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Houlton Regional Hospital registered nurses started picketing at 9 a.m. Tuesday as part of a four-day strike aimed at getting hospital administrators to negotiate a contract that maintains safe staffing guidelines and guarantees an additional nurse in the emergency department.
This is the second strike in six months by the facility’s registered nurses, who are represented by the Maine State Nurses Association, part of the National Nurses Organizing Committee. Nurses announced the plan last week to protest lack of a contract with the hospital and unsafe staffing levels.
On Tuesday, at the corner of North Street and Putnam Avenue about a block from the hospital, the nurses called for patient safety as a steady stream of cars honked in support.
“We’re out here today because we are looking to keep our current language in our contract to ensure that we can keep our staffing where it is,” said RN Erin Mitchell, who works in the emergency department. “We’re also asking for one additional staff member so we at all times will have three nurses in the emergency department.”
Hospital officials said last week that they had a comprehensive plan in place for the strike and will remain open to “provide care for our patients, and put patients and our community first.”
On Tuesday the hospital declined to make additional comments.
The nurses have been working without a contract since the previous one expired on Nov. 30, 2024. While hospital officials pointed to a 21% salary increase contract offer, the issue is not money, the union said.
The continued sticking points involve registered nurses’ concerns about understaffing in the emergency department and intermediate care unit, and also that the hospital wants to remove the safe staffing language defining patient care standards that has been in previous contracts, according to the Maine State Nurses Association.
The safe staffing language ensures a minimum number of staff, according to Mitchell.
Long wait times for emergency department patients, babies being delivered in the emergency department and stalled contract negotiations pushed the hospital’s registered nurses to call the two-day strike in November. Again, this week, the nurses chose a four-day strike without pay to stand-up for patient care.
“We want to have three nurses [in the emergency department] at all times. After the pandemic we had a wave of acuity because of people moving to this area and we’ve seen that increase ever since the maternity unit closed,” said registered nurse Beth Cook, who works in the ambulatory surgery unit, the emergency department and the acute care unit. “Anyone who goes to the emergency department would agree with us that three nurses at all times seems like an easy ask.”
When the hospital’s labor, delivery and post-partum unit closed last May management laid off 12 nurses and had agreed to three nurses in emergency care, Mitchell said.
“Now that they have new management they have taken that off the table,” she said.
Last June, Houlton Regional Hospital and Northern Maine Medical Center in Fort Kent signed a management service agreement for Northern Maine Medical to provide executive management for Houlton’s hospital for one year, focused on collaboration leading to a formal affiliation.
At the time, hospital officials said that the agreement, set to expire on June 12, was intended to increase patient access, enhance quality outcomes and improve the long-term financial stability of HRH and NMMC.
On Tuesday, hospital officials declined to comment on the status of a future agreement between the two Aroostook hospitals.
“It is unfortunate that the union continues to make allegations that the hospital staffing is unsafe,” HRH officials said last week. “Nursing leadership works extremely hard every day and every shift to ensure that safe staffing is achieved. Due to this diligence, the nurse-to-patient assignments are well within national benchmarks.”
The striking nurses question the hospital’s reference to meeting national benchmarks because they do not currently exist.
“The American Nurses Association has pretty vague language as well for acute-based staffing,” said Cook.
In Maine there are no laws dictating nurse-to-patient ratios. In January, the national Joint Commission on the Accreditation of Hospitals set a new safe staffing standard with the addition of National Patient Safety Goal 12. It does not specify nurse to patient ratios, but instead hospitals must demonstrate continuous registered nurse coverage and support staff to meet patient needs.
Emergency departments by nature are unpredictable and they often need more than two nurses, Cook and Mitchell said.
“If someone comes in and needs CPR, or other life saving interventions, you need more than two nurses, because you’re calling life flight, you’re giving medications, you’re at the bedside, you’re comforting a grieving family,” Cook said.
At the same time they may be working with a patient with thoughts of self harm, or a confused older patient trying to get out of bed, while also helping someone with severe pain or or taking care of someone who needs fetal heart tones, she said.
“There is such a variety of patients that can come in,” Cook said. “emergency care is so unpredictable that if you have to call someone to come in, it’s too late, you know.”
It was a hard choice for the nurses to lose nearly a week’s wages but they are doing this because they really care, they said.
“We want to keep the level of care, in the way that it’s been, that people are used to,” Mitchell said. “We don’t want them to come in and just be a number on the board. “
The HRH nurses are asking the Houlton hospital to retain the safe staffing language in the existing contract and to add an additional nurse in the emergency department. They are circulating a letter for members of the community to send to the board of trustees or to email HRH Trustee President Lynette McLaughlin, urging the trustees to support a fair contract.
