AUGUSTA – A key group in a compromise that averted legislative action to impose nurse-to-patient ratios in Maine hospitals balked at a draft proposal for new nurse staffing rules at a public hearing Wednesday.

The Maine State Nurses Association, the state’s largest group representing nurses, said the proposed language would allow hospitals to count nursing supervisors as direct care nurses in calculating staffing levels. The organization sought legislative action in 2000, alleging some hospitals use too few nurses in relation to the number of patients, endangering patient safety.

“The proposed rule changes, as submitted, address some issues, but fall short in addressing the major issues: safe staffing for patient safety,” testified Patricia Philbrook, MSNA executive director.

But other players in the compromise, including the Maine Hospital Association and OMNE – Nursing Leaders of Maine, disagreed, supporting the draft created by the Department of Human Services.

The new rules would put more responsibility on hospitals to define what the components of their staffing plans are, said Sandy Bethanis, who drafted the proposed DHS rule. They would require hospitals to accept the input of direct care nurses at least annually, and set clearer guidelines concerning temporary nurses hired to fill vacancies, Bethanis explained.

“This is an embellishment of our regulations,” she said.

The new rules are being created at a tough time for hospitals. A national shortage of nurses is expected to be protracted and it has created staffing problems across the country. In one case, a hospital in Texas has advised patients to bring family members with them if possible.

Meanwhile, Eastern Maine Medical Center in Bangor imposed a new staffing plan recently without input from direct care nurses.

Some players in the compromise claim the MSNA is opposing a plan it previously endorsed.

Mary Mayhew, vice president of government affairs for the Maine Hospital Association, said in an interview that the language was agreed upon by the nursing organizations and hospital association after numerous meetings. She said the MHA wouldn’t rule out additional language changes. But she suggested the latest complaints were positioning.

“I think they are trying to get more prescriptive, more of a cookie-cutter approach to this through the rule-making process,” Mayhew said.

During the hearing, Mayhew said “hospitals must have maximum flexibility to plan staffing to meet the complex and changing needs of patients with the most appropriate staff. Patient need drives staffing patterns now and must continue to do so.”

Helen McKinnon, president of OMNE, said the MSNA is trying to get more control over day-to-day staffing decisions.

She said hospitals already have safe staffing rules, and the addition of more detailed rules to state law books won’t result in any changes patients would notice.

“The patient staffing is adequate or we don’t take patients,” she said.

Joseph Niemczura, president of the Maine chapter of the American Nurses Association testified that his organization supports the DHS draft.

Alan J. McDonald, a Massachusetts-based lawyer representing MSNA, said some of the proposed language changes conflict with federal labor law in such a way that there would be numerous legal challenges. He said proposed wording could be construed to mean all nurses are supervisory, which would affect their ability to organize for collective bargaining.

He said failure to remove the language would signal an alliance between the state and hospitals and managers who seek to eliminate collective bargaining.

“There’s no need to engage that debate, because it’s not your intention we assume,” McDonald said. He added that if the language were used it would contribute to the “continued and significant RN flight from your institutions.”

Bethanis said after the hearing that all the comments would be taken into account, before rule-making moves forward.