Workplace dynamics are playing out as the Down East Community Hospital (DECH) board and administrators respond to a petition of no confidence in Chief Executive Officer Steve Lail, Chief Financial Officer Lynette Parr and Chief Nursing Officer John Marshall. The petition was delivered by DECH registered nurses and technicians to the home of DECH board Chair Jacqueline O'Clair and is supported by both the Maine State Nurses Association and National Nurses Organizing Committee.
      Roberta Alley, an 18-year registered nurse, cites in the petition's public release, "The lack of respect toward nurses and technicians shown through contract negotiations is only the tip of the iceberg in terms of poor decision making and climate issues at DECH." Alley, DECH's chief nurse representative and negotiator, says, "We have lost three more full time nurses in the last month because of the current environment, and we already had an RN vacancy rate over 25%."
      In response, the DECH board says in a release, "We have full confidence in and strongly support our leadership team and the direction being provided by our CEO, Steve Lail." With regard to specific issues raised, the board's letter says: "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 while also planning for the challenging times that lay ahead of us."
      What started in September 2023, when administrators and union representatives began contract negotiations, has devolved into treading water, as both sides continue to contest issues. On October 18 the contract expired, with staff remaining on duty. With no progress, in January public rallies were held seeking support for the union members. Then on April 30 union nurses and technicians held a two day strike. This was the first strike in DECH history and was the first strike at a critical access hospital in the history of the state of Maine. On June 20 the petition of no confidence was delivered to the board and its chair. The last meeting between the administration and the union was on June 26.
      The petition lists six points of concern/failure that touch on three primary issues: recruiting and retention of permanent staff as opposed to the "Band aid" approach using temporary traveling nurses; lack of communication/transparency; and the inability to foster a culture of community and caring that – according to the union – impacts patient care.
      "We have 422 nurses with active licenses in Washington County," says Alley. "We only have 30-35 part time and full time staff RNs working at DECH, the largest facility in the county and one of only two hospitals. We only need about 15 more nurses to be fully staffed. There is no nursing shortage, there is only a shortage of nurses willing to work under current conditions. We need to improve our patient care and working conditions, so nurses come and stay." Alley says, "The vacancies, turnover and the use of temporary traveling nurses to fill in are just that -- a temporary solution. They don't solve our systemic problems. Our patients and communities are better served if the hospital invested in recruiting and retaining permanent staff nurses and techs and improving working conditions. As staff nurses and techs, we know our community, and we are committed to caring for our patients."

DECH administration responds
     In response, the board issued a letter of support for the current administration as well as a direct letter from O'Clair to Alley and others addressing points made in the petition.
      With regards to recruiting and staff retention, O'Clair says, "We are working with our universities and community colleges to create a more stable workforce in the future. Financial requirements and pressures of regulations do influence how the hospital must staff; however, as with any position anywhere, employees may not like the changes we must implement, and they will leave to seek other opportunities." The hospital administration adds that they are in compliance with Centers of Medicare and Medicaid Services (CMS) guidelines and state mandates.
      On the issue of communication and patient safety with regards to the decision to combine the medical surgical unit and specialty labor and delivery (L&D) unit, O'Clair says, "It was clearly stated that should this not happen would have resulted in our shutting down (L&D), leaving no hospitals with this service in Washington County, resulting in the possibility of nurse layoffs and/or reassignment. The union was also notified and bargained new language for core staffing and floating/staff responsibilities."
      O'Clair also takes issue with the statement regarding 25% unfilled staff nursing positions, part time travel nurses and cross utilization of staff. "This again does not accurately state the conditions this hospital faced as a result of COVID mandates and people wishing to become travelers. As with all hospitals, we have faced severe shortages and, as our restrictions are lifted, have reduced the number of locum staff by half, and we always try to accommodate nurses who would like to move to other departments."

Hourly pay and salaries examined
     Many experts say that culture in any business is driven from the top down, and it has been acknowledged by both DECH administration and nurses/technicians that a positive collective culture allows for success in patient care.
      Alley says, "We surveyed our members 15 months ago and found that 80% had seriously considered leaving in the prior six months and that the climate and relationships with upper management were poor."
      The union disclosed a DECH administration offer of a 1% increase in salaries and deemed it "disrespectful." The current inflation rate is at 3.5%. They added, "We called a strike because management refuses to offer competitive compensation to recruit and retain permanent staff to provide optimal care for our community."
      The average hourly rate for a nurse in the state according to state data is $41 per hour. The average nursing salary is $84,340. DECH nurses are paid $30.90 per hour to start and increase up to $44 per hour, according to the union. Records from 2019 to 2022 show the hospital had a total gain in net assets of nearly $20 million.
      DECH has filled staffing shortages utilizing traveling nurses with costs as high as $300 per hour, plus temporary housing. The hiring of traveling nurses was a pandemic response due to the shortage of professionals. That "need" results in some nurses, including some DECH nurses, leaving for higher paid positions.
      Another point of contention is the increase in administrative salaries, as reflected in IRS filings. From 2020 to 2022 both Lail and Parr received increases of 37% and 48% respectively. Lail's salary increased by $106,000 and Parr's by $93,000.
      Julie Hixson, DECH director of marketing and communications, says, "During 2021/2022 an increase was given to the CEO, CFO/COO and all leaders who provide services at both hospitals. That increase was a CCH [Calais Community Hospital] budget item, not a DECH budget item."
      The board's letter states, "We truly value our employees and strive to ensure that we are paying fairly. The senior leadership and the board regularly evaluate and discuss regional salary surveys and benefits packages which compare overall compensation in our efforts to stay competitive. We feel that we are now at parity with all comparably-sized institutions."

Change in culture alleged
     Alley says, "In my 18 years there have been shifts in culture. When I started at DECH there was an episode when we had safety issues, and staff morale was horrendous. There was a staff and community effort that led to ousting of administration and the board of the hospital. This change led to a time of great morale and a sense of community within the hospital."
      Alley contends that in the past the administration welcomed feedback from clinical staff. "They would incorporate our feedback into those decisions," says Alley. "Everyone knew one another, and relationships were strong. Administration has changed, and that environment and culture are now gone, and with that a lot of staff have left and continue to leave."
      Hospital administrators believe the work culture is intact if both the Machias and Calais hospitals are taken into consideration. "We have 500 employees between the two facilities, and these 50 union employees represent 10% of the workforce," says Hixson. "We have a multitude of non union employees who do not feel the same way about the organization and are disappointed at what is playing out in the media."
      Hixson says, "We conducted our first anonymous survey, held and are holding lunches with the CEO, state-of-the-hospital meetings with the CEO and have asked department leaders to invite leadership to talk at their staff meetings, which many departments have done."

Negotiations continue
     Alley believes that, if negotiations continue like they have, "a strike is always possible if agreement can't be reached." She also contends that change must occur for the benefit of staff and most importantly patients. "It is in everyone's best interest -- staff, management, patients -- to have a stable, local workforce to care for our community. I don't believe there is any disagreement about that. Clearly, we currently don't have the conditions for that to happen, and that's what we are fighting to change."
      Hixson, though, states, "Our nursing and clinical staff have received upwards of a 40% wage increase over the past three years. We need to keep true to our mission and to all staff and hope the union decides to accept a fiducially responsible offer. We hope the nursing staff recognize that we combined OB and med/surg as a final effort to continue OB services at this hospital."
      Hixson confirms that there was a meeting with the union on June 26 and that they await the written proposal from the union. "We have not seen any marked progress to date but will know more once we receive their proposal."
      Hixson does not anticipate another strike, but if one were to occur the hospital is prepared. "The administration will continue to work to improve communications both up and down the ladder. We will continue to train our department leaders and do what we can to protect the reputation of the hospital."