It is hard to understand how the Bangor Daily News came to the conclusions reached in your Aug. 28 editorial, “Compromised Compromise,” on the issue of appropriate staffing levels for nurses at Maine hospitals.

Maine’s nonprofit, community-governed hospitals are committed to ensuring quality patient care 24 hours a day, seven days a week. Our nurses and other caregivers are the heart and soul of our hospitals. The debate has unfairly pitted hospitals against our most valuable resource and centers around a legislative initiative that failed to address the true challenges confronting the healthcare work force. Even worse, mandating inflexible staffing ratios may have severe negative consequences for both our caregivers and patients.

The compromise reached between hospitals, the Maine State Nurses Association, Maine Department of Human Services and others, was, in most parties’ view, completed. DHS has just finalized rules by which this compromise will be implemented. However, even before the rules go into effect and experience gained under this compromise, MSNA charges that the Maine Hospital Association preemptively ended negotiations months ago. This is news to us, and I think, to the Department of Human Services (or else why would DHS have begun rule-making?).

The Maine State Nursing Association, representing mostly unionized nurses, is seeking to re-write history from last spring’s negotiations. They had, at various times, three different representatives take part in these negotiations to craft a compromise. Not one of their representatives stated the view that the negotiations were ending prematurely. While they may have been skeptical about the results once this compromise was reached, they did agree to the compromise. The compromise produced recommended changes to Maine’s hospital staffing regulations that we believe are substantively focused on ensuring that patient needs are met and quality care is provided.

Your editorial claims hospitals aren’t taking a constructive approach to this issue yet hospitals aren’t the ones backing out of this compromise before it has even been implemented. Webster’s defines compromise as “a settlement of differences in which each side makes concessions.” What MSNA is saying by its actions is they don’t want to make concessions and have returned to their original position of mandated nursing ratios.

The Maine Hospital Association is opposed to mandated nursing ratios because they are a simplistic, cookie-cutter approach to a highly dynamic environment that at its core is about individuals and their needs. 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. The new regulations create a specific framework around how that is accomplished and sets criteria for measuring its effectiveness. This is not a one-size-fits-all problem that can be addressed with an inflexible formula.

In an earlier BDN news article on this issue (Aug. 27), a Maine legislator who is also a nurse and a proponent of fixed ratios says she heard from a nursing friend in California that their state’s law mandating fixed ratios “seems to be working well.” This is real news since California has been at an impasse over the law for two years now and the law won’t even be implemented for at least another year. Your reporter should have done his own research on the California law rather than take a proponent’s word for fact.

In Maine, DHS’ Division of Licensing and Certification takes very seriously their role in protecting public health and safety through their hospital licensing process. In crafting new rules to implement this compromise, the division has acted responsibly and in the best interests of patient care. The Joint Commission on Accreditation of Healthcare Organizations takes a similar approach to that taken in Maine. This national accrediting organization has rejected nurse-staffing ratios and has also endorsed principles embodied in Maine’s approach.

The BDN editorial, by taking one side’s arguments as fact and never even bothering to discuss this issue with hospitals, has done a disservice to its readers. Moreover, your coverage of this issue and the nurses’ union’s blind devotion to fixed ratios continues to detract from the more constructive efforts undertaken by the healthcare community to address Maine’s healthcare work force challenges. Those efforts include: creating career development programs including financial support for continuing education, improving communications, providing leadership training focused on employee retention, assessing the work environment to identify and implement important changes to improve job satisfaction, investing in technology to ease regulatory burdens and promote worker safety and identifying other objectives that contribute to loyalty, commitment and respect within organizations. The Maine Hospital Association and its member hospitals are committed to advancing these initiatives. We recognize that more work needs to be done.

The nursing shortage is real and concern about improving the environment in which nurses provide essential, hands-on care to patients is legitimate. However, the issues are far more complex than your one-sided editorial portrays them.

Maine’s Legislature took an important step forward earlier this year by rejecting simplistic fixed nursing ratios that would have caused as many problems as it would have solved. The compromise agreed to and negotiated in good faith should be given an opportunity to work. We urge the Maine State Nurses Association to follow-through on their earlier commitment to give this compromise a chance to work. We ask the Bangor Daily News editorial staff to do the same.

Steven R. Michaud of Topsham is president of the Maine Hospital Association.