BANGOR – Registered nurses will care for more patients in all noncritical hospital units at Eastern Maine Medical Center under a new plan devised by administrators.

The plan, which will increase the number of patients per nurse by about 25 percent, angers some direct care nurses who say they were left out of the more than six months of planning that went into setting up the new staffing levels. They argue it could reduce quality of care at the hospital, which serves northern and eastern Maine.

“We’re not afraid to work hard, and this ratio is not about having to work harder. It’s about the consequences of this, and the consequences are to the patient,” said Carol Card, an EMMC telemetry nurse who gathered with nine other nurses for an interview.

“We want to see implementation of their standards stopped,” said Judith Brown, an intensive care unit nurse and president of the Maine State Nursing Association’s EMMC chapter. The start of implementation was May 1.

Besides quality of care, the nurses said, the change raises questions about an administration that doesn’t collaborate with its employees and about the hospital’s ability to keep nurses in a tight employment marketplace.

Pat Philbrook, the president of MSNA in Augusta, said EMMC’s secretive creation of the new rules may mean that the nurses’ union again will promote a bill to create rigid California-style nurse-to-patient ratios, instead of the more flexible compromise that was passed by the Legislature.

EMMC CEO Norman Ledwin was traveling Friday and was not available for comment.

The plan would have each registered nurse responsible for five instead of four patients. At night, the number of patients would be six to eight per nurse depending on the department. Critical care units would not be affected.

Charge nurses would be freed from having patients, but might be pressed into duty whenever nurses called in sick, because under normal circumstances they would not be able to ask for replacements.

In addition, the rules mandate one nurse technician for every 10 patients, and some routine duties now performed by registered nurses will be assigned to other workers.

Hospital executives said the plan would free up time for registered nurses to perform the duties involved with patient assessments, which are beyond the scope of nurse technicians.

A larger pool of nurses to help any hospital unit will be available under the new plan and will be used to meet additional needs based on patient acuity assessments, said Lorraine Rodgerson, EMMC’s vice president of nursing.

“I don’t think it will make any difference to patients,” Rodgerson said. There will be additional nurse technicians and other changes to allow registered nurses to focus more on key functions, she said.

Rodgerson said there is ample evidence that hospitals using similar staffing models haven’t had any adverse impact on patient outcomes.

Both nurses and administrators said EMMC’s nurse-to-patient ratios have been superior to those at many other Maine hospitals. Sandy Bethanis of the Department of Human Services’ division of hospital licensing, said the state does not now compare patient-to-nurse ratios at Maine’s hospitals. It only looks to see whether levels meet needs as defined by state guidelines.

Judith Brown said the hospital’s nursing strength has helped it be one of the best hospitals in the state. But she said she worries the changes will erode the level of care.

Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania and a former vice president of the Robert Wood Johnson Foundation, said there is consensus on some issues surrounding nurse-to-patient ratios.

“The research shows pretty definitely that the more nurses there are, the better the outcomes,” she said. The key issue is the number of registered nurses. Increasing unlicensed technicians does not influence outcomes, she said.

Aiken said, “Having more nurses is actually less expensive. There are fewer errors, fewer adverse events and fewer deaths.”

Apparently, however, a driving force behind the new staffing levels at EMMC is the desire to save money. A staff memo about the changes from Fran Loring, a surgical department head, said finances should concern everyone at the hospital.

“Everyone will need to have a hand in possible savings in order to adjust to shrinking revenue, increased expenses and now-lower volume,” Loring wrote.

Workers in Loring’s department are now expected to arrive and leave promptly at assigned shifts, and overtime requests face stricter scrutiny.

Dr. Erik Steele, vice president of clinical services, told nurses in a meeting that the staffing changes were created largely to address pressure from insurers such as Anthem to cut costs.

Steele said, “If you’re a hospital these days not looking at your costs every single day, you’re not doing your job and frankly you’re not going to survive.”

EMMC direct care nurses first learned of the staffing plan from Loring’s memorandum. Within days they had filed a grievance saying the administration’s effort violated their October contract calling for them to be part of discussions.

“We are ready, willing and able to work with them on this problem and offer whatever help we can to solve it,” Card, the telemetry nurse, said.

Greg Howat, EMMC’s vice president of human resources, says MSNA nurses’ input wasn’t necessary or required. There were nurse supervisors and physicians involved and “we think those nurses and physicians are more in tune with the issues of quality of care.”

But some nurses claim that administrators are acting without the experience of current bedside nurses. They overlook ways to save money that won’t affect patients because they insulate front-line workers from the planning process.

“This whole thing would have evolved much more smoothly [if direct care nurses had been part of the process]. People are very concerned about where we’re going,” Card said.

The 10 nurses said they are dealing with patients who are sicker than they were years ago. They are also checked in and discharged more frequently, which adds to the nurses’ workload. They said they don’t believe the administration’s other efforts to remove some of their duties and add technicians will significantly improve their job.

Charlotte Nolte, a respiratory nurse, said patients deserve better. She recounted a case in which a nurse was summoned by a terminal cancer patient needing pain medication.

She recounted that the woman said: “I hate to ask because I know you nurses are so busy, but could you rub my back a little.” The whole time the nurse rubbed her back she was saying “Oh, thank you, God,” Nolte said.

“When a patient apologizes for calling, something is wrong,” Nolte said.

EMMC’s new plan is also causing the MSNA to reconsider its decision to support a compromise between hospitals and nurses at the Legislature over a bill that would have put in place rigid nurse-to-patient ratios similar to those in place in California.

“It just shows that we need it more than ever – we need a law saying this is what we need for good patient care,” said Philbrook of the MSNA.

The direct care nurses also think the new ratios will further discourage nurses from working at EMMC.

“The young people who don’t have any obligation to Bangor, Maine, are going to be out of here,” Card said.

But Rodgerson said new nurses have been joining the hospital. “I’m confident that it will not prevent us from attracting nurses,” she said.

The hospital intends to maintain its nursing staff at 956 nurses, said Rodgerson.

The nurses who spoke Thursday night said they’d been told that positions wouldn’t be filled as attrition whittled the ranks. Rodgerson said that is untrue.

According to Brown, MSNA will be seeking allies in the community to fight the changes it believes will erode care.

“This is not a bad hospital,” said Brown. “We think it’s one of the best hospitals in the state, but we want it to stay that way.”