In this Feb. 10, 2021, file photo, the afternoon sun shines on Maine Medical Center in Portland. Credit: Troy R. Bennett / BDN

The heated debate over whether nurses at Maine’s largest hospital should form a union is coming to a head this month, as ballots go out to more than 1,500 nurses at Maine Medical Center in Portland beginning Monday evening.

On the yes side, union organizers started the push to form a bargaining unit within the Maine State Nurses Association more than a year ago, even before the coronavirus pandemic. They finally filed a petition in January with the National Labor Relations Board.

While praising the care provided by the hospital, they have argued that a union would give them more of a voice as management makes decisions about things like wages, staffing levels and protective equipment — decisions that they said affect them and their patients, and that have taken on greater importance during the pandemic.

But their effort is hardly a slam dunk.

On the no side are nurses publicly opposed to the unionization effort in recent weeks, who have insisted that the hospital’s leadership already treats them well without the representation of a collective bargaining unit.

Along the way, a number of other groups have weighed in. Maine Med’s leaders have publicly opposed the union effort and hired an outside firm that specializes in fighting organizing campaigns, Reliant Labor Consultants, to provide guidance to the workers.

Democratic leaders in the Maine State House have pushed back, expressing concern that the hospital is mistreating its nurses by forcing them to attend training sessions held by Reliant. And a group of former patients claiming to have more than 1,500 members has publicly backed the formation of a union.

Gov. Janet Mills — whose sister, Dora Anne Mills, works for Maine Med’s parent group, MaineHealth — also briefly got involved, chastising the hospital’s leaders when they gave away a small number of coronavirus vaccines to the consultants, who’d come from out of state.

Now, the nurses will make up their own minds.

Union supporters said that nurses have at times felt overstretched after an influx of patients or that they don’t always have best protective equipment that they need. The challenges have been greater during the pandemic, when units have sometimes been swamped with patients, more people have needed to call out sick and there has been greater demand for highly protective N95 masks.

They said that a union would help provide a direct line to the leadership of the 637-bed hospital as it makes decisions about those issues that can affect them and their patients.

Janel Crowley, a registered nurse who has worked in the hospital’s neonatal intensive care unit for a decade, said earlier this year that her immediate supervisors do care and try to help, but aren’t always able.

Crowley recalled that about two years ago, she and her colleagues reported that staffing levels were low and that, “We’re kind of running at bare minimum. Are we going to hire anybody?”

In response, Crowley said, “We would get told, ‘Well, we brought it up. And we’re being told that according to the algorithm, we’re fully staffed right now.’ And it’s things like that that our direct managers have no control over, and we understand that. So that’s why we’re trying to get this seat at the table, to really deal with the people who make the decisions that have no direct line to what’s going at the bedside.”

But other nurses have come out against the unionization effort, arguing that they already receive the best treatment nurses can expect, even as the pandemic has forced all health care organizations to make hard decisions around wages, supplies and safety measures.

“I’ve been offered benefits that outshine anything I could find anywhere else,” said Lisa Huntress-Beecher, a cardiology nurse who has worked at Maine Medical Center since finishing nursing school in August 2019.

Huntress-Beecher said that she feels well supported by her managers and worries that the formation of a union would make it harder to approach them without a union representative present.

She also said her ability to treat patients could be interrupted if the union calls a strike and questioned how many concessions a union would realistically be able to secure given larger constraints including the coronavirus and industrywide nursing shortages.

“Maine Med is responding to this nursing shortage during a pandemic with big offers to get nurses to come in. They’re doing the best they can. Managers are doing the best they can, with making sure that staffing is at capacity. Our charge nurses do the best they can with making sure that the nurse ratios to patients are at a level that the nurse is able to give her quality or his quality care during their shift,” Huntress-Beecher said.

There has been an uptick in interest in nursing unions during the pandemic, and unions have also frequently raised the alarm about areas where they thought health care groups were not doing enough to protect their workers.

That has included the Maine State Nurses Association, which is an affiliate of the National Nurses United union and currently has about 2,000 members. Its largest existing unit is at Northern Light Eastern Maine Medical Center in Bangor.

There is some research that shows better patient outcomes, worker productivity and transparency with the existence of nurses unions at hospitals and nursing homes.

But the leaders of Maine Med have said that they already support its nurses without the involvement of “a third-party that does not share our Values.”

They have said that management has demonstrated those values by providing “appropriate” supplies of protective equipment and vaccines, not cutting their jobs or benefits, and offering “Market-based wage increases” this year.

The facility currently has four out of five stars in its overall rating from the federal Medicare program and a top score on safety from the independent Leapfrog Group.

While Maine Med has consistently enjoyed some of the highest profit margins of any hospital in the state, its parent organization, MaineHealth — the largest private employer in Maine, with about 22,000 workers and numerous other hospitals — has suffered operating losses over the last year from delaying elective services during the pandemic and paying more for things such as protective equipment.

But federal relief funds have helped it to make up for some of those losses.

Once ballots have been sent out to the Maine Med nurses on Monday evening, they’ll have a month to return them. They’ll then be counted on April 29 during a video conference at a regional office of the National Labor Relations Board.

The union would be certified if a majority of the nurses vote yes. But any of the parties would be able to file an objection to the outcome within seven days of the count, and any decisions on that objection could be appealed to the agency’s Washington office.

This article appears through a media partnership with Maine Public.