Northern Light Health Eastern Maine Medical Center in Bangor is seen in this May 2019 file photo. Credit: Linda Coan O'Kresik

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Nurses in the Northern Light Eastern Maine Medical Center unit tasked with caring for COVID-19 patients submitted a letter to hospital administration on Friday with a list of demands that included a higher level of personal protective gear.

In the letter, the nurses asked the hospital’s administration to provide N95 respirators for nurses treating suspected and confirmed COVID-19 patients. The nurses also asked for expanded use of negative pressure rooms, a respiratory therapist on the floor at all times and $1,000 bonuses “for the additional work, stress and danger” of moving to the front lines in the fight against COVID-19, the illness caused by the new coronavirus.

The hospital previously had all nurses in the unit using N95 respirators, which filter air particles and provide a seal around the mouth and nose, said nurse Jessie Lambert, a steward with the union representing nurses at the Bangor hospital.

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

However, when Lambert, 38, arrived for her shift at the COVID-19 unit on March 21, nurses were only allowed to use the respirators when in certain circumstances, she said, such as when they are treating patients on respiratory machines or during and after nebulizer treatments. Otherwise, they have been instructed to wear looser surgical masks.

The shift in hospital policy mirrors a change in guidance issued by the U.S. Centers for Disease Control and Prevention. In late February, the CDC said workers should use N95 respirators when entering any COVID-19 patient room or care area. But on March 10, the CDC revised its guidelines, declaring that surgical masks were an “acceptable alternative when the supply chain of respirators cannot meet the demand.”

Hospitals across the country have reported shortages of N95 masks and other personal protective equipment in the face of the COVID-19 pandemic, which advocates say has left frontline healthcare workers potentially vulnerable to infection.

In their letter, the nurses in the unit, which had been used to treat cardiac patients before it was converted to provide care for potential and confirmed COVID-19 cases, said they “accept the responsibility” of stepping to the front line of the fight.

“In turn, we are asking our employer to make sure that we and our patients have all the best protection possible so that they have the best chance to heal and recover, and so that we can keep ourselves and our families safe,” the nurses wrote in a draft of the letter shared with the Bangor Daily News.

The hospital has not announced any confirmed cases of the virus in its COVID-19 unit, but Lambert said it was being used to treat patients exhibiting symptoms and awaiting test results. Asked what would happen if the hospital did not meet the demands outlined in the letter, Lambert said, “We will plan our next steps as appropriate.”

Northern Light Health spokesperson Suzanne Spruce declined to comment on the letter, but she said staff have “personal protective equipment (including N95 masks) to use when appropriate.” She also noted that “these items are highly coveted and in short supply across the nation.”

Northern Light Health “subscribes to the principles and some specifics outlined in CDC guidelines, as well as lessons learned from organizations that are already responding to a large patient volume from COVID-19 virus,” Spruce said.

Concerns over protective equipment have been raised by the country’s largest nurses union. On Friday, National Nurses United, the parent group of the Maine State Nurses Association, said it had filed over 125 complaints to Occupational Safety and Health Administration offices in 16 states regarding failures of medical facilities to provide proper equipment to staff.

Four of those complaints were filed against Maine employers, said Todd Ricker, union representative for the Maine State Nurses Association. The complaints were filed last week against EMMC, Calais Regional Hospital, Down East Community Hospital in Machias and Northern Light Homecare and Hospice in South Portland, Ricker said.

[Feds sending more gear to Maine in coronavirus fight, but CDC head says it’s not enough]

EMMC is the largest hospital in the state with unionized nurses. The union was unable to provide information on how many of the nurses in the COVID-19 unit signed the letter before it was submitted on Friday, but Lambert said the majority of the nurses in the unit had added their signatures.

“If we don’t keep frontline workers healthy, we won’t have anyone left to care for the sick,” Lambert said.

Neither the union nor EMMC were able to say how many nurses work in the new COVID-19 unit, but union representative Todd Ricker said the hospital employs about 900 nurses in total at any given time.

Northern Light Health spokesperson Spruce said she could not provide figures on EMMC’s supply of protective equipment and N95 masks in particular. But health systems are reacting to “enormous [personal protective equipment] usage with no certainty that our supplies can be confidently replenished,” she said.

Cokie Giles is Lambert’s mother and an endoscopy nurse at EMMC, as well as the president of the Maine State Nurses Association, the union that represents nurses at the hospital.

Giles noted the CDC still recommends respirators for the treatment of COVID-19 patients if they are available. The union asked for an update on the hospital’s supply of protective gear at the end of February and was told the hospital had 4,000 N95 respirators, Giles said.

Lambert argued the hospital should not be rationing respirators before it is necessary.

“The CDC requirements aren’t saying surgical masks are enough, they’re just saying they’re better than nothing,” Lambert said. “The union was reassured by the administration that the supplies were available to support this. Then as soon as the CDC changed their guidelines, the hospital changed policy.”

As of Tuesday, the state has confirmed 303 cases of COVID-19. Forty-three of those cases, or about 1 in 6, were health care workers, according to Nirav Shah, the director of the Maine Center for Disease Control and Prevention.