Machias hospital nurses, technicians at odds with leadership over staffing, work environment

Registered nurses and technicians at Down East Community Hospital in Machias picket to mark the start of their strike on April 30. (Courtesy of the Maine State Nurses Association/National Nurses Organizing Committee)

The board overseeing Down East Community Hospital in Machias is pushing back on claims hospital management isn’t doing enough to address staffing and work environment challenges after registered nurses and technicians delivered a petition of no confidence in the hospital’s leadership earlier this month.

On Friday, the board issued a statement of support in the hospital’s leadership in light of the petition for a no confidence vote.

“While such a vote would have no binding effect on this board, we feel that it does send the wrong message about our organization to our employees and to the communities we serve,” the letter reads. “We wish to express the board’s strong and unequivocal support of our hospital leaders during these stressful times.”

The employees, who are represented by the Maine State Nurses Association, hand delivered the petition to the board chair at her home on June 16. The action came after Down East nurses and technicians held a strike in April over compensation and staffing they said was inadequate and jeopardizing patient care, as well as recent unsuccessful legislative attempts to address safe staffing concerns across the state.

The petition accuses chief executive officer Steve Lail, chief financial officer Lynnette Parr, and chief nursing officer John Marshall of failing to prioritize patient safety, communicate with staff, retain high-quality workers, compensate staff fairly, and reach a fair contract. The unionized staff have been bargaining for a new contract since September 2023, before their contract expired on Oct. 18.

Board chair Jacqueline O’Clair said the hospital had addressed each of these concerns in a letter to the union on June 19, ahead of the board’s joint statement Friday.

“I ask everyone to just step back and remember that we all do need to work together to repair the hard feelings that have occurred as a result of these negotiations,” O’Clair wrote.

Following both letters, union representatives stand by their petition of no confidence.

Berta Alley, a registered nurse in the infusion clinic and chief negotiator for the union, said O’Clair did not address any of the serious concerns raised in the petition and Joelle Jackson, a medical lab technician, said the union was disappointed that the board’s joint statement defended the decisions of management.

“We wrote and signed the petition because management refuses to listen to us,” Jackson said. “The petition to the board lists our concerns about patient care, staffing, recruitment and retention.  These are issues that affect everyone in our community.”

Concerns about patient safety

Many of the union’s concerns about patient safety stem from the hospital’s decision to combine the medical-surgical unit with the specialty labor and delivery unit last year.

“Specialty units are specialty units for a reason,” the petition read. “Nurses train specifically in these areas and receive specialized training to meet the patient needs of that population to provide optimal patient care.”

The hospital removed one labor and delivery nurse per shift and began cross training of medical-surgical staff to help the remaining labor and delivery nurse, which the union said in the petition was  insufficient and has caused several experienced nurses to quit due to safety concerns.

Nurses, technicians in Machias strike over staffing and retention issues

In her response, O’Clair listed a combination of online and in-person training available, noting that nurses now have access to a simulation lab for labor and delivery training and the hospital has signed an agreement with a community college in Bangor for obstetrics training.

Further, O’Clair noted that if the units hadn’t been combined, the hospital would have had to shut down the labor and delivery unit, likely resulting in layoffs and leaving no hospitals with this service in Washington County.

Risks of closure extend beyond Machias. More than a third of Maine’s rural hospitals are at financial risk of closure due in part to low patient volumes and narrow operating margins.

In the board’s letter of support for hospital leadership, members wrote that the hospital has prioritized service expansion for its area, including by acquiring Calais Regional Hospital to prevent its closure in 2022.

“As a board, we are fully aware of our financial situation and all future projections for both of our hospitals,” the letter reads, with the board going on to say, “Our goal is to remain independent as an organization and set our own course, this can only be achieved through financial prudence.”

The union petition also noted that some departments had no running hot water for more than four weeks, which O’Clair attributed to damage that needed a specialty part to repair and said had “very minimal effect on patient care.” Additionally, the union outlined concerns about the lack of an educator for staff, though O’Clair said in her response that the hospital has since added one.

Retention and compensation

The union also blames the hospital leadership for failing to retain experienced, high-quality staff and foster a culture of community and care. According to the union, 25% of nursing positions at the hospital remain unfilled.

“[The hospital’s] top-down decision-making and take-it-or-leave-it attitude has resulted in many nurses transferring out of departments where they have enormous experience

or leaving the hospital altogether, which does not benefit our patients or the community,” the petition reads, noting similar challenges with provider retention.

O’Clair responded that the union’s description does not account for the challenges stemming from the COVID-19 pandemic. As previously reported by Maine Morning Star , a significant number of workers left in 2021 because of the COVID-19 vaccine requirement, which led the hospital to rely on travel nurses to keep services in operation.

“As with all the hospitals, we have faced severe shortages and as our restrictions are lifted have reduced the number of [temporary] staff by half, and we always try to accommodate nurses who would like to move to other departments,” O’Clair wrote. “We are working with our universities and community colleges to create a more stable workforce in the future.”

The board as a whole echoed O’Clair’s stance in the letter this week.

“In the evolving future of healthcare, we feel confident that our leadership team has developed a

strategic plan that will continue to make us successful as an organization and allow us to provide vital services to our communities while also planning for the challenging times that lay ahead of us,” the letter reads. “This board works closely with Steve and the senior leadership team in all decisions that affect the viability of this organization.”

Nurses and technicians said that staff are also leaving for reasons aside from finances, pointing to what they see as the breakdown of community in the small hospital.

“Many nurses and technicians wouldn’t even recognize the executives if they walked in the room,” said Joelle Jackson, a medical lab technician. “We are all neighbors here and that neighborhood used to extend into the hospital, but it no longer does.”

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