Like many American hospitals, Eastern Maine Medical Center in Bangor faces a shortage of registered nurses, which only promises to worsen as more nurses retire and fewer young people enter the field.
And, like other hospitals, Eastern Maine is using some innovative strategies to attract and retain its nurses, including a growing push to bring a cadre international nurses to Bangor.
In 2015, when Deborah Sanford — a nurse herself — was named the hospital’s chief nursing officer, she knew she needed to take a hard look at how Eastern Maine could do a better job with its nursing workforce.
“We had an aging nursing population, not enough students coming along in nursing school, and we were concerned that our nursing staff was not as diverse as it should be,” Sanford said recently.
Plus, since more than a quarter of all newly graduated nurses leave the field within the first two years, usually citing work-related stress, even new hires weren’t going to solve the problem.
So Sanford developed a three-pronged strategy to address the issue.
First, she implemented a residency program for new graduate nurses, enhancing their orientation with support services such as clinical workshops, classes and career development counseling. Then, she made a push for hiring experienced nurses from areas of the country where, she said, there’s an actual surplus of nurses.
“In places like Memphis and Detroit and parts of Texas, nurses can’t find jobs,” she said.
The hospital is now attracting some nursing staff from these areas.
Finally, Sanford looked into employment agencies that bring foreign-born nurses to the United States. In addition to filling out the ranks of nursing at Eastern Maine, Sanborn saw the potential to bring a much needed shot of diversity to her workforce.
Eventually, Eastern Maine contracted with Florida-based Avant Healthcare Professionals, and in spring 2016, the first group of about 20 international nurses began arriving in Bangor. They hailed from Nigeria, Trinidad, the Philippines, the Dominican Republic and other developing nations. All were licensed professional nurses in their home countries. All had undergone clinical training to bring their nursing skills into alignment with U.S. standards, and all had taken and passed the National Council Licensure Exam, which qualified nurses for licensure in the United States.
And they had all spent two fast weeks immersed in American culture and learning how to navigate the complexities of living here, from how to get a driver’s license and open a bank account, to dealing with the friendly nosiness of the American people — or the possibility of outright bigotry.
Among them was Augustine Christopher, a native of Nigeria who arrived with his wife, Ngozi, and their two preschoolers. They now have a third child, born in this country, and Ngozi has become a staff nurse at Eastern Maine, as Christopher hopes to do when his two-year agency contract is fulfilled early in 2018.
“Leaving your place of birth is never an easy decision,” Christopher, 39, said. He left behind beloved family and friends in Nigeria, he said, and a way of life that was in many ways familiar and dear.
But the challenge of practicing health care there was too frustrating. Even in the 250-bed tertiary care hospital where he worked, basic tools that American nurses take for granted, such as reliable electricity and clean, running water, were scarce.
“When you want to wash your hands, you scoop water from a container,” Christopher said of his former workplace. “It’s not really that hygienic.”
During the night, it was not uncommon to care for patients with only a flashlight for illumination. Computerized medical record, intravenous infusion pumps and electric beds that change position with the touch of a button were almost never available.
At Eastern Maine, Christopher said, he has the resources and the professional support to care for patients as he’s been trained to do. Avant has highlighted his story on its website.
Another early arrival in Eastern Maine’s international recruitment program was Nakiesha Lindsay, a 33-year-old nurse from Jamaica. Conditions in the 350-bed teaching hospital where she previously worked were similarly limited, she said, including the near-total absence of technology.
As an example, she said, the hospital didn’t have graduated weights to hold healing bones in place after surgery, so nurses filled bottles with water to use as weights.
“Technology is definitely more advanced here,” she said.
At Eastern Maine, she works in a variety of different specialty areas, but she doesn’t have a favorite.
“I like all the areas,” she said. “I like the opportunity to learn and the wealth of knowledge.”
Lindsay arrived in the U.S. with her two children, now 7 and 3, and her husband, Rohan, who works at the Kids Peace program for special-needs children in Ellsworth.
Both Christopher and Lindsay said they have been met with warmth and respect by the majority of their patients, their colleagues and the Bangor community. Still, there have been moments.
Christopher has had a few patients ask to be cared for by a different nurse, apparently uncomfortable with his dark skin and the lilting accent of his fluent English. It doesn’t bother him too much.
“I just tell them it’s their loss,” he said, with a smile and a shug.
He also encountered a potential landlord who suspected he might not be a responsible tenant, despite his status as a family man and a medical professional.
But for the most part, he said, living and working in Bangor has been a positive thing for himself and his family.
“I don’t think there’s any country where you don’t find some kind of discrimination,” he said.
Lindsay said her greatest concern in moving to the U.S. was for her children.
“But I have found people here to be very warm,” she said.
On his first day of school at the Abraham Lincoln School in Bangor, she said, “My son came home and told me, ‘Mom, everyone wanted to sit next to me today,’ and I thought, ‘Whatever these parents and teachers are doing, they are doing something right.’”
She, too, hopes to stay on at Eastern Maine as a staff nurse when her contract expires.
It hasn’t all been easy, she said, and there are days when she feels unsure of the road ahead. “But we learn as nurses that you go through certain phases in accepting change. Sometimes you go back, and then you progress.”
Eastern Maine’s Deborah Sanford said international nurses like Lindsay and Christopher will help the Bangor area become a more welcoming community for people of different backgrounds. The area, though largely white, already attracts a multicultural population of physicians, university professors and others, she noted, and the hospital is among those area organizations committed to building more diversity here.
In addition to welcoming some agency nurses to join the regular staff, she expects another group of Avant nurses to arrive early next year.
Sanford said the agency nurses at Eastern Maine may occasionally encounter patients who feel uncomfortable being cared for by someone from another culture. But unless there’s a direct personality conflict or some other reason to make a switch, she said, all nurses are expected to care for their assigned patients and patients are expected to accept that care as the professional service it is.
“There is no tolerance for discrimination between patients, staff, visitors and the community,” she said. “We’re embracing our role as educators and advocates for diversity.”
Attorney and former Bangor mayor Joe Baldacci, a vocal supporter of developing Bangor as a center of multiculturalism, hopes the international nurses now practicing at Eastern Maine will help attract other international residents.
“We extend a welcome to all kinds of people who want to come here, settle, work and raise a family,” he said. “We need to have an open and welcoming community here in order to build a vital and vibrant economic future.”
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