HOULTON, Maine — More than five months after their initial contract expired, nurses at Houlton Regional Hospital have ratified a one-year contract with the facility that includes safe staffing provisions and health and safety language for staff.

The contract for the 100 unionized registered nurses, who are represented by the Maine State Nurses Association-National Nurses United, first expired last fall. A short time later, they agreed to a contract extension. Negotiations between the nurses, their union representatives and the administration at HRH started in November.

Vanessa Sylvester, Maine State Nurses Association spokeswoman, said on Monday evening that the nurses were happy with the safe-staffing language in the new contract, which was ratified earlier this month.

Judy Eastham, an RN at the hospital, said negotiations were difficult because of the economy and the “inefficient and wasteful way that provider reimbursements work in our current health care system.” Such economic roadblocks were the reason the nurses agreed to a one-year contract only, she said.

“However, nurses secured safe-staffing language for HRH’s largest department, the acute care unit,” she added.

As part of the new contract, a new provision mandates that there be five nurses in the unit at all times, no less than one nurse for five floor care patients and no less than one nurse per two unstable intermediate care patients.

Orientation for the nurses, which they described as key to safety, also will be enhanced.

Sylvester said health and safety provisions and a night shift incentive also are part of the newly ratified contract.

Nurses at the hospital maintained during contract negotiations that ensuring patient safety was their top priority. While they also were seeking additional positions in the emergency department, hospital administrators said funding wasn’t available.

The state owes the facility $4 million for the care it has extended to patients covered by the MaineCare program since 2007. When the hospital put together its 2011 budget this past October, the $44 million budget contained no wage increases for the first time in 14 years.

Because of the outstanding bills left unpaid by the state and a decline in the number of patients it usually sees, the hospital already has had to borrow $1 million.

Tom Moakler, the hospital’s CEO, has stressed that staffing patterns at the hospital are adequate, so there is no need for additional staffing. He also said the hospital’s safety record is “excellent.”

Moakler said Tuesday evening he was pleased that a settlement had been reached.

“We are glad they accepted our language for safe staffing,” he said.

The Houlton nurses are represented by the same union that covers nurses at The Aroostook Medical Center in Presque Isle and Eastern Maine Medical Center in Bangor. The TAMC nurses negotiated a new contract late last year after four months of talks and the threat of a one-day strike.

According to union members, the contract ratified by the TAMC nurses includes “many new patient safety provisions that was the key issue for the nurses.”

Cokie Giles, the president of MSNA, urged EMMC to settle its contract with nurses at the 400-bed hospital.

The nurses, whose previous three-year contract expired at the end of September, are demanding that the hospital include formulas for nurse staffing levels as part of their  new contract. Other issues include health insurance and job security.

Giles said EMMC “has been spending patient care dollars on newspaper and magazine ads and attorneys to disparage the nurses” instead of working to settle the contract.

“It is time for EMMC administration to really sit down with the nurses and get to work on safe staffing so we can provide safe care for patients in the Bangor community,” she said in a written statement. “Fighting the nurses and our union is a waste of this hospital’s resources.”

Hospital officials maintain that nurse staffing levels at EMMC are in keeping with national standards and that patients receive high-quality care. They also have said that staffing decisions must be made by hospital administrators in order to respond to changes in patient acuity, hospital census, reimbursement levels and matters of public policy related to health care reform.

The two sides will meet again May 3.