AUGUSTA — On the final day of her 3-11 p.m. shift as a nurse at Riverview Psychiatric Center, Kim Bickford heard state and hospital officials explain to legislators why the hospital is so short-staffed that a third of its nursing positions are unfilled.
They should have asked her.
“I’ve been mandated (to work overtime) two or three times a week for the past four months,” the Waterville resident said, “working up to 60 hours some weeks.”
One night she was so tired from working so many hours at Riverview she forgot to deliver the evening meal to her elderly parents before she went to work.
“Ever since I gave my notice, I have had a huge sigh of relief,” she said.
Bickford and a dozen other Riverview staff members attended a work session Friday of the Legislature’s Government Oversight Committee which was looking into how staffing affects patient and staff safety at the 92-bed, state-run Augusta hospital that treats forensic patients — those placed there through the court system — and civil patients.
Riverview Superintendent Jay Harper told the committee that staff injuries have dropped from at least 20 a month a year ago to nine or fewer a month today. They also heard Department of Health and Human Services Commissioner Mary Mayhew say that the budget allows Riverview 364 positions and that 51 of those are vacant.
Mayhew and Harper spent almost 2 1/2 hours in front of the committee, time that the governor later characterized as “wasted.”
“If the Legislature stopped holding useless hearings like this, it would be the best thing they ever did for the Maine people,” Gov. Paul LePage said in a statement issued through his communications director, Peter Steele. “They had no recommendations, no action items, no proposed legislation — nothing but attacks. The last report to the court master found the negative news brought on by the constant drumbeat of legislative hearings is hurting Riverview’s ability to recruit needed employees.”
Mayhew had asked the committee Friday when it expected to complete its work and develop a draft report on Riverview, but the House Chairman, Rep. Chuck Kruger, D-Thomaston, told her that was still unclear.
Daniel Wathen, court master for a consent decree that governs how the state is to treat individuals with severe and persistent mental illness, pointed out that 47 of Riverview’s vacant posts are for nurses and mental health workers, all direct care providers. The legislators and Wathen said the hospital’s staffing was in crisis.
Bickford’s departure will add to the vacancies. The nurse says she made the decision to leave with some reluctance. She has worked at Riverview for a total of about 3 1/2 years.
“I don’t want to leave my patients or my staff,” she said, so she’ll return as a per diem nurse through Maine Staffing, an agency that supplies Riverview nurses on demand. Bickford said that will be maybe a couple of shifts a month, but no more forced overtime.
In the meantime, she will begin a full-time post with MaineGeneral Medical Center on Monday, something she’s thrilled about because she will still be helping people with mental illness, some of them discharged from Riverview, some from MaineGeneral.
Bickford came to Friday’s session because she had missed a forum for workers on Tuesday night when she had to work. There, workers told of the constant drain on morale of having to volunteer to work overtime hours to avoid being mandated to work an extra four- or eight-hour shift, sometimes at the end of a double shift, and of trying to find time to care for their families and other responsibilities.
Workers can be mandated or ordered to work to maintain staffing levels at the hospital.
“We share your concerns,” Mayhew told the legislators on Friday. “We have been working tirelessly to fill those vacancies.”
She told the committee that Riverview hired 29 people in the past 30 days.
“The heart and soul of our operation is staff,” she said.
However, Wathen cautioned that the numbers of those recently hired involved nine internal candidates, and those would not reduce the overall vacancy number.
Mayhew also said the hospital’s human resource personnel work through the Department of Administrative and Financial Services.
She said coming up to full staffing and retaining employees will require help from the Legislature, including changes to rules to allow more flexible shifts, including three-day 12-hour shifts that would carry full-time benefits. In the meantime, she said, the department has worked with the union that represents the hospital’s mental health workers to allow the establishment of a per diem pool of mental health workers.
When Mayhew pointed to the competition for nurses among MaineGeneral Medical Center, the veterans’ hospital at Togus and Riverview, Rep. Anne-Marie Mastraccio, D-Sanford, told her “MaineGeneral didn’t just open. Togus didn’t just open.”
Pay for a nurse III or charge nurse at the hospital, the predominant registered nurse job class at Riverview, ranges from about $26.15 to $32.40 hourly and includes recruiting and retention stipends. Mayhew said the department arranged to have recruiting letters sent to all licensed nurses in the state, and Bickford said she received one herself.
Harper also said the hospital now has hired a recruitment specialist who will be on board shortly. He also said some recruiting problems — particularly with trying to hire psychiatrists — result from publicity Riverview receives. He also said the hospital has a new director of nursing, Larry Plant, who holds a doctorate in nursing, and a department spokeswoman said the hospital is actively recruiting to fill the job of assistant director of nursing.
The previous director of nursing, Roland “Buck” Pushard, left state service Oct. 9, 2015, according to a department spokesman.
Colleen Cutler, who was assistant director of nursing at Riverview until Oct. 31, 2015, sat in the back row of chairs at Friday’s hearing, listening to the questions and answers.
“What you’re doing, which might be good, is not good enough yet,” Sen. Christopher K. Johnson, D-Somerville, told the commissioner and superintendent.
Wathen provided the committee with a written list of potential recommendations he is considering making to the judge handling the consent decree case:
• Not counting acuity specialists — those hired to help manage patients considered dangerous to themselves and others — as mental health workers when doing staffing ratios.
• Adding a mental health worker to a unit if a client on the unit needs one-to-one staffing.
• Recommending that mental health workers and, when appropriate, acuity specialists attend treatment team meetings.
Riverview has 372 employees, including people who work on Riverview outpatient teams.
The federal Centers for Medicaid and Medicare Services agency, which oversees Riverview funding, found numerous problems during an audit, including the use of stun guns, pepper spray and handcuffs on patients; improper record-keeping; medication errors; and failure to report progress made by patients. As a result, the hospital lost eligibility for federal reimbursement of about $20 million annually, though state officials say they are developing plans for Riverview to be re-certified this year.
The acuity specialist positions were created about two years ago to replace corrections officers who had been briefly at the hospital following a particularly vicious assault by a patient on a mental health worker.
After Friday’s hearing, Mary Anne Turowski, of the Maine State Employees Association, and Sylvia Hebert, of AFSCME 1814, two unions representing Riverview workers, issued a joint statement saying, “Front line workers at Riverview have been working excessive and unsafe amounts of overtime for too long. They have asked the administration to fill vacancies and hire more direct care staff, but the response has been slow and inadequate to meet the need. The workers at Riverview work hard every day to provide the best treatment possible. Riverview nurses and mental health workers look forward to collaborating with the Legislature to find solutions to ensure safe staffing to provide the best treatment for their patients. We believe this will depend on increasing wages, improving scheduling, and improved communication and respect for front line workers from management.”
Betty Adams — 621-5631
Twitter: @betadams
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