified on the problems of understaffing and long shifts. “We work 12-hour
shifts and a lot of days we don’t get our fifteen-minute breaks,” she said. We just continue to
work. A lot of times we don’t get our lunches, or we watch monitors during lunch or answering
the phone. We’re just sort of used to it – we just do it. We’ve given the hospital suggestions
about how to deal with this – like keeping the Charge Nurse without assignment. You need
someone to help you.” Trundy continued, “We don’t want to be here to seem like complainers
and we don’t want to be on the picket line, but we’ve given suggestions about how to do things
and they’ve said they have no intention of meeting you anywhere on the continuum. How do we
negotiate? We both have to be willing to bend on issues. We hope they are willing to consider
our suggestions.”
When asked whether she knew the labor laws regarding breaks, Trundy said “We have
the right to take breaks – that’s mandated by law.” She noted that, too often, employees feel they
must make reports anonymously.
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Eloise Rhyne
Rhyne has been a nurse
for 43 years and has worked for
23 years at EMMC. She works
12-hour shifts in the ICU, which
she feels is too long. She said
that it is good when nurses in the
ICU are assigned one or two
patients, but sometimes is they
are assigned more and the
Charge Nurse has assignments
also. In the ICU, a patient might
come in who is in desperate need
of care, and there is no one to
cover the load. She said that as
the numbers of patients go up, if
a nurse in the ICU “misses one little thing, the patient is critical within the hour.” Since nurses
fight to help their patients, they also cover for each other when they have large loads. This means
they often miss breaks, according to Rhyne. “We don’t get our breaks,” she said, “don’t get
supper hours because it’s critical and we don’t want to leave one nurse with four patients.”
When asked whether overtime is mandated, Rhyne said no, but explained that once she
had been asked to work a sixteen-hour shift and go to another floor to pick up seven patients.
Out of concern for patient safety, she said no, and the supervisor told her she is “ not a very good
team player.”
Emily Braley
Braley has been at EMMC for 11
years, 10 of them as a nurse. She spoke
about the issue of health insurance.
According to Braley, EMMC wants to
remove nurses’ options for insurance
and provide only what she called
“catastrophic” insurance, with a $10,000
deductible.
When questioned about
the change, the EMMC said they
couldn’t afford other policies. Yet, said
Braley, the hospital’s own website
shows financial health.
“Shouldn’t
keeping employees healthy be a priority
for the hospital?” she asked. Braley said that there could be no other justification for EMMC’s
decision other than increasing profits. She also explained the differences between insurance
offerings for union and nonunion employees. According to Braley, EMMC’s insurance offerings
are a deliberate strategy to pit employees against each other to weaken the union.
P a g e | 16
Alan Young
Young is an ex-patient who
has been hospitalized many times.
He first described how patients are
held in hallways because wards
are
kept
empty
due
to
understaffing. Therefore, beds are
not available. Young said he even
once had a heart attack in a
hallway bed. His last hospital
visit was for knee surgery and he
needed help to get out of bed and
use the bathroom.
When he
buzzed for help, no one came.
After ringing the call button every
five minutes for 45 minutes, he
soiled the bed. “Is this quality patient care?” Young asked. He said, “Nurses are born with a
special gift. The care they provide for patients who have to be in the hospital is so crucial to
healing.” His major concern is that understaffing interferes with this role of nurses in care.
Robert Toole
Toole is an ex-patient who has
lived in Bangor all of his life and
whose wife has had four children at
EMMC.
Though some of his
experiences at the hospital were good,
Toole felt that more recent ones had
been negative. On one recent occasion
he went to the ER with severe back
pain. He said, “They put me on a
gurney and left me in the hallway. I
have diabetes, my sugar was low, and I
was in trouble.” Toole said that there
were not enough care providers, and
that he expects more from hospitals.
“When you’re in the hospital, you
expect to be cared for, not to get sicker.
I thought I had been forgotten,” he
said. Toole was also concerned that
nurses are not used effectively.
“Nurses are placed in other locations
where skills are wasted,” he said.
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Joe Gallon
Gallon was a patient early in 2011 at EMMC. Undergoing serious surgery and
complications following surgery, he was treated by a number of nurses during numerous stays at
the hospital. He felt the nurses were caring and very professional. Several events made him
think, however, that the hospital was low on staff. For example, he described being “tied up on
an IV pump constantly.” “Every time I turn around it starts to beep,” he continued. “Fifteen
minutes, nobody shows up. I waited another fifteen minutes. Nobody shows up. I called in
again, they said they were very busy but somebody will be down. Eventually someone came
down.”
Maureen Caristi
Caristi is an R.N. who spoke from both the experience of working at EMMC and of being a
patient there. She said that once she “was a patient, a very sick patient.” On this occasion,
Caristi was moved from a floor to the ICU, then back to the other floor, after which she went into
a respiratory arrest. Once again, she was moved to the ICU and had multiple problems, ending
her visit with “open wounds, bed sores, and tendrils embedded in her leg...” Caristi said that safe
staffing “should be a moral, ethical deal” and that she never thought she would get up and speak
about it. “…it should be a legal thing,” Caristi continued. “They have to have safe staffing and
better patient care.” Having once been a steward, she said, “I can tell you for a fact there is
retribution from management when we speak out.” She talked about one instance when she saw
a family who sat in the ER for two days. She said that a family member died the next day.
“[EMMC] told the family there were no beds, but in truth there were, just nobody to take care of
the patients,” said Caristi.
Monica Rizzo
Rizzo is an RN in northern California. She has
been a med/surg nurse for nine years and is a union
member. She said that the union supports her and
cares for her as a person, and also works for patient
safety. Rizzo works the night shift, 11pm-7:30 am.
Although the state of California mandates ratios of 12-5 or less for the med/surg unit, her hospital gives
nurses 1-2-4. Rizzo said that the management at her
hospital realizes that nurses have to provide not only a
healing environment, but also essential care and
teaching. For example, nurses have to teach patients
home care skills such as dressing changes and
injections. Rizzo also said that RNs at her hospital
have a break schedule that works. “I have a designated
break relief that works with me, comes to me and says
P a g e | 18
you have 15 minutes – go on break,” she said. “We have a telephone. I take my fifteen minutes
to walk around, come back, and know my patients were cared for. Then I have my thirty
minutes, again can have my rest period uninterrupted, and know my patients were cared for.
Last fifteen minutes the same. I can go home and not feel guilty something has happened,
praying something won’t come up.” When asked if a person was hired for break relief, Rizzo
replied that yes, her hospital schedules an RN whose whole assignment is break relief. “We have
six nurses plus her,” Rizzo said. “She provides seven hours worth of break in an 8-hour shift;
that’s all they have time for.”
Judy Brown
Brown, who is president of MSNA
Local #1, said she approaches this
issue not only as a nurse and union
leader, but also as a community
member. “I’m very concerned that the
hospital does not want to deal with
nurses, the people who have dedicated
their lives [to patient care],” said
Brown. She said that the situation
must improve.
She described an
incident when she once had time to sit
and talk with a young male patient.
He said he was very uncomfortable,
because he “never knew when somebody could come in and relieve pain.” “After discussing his
pain level and conferring with his doctor,” Brown continued, “we were able to reduce his pain
from level seven to a two in about half an hour.” She was able to get him relief only because she
had time to “sit with him and know what’s going on with medications.” Brown continued, “This
is not an economic issue; it’s a moral issue.” She and the nurses did not want to go on strike.
“We want to get this solved,” she explained.
Cokie Giles
Giles spoke more than once from the
audience.
As a member of the
bargaining team, she spoke about the
hospital’s response to staffing requests,
and about a mandatory forum all nurses
had to attend. Giles said that one nurse
who spoke in criticism of the hospital
got a written warning from the
administration a week later.
P a g e | 19
Conclusion
The mission of the WRB is to provide a community forum to legitimize worker’s voices and
to remedy workplace injustices in Eastern Maine. Our examination of the contract negotiations
and working conditions within the EMMC show that there is much to be done to improve the
largest hospital in Eastern Maine. After meetings with both sides, a full study of the issues and
real conditions at EMMC and a public forum of testimonies, the WRB has come to a number of
conclusions:
a. Workload and stress caused by understaffing, shift schedules, and job requirements
have had a critical negative effect on patient care at EMMC. From the ER to the
ICU, understaffing has resulted in many negative conditions for both nurses and patients,
including:
i.
facilities are not being fully utilized due to insufficient staffing, resulting in
patients being held on beds in hallways in other areas or being held in highly
monitored areas like the ICU long after they could have been transferred out to
begin the transition toward recovery and exit from the hospital;
ii.
the nurse/patient ratio is so high that nurses need to rush just to give out
medications on schedule and fulfill minimum nursing care requirements, and
cannot give quality patient care or take time to talk to patients about their
condition or view changes in patients’ symptoms;
iii. the burden of job requirements and lack of backup causes nurses to sacrifice
legally required breaks throughout their mandated 12-hour shifts, resulting in a
higher chance of poor care or mistakes;
iv.
floating assignments place nurses in areas outside their expertise, which could
threaten patient care; and
v.
stress caused by long shifts, understaffing, poor organization of facilities and
assignments and efforts by management to question and divide staff are causing a
lessening of the quality of patient care at EMMC.
b. At times there is authoritarian and disrespectful supervision of nurses in the
hospital and a fear of reprisal toward those who question policies. Many testimonies
at the WRB’s forum describe a threatening attitude being expressed by supervisors when
nurses questioned demands. For example, one nurse questioned working four hours
overtime (on top of a 12-hour shift) and adding seven more patients. When, out of
concern for patient safety and care, she refused, her supervisor simply looked down on
her, saying she was “not a good team player.” When forced into these difficult situations,
nurses have the right to sign an Assignment Despite Objection (ADO) form. However,
one nurse told the WRB that she did this and was followed around by an administrator
who made notes on a clipboard about her work, intimidating her. One nurse testified that
if nurses make serious complaints to administrators, it is usually done anonymously.
This is a very poor working climate, which will in turn affect patient care. In order to
monitor and document situations in which nurses work shorthanded, the ADO forms
should be encouraged rather than discouraged.
P a g e | 20
c. Both on the job and during contract negotiations, nurses must be viewed with more
respect, as professionals with experience and expertise in medical care. During
bargaining and mediation, the hospital seemed to take an antagonistic ad hominem
attitude. This was expressed by an almost immediate rejection of continuing direct
negotiations and a number of costly advertisements in local newspapers. It was also
expressed by a very expensive three-day lockout that clearly threatened patient care, due
to replacement nurses who were unfamiliar with facilities and hospital policies. All
nurses who gave testimonies or met with the WRB seemed to agree that they have not
been viewed as experienced professionals worthy of respect.
d. EMMC administration must be more transparent and accountable to the
community. The public has a right to information from any institution that receives
public money. Though the administrators certainly cannot answer each and every
question from members of the community, they must not hide behind their website and
newspaper ads. The nurses were denied information to which they had a legal right
during negotiations, and were forced to file suit. The following are some questions that
EMMC should answer to the community:
i.
ii.
iii.
iv.
v.
vi.
vii.
How much did the administration spend on the lockout / strike?
What policies does EMMC have to encourage a supportive climate that embraces
constructive criticism?
Since the nurses at EMMC organized their union (the Maine State Nurses
Association) in the 1970s, EMMC administration has consistently engaged in
attacking and undermining the nurses union. What policies and mechanisms does
EMMC have to ensure that its staff respect the union, the union’s elected officers
and the processes of collective bargaining and contract maintenance?
How has the patient census changed over the past two years and how have
staffing numbers changed?
Were EMMC Board member and EMHS Board members and Corporators
involved in the decisions to lockout nurses, to spend money on replacement
nurses and to spend money on extensive advertising? If so, how?
What is the role of EMMC Board members and EMHS Board members and
Corporators, and how are these individuals chosen?
What is the relationship between EMHS’ non-profit and for-profit entities? What
protections exist to ensure that neither entity is receiving funds improperly?
At the EMMC, the ongoing problem involving the understaffing of nurses continues to
have a severe and detrimental impact upon patient care, constructive labor relations with nurses
and other support staff and the overall working environment of the institution.
In the mid 1970's, the nurses of the EMMC first organized their union and worked
collectively to address the issue of unsafe staffing levels and its harmful impact upon patient
care. Since that time, the MSNA has continued to be a strong and dedicated advocate for safe
staffing levels, manageable and humane shift schedules and fair job requirements.
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The management of the EMMC has both a moral and legal responsibility to work with
the nurses of the MSNA on a continuous basis to resolve these issues. After all, it is the nurses
of the MSNA who, through their experience, expertise and dedication, know best how to achieve
and maintain quality care and safe staffing levels at the EMMC.
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Acknowledgements
This report would not have been accomplished without the dedication and efforts of the
many people. Special thanks are due to Julie Grab, who put extensive work into writing this
report, and to Rep. Adam Goode and Rev. Mark Doty, who wrote a very thoughtful editorial in
the Bangor Daily News on the issues at EMMC (included in Appendix B).
Thanks to Eric Mehnert for moderating the Public Forum on April 25, 2011 that allowed
for the testimony incorporated in the report, and to these WRB members for attending the forum:
Valerie Carter, Doug Allen, Ilze Peterson, Beth McKillen, Bjorn Claeson, Margaret Baillie, Jon
Falk, Julie Grab, Bill Murphy, Lisa Butler, Rep. Adam Goode, and Rev. Mark Doty. We also
want to thank the Bangor Public Library for hosting the public forum.
Thanks to Jack McKay, Vanessa Sylvester, Martin Chartrand, and Laura Binger, who
provided staff and logistical support and helped those involved stay focused and direct their
energy in an effective manner. Thanks to the individuals and organizations that fund Food AND
Medicine.
Thanks to the nurses and their union for having the wisdom, courage and strength to
bring these difficult issues to the public, where they rightfully belong, and thereby aiding in
making our hospital a better place.
Finally, this whole effort would not have been achieved without the time, perseverance
and wisdom of the WRB steering committee: Bjorn Claeson, Julie Grab, Bill Murphy, Rep.
Adam Goode, Rev. Mark Doty, and Eric Mehnert. These individuals gave a huge amount of time
to organizing support for nurses and patient care in a host of ways, including the public forum
and this report.
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Appendix A: WRB Invitation to Corporators
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Appendix B: WRB Op-Ed
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Appendix C: WRB Letter to Deborah Carey Johnson
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Appendix D: Deborah Carey Johnson letter to WRB
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Appendix E: BDN Coverage of Forum
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Appendix F: Eastern Maine Health Systems Directory
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Forum on Eastern Maine Medical Center Staffing and Healthcare Quality
Outcomes at the Bangor Public Library, April 25, 2011
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