What Happens to a Small ER's Night Shifts When Half Its Full-Time Nurses Leave? The Northern Maine Medical Center Math

Key Takeaways

• In June, the emergency room at Northern Maine Medical Center in Fort Kent, Maine, had 13 registered nurses: 10 full-time and 3 per diem. Since then, 5 of the full-time nurses and 1 of the per diem nurses have left or given notice, The Maine Monitor reported on October 1, 2026.
• The nurses wrote a letter to the hospital’s chief executive. The Bangor Daily News reported that it named pressure to work a mix of day and night shifts. It also named changes to scheduling practices. The hospital says the nurses left for other jobs and moves, and that its emergency room is safely staffed.
• At night the emergency room runs two registered nurses. The reports confirm two nurses only overnight. We assume two at every hour, as an illustration, not the hospital’s staffing plan. That takes 28 twelve-hour shifts or 42 eight-hour shifts a week. Either way, 14 of those shifts are nights.
• Ten full-time nurses working full-time hours cover 30 twelve-hour shifts or 50 eight-hour shifts a week. Five cover 15 or 25, which leaves 13 or 17 shifts a week for someone else. If only full-time nurses worked nights, each one’s share would double, from 1.4 to 2.8 nights a week. This is our math, not the hospital’s numbers.
• This is a Maine story. The same weekly count applies to any small emergency room in Texas that keeps two nurses on around the clock.

Table of Contents

• What Happened to the Emergency Room Nurses at Northern Maine Medical Center?
• How Is the Northern Maine Medical Center Emergency Room Staffed at Night?
• How Many Nurse Shifts Does a 24-Hour ER With Two Nurses Need Each Week?
• What Does Losing 5 of 10 Full-Time ER Nurses Do to the Weekly Shift Count at a 24-Hour ER?
• Why Do Night Shifts Get Harder to Cover When an ER Loses Nurses?
• Why Should a Texas Critical Access Hospital Care About a Maine Emergency Room?
• What to Do This Week
• Frequently Asked Questions

About half the nurses in the emergency room (ER) at Northern Maine Medical Center have left or given notice since June. The nurses who signed a letter to the hospital listed several complaints. One was pressure to rotate between day and night shifts. This piece does not take a side in that dispute. It does the shift count behind it: how many nurse shifts a small ER needs each week, and what happens to the nights when half the full-time nurses leave.

What Happened to the Emergency Room Nurses at Northern Maine Medical Center?

Five of the ER’s 10 full-time nurses, and 1 of its 3 per diem nurses, have left or given notice since June. Per diem nurses work shifts as needed, without a set number of hours each week. The figures come from two union nurses, Ami Maxwell and Kim Paradis, as reported by The Maine Monitor.

The hospital is in Fort Kent, at the northern tip of Maine. It has 25 beds. The federal government lists it as a Critical Access Hospital in its hospital data. Its ER sees about 7,000 patients a year, about 19 a day. The next-closest ER is in Caribou, “nearly an hour’s drive away,” the Monitor reported.

The nurses are represented by the Maine State Nurses Association. They signed a contract with the hospital in May, after about two years of talks. On October 2, the ER nurses gave the chief executive, Jeff Zewe, a signed letter. In the Bangor Daily News summary, the letter’s complaints included staff “pressured into working a shift rotation (a mix of day and night shifts)” and “changes to scheduling practices.” Others included a hostile work environment and “a lack of communication between administration and staff.” The letter also named a high number of expensive traveling nurses and working short staffed. The letter itself has not been published.

The hospital gives a different account. Its spokeswoman, Pam Sime, told the Bangor Daily News that two nurses left for “leadership positions at other facilities.” One left to become a travel nurse, and one moved out of state. One was a per diem nurse “used intermittently as needed.” She also said three of the departing nurses asked to stay on per diem or applied for other jobs in the hospital. “The ER remains staffed with fully qualified staff including RNs,” she said.

The hospital’s board later put out a statement. WAGM-TV reported that the board called the ER safe and well staffed. The board also said staffing is planned around how many patients come in and how sick they are, and is reviewed every shift.

None of the reports we read through October 12 said the ER had closed or turned patients away.

How Is the Northern Maine Medical Center Emergency Room Staffed at Night?

The hospital’s statement to the Monitor describes the ER’s overnight team, from 11 p.m. to 7 a.m., as two registered nurses plus one nurse practitioner or physician assistant, one physician, one security officer, and a nurse supervisor who is not assigned patients.

Three facts about the night team have come up in the reporting:

• The night clerk is gone. On September 6, the hospital cut the waiting room clerk who checked patients in at night, Maxwell and Paradis told the Monitor. The nurses and other staff now do the check-in. The hospital says they are trained on it.
• A plan for one nurse at night was dropped. The hospital told staff it would move from two registered nurses overnight to one nurse and a nurse technician, Maxwell said. After staff objected, it dropped the plan. “[It is] not a model we are moving to,” Sime told the Monitor.
• The second night nurse dates from 2023. The hospital had one registered nurse overnight until 2023, when it added a second, according to its statement.

The two sides read the nights differently. Sime said the ER sees one to two patients a night on average. Maxwell said the nurses worry about the nights because two nurses cannot handle several serious traumas at once while also checking people in.

How Many Nurse Shifts Does a 24-Hour ER With Two Nurses Need Each Week?

Two nurses on duty every hour of the week is 2 × 24 × 7 = 336 nurse hours a week. On 12-hour shifts that is 28 shifts. On 8-hour shifts it is 42 shifts. The reports confirm two nurses only overnight. We assume two at every hour, as an illustration, not the hospital’s staffing plan.

The hospital describes its overnight team for 11 p.m. to 7 a.m., an 8-hour stretch. That fits an 8-hour night shift, but a nurse on a 12-hour night, such as 7 p.m. to 7 a.m., would cover it too. None of the reports says which shifts the nurses actually work, so we show both.

A nurse who stayed, Terry Caron, told WAGM-TV the hospital could not staff a “mid-shift nurse,” which left the busiest hours with two nurses. Days may therefore need more than our count.

We assumed full-time means three 12-hour or five 8-hour shifts a week, because the reports do not give this hospital’s hours. Our 8-hour vs 12-hour shifts guide covers the trade-offs between the two.

What Does Losing 5 of 10 Full-Time ER Nurses Do to the Weekly Shift Count at a 24-Hour ER?

It leaves 13 twelve-hour or 17 eight-hour shifts a week for someone other than the full-time staff. This is our math from the published headcounts, not the hospital’s numbers.

In June, 2 spare twelve-hour shifts a week had to cover every vacation, sick and training day. With 250 hours of time off per full-time equivalent (FTE, one full-time position), as in our relief factor guide, two nurses around the clock takes about 9.6 FTEs. A nurse on three 12-hour shifts works 0.9 of a full-time week, so that is about 10.6 nurses on 12-hour shifts, or 9.6 on 8-hour shifts, as our staffing guide works out. So on 12-hour shifts, the June roster would have needed help from its per diem nurses.

The second row is what losing five full-time nurses does. The gap is 13 twelve-hour shifts (156 hours) or 17 eight-hour shifts (136 hours) a week, before anyone takes time off.

The third row adds the three contract nurses the ER has brought in, Maxwell told the Monitor. A contract nurse is hired through an agency for a set number of weeks. The hospital’s press release calls them travel nurses. We assumed each works the same hours as a full-time nurse, which the reports do not say.

The 2 per diem nurses still on the roster, departing nurses who asked to stay on per diem, and any new hires could shrink the gap. The reports give no hours for any of them.

Why Do Night Shifts Get Harder to Cover When an ER Loses Nurses?

Because the 14 night shifts a week stay fixed while the number of nurses sharing them falls. Shared evenly among full-time nurses only, that is 14 ÷ 10 = 1.4 nights a week each with 10 nurses, and 14 ÷ 5 = 2.8 with 5. On 12-hour shifts, 2.8 nights is almost all of a full-time nurse’s 3 shifts a week. This is a worst case. Contract and per diem nurses can work nights too, and the reports do not say who covers this ER’s nights.

A hospital has a few ways to share nights out. It can hire some nurses into night-only jobs. It can ask for volunteers and pay more for nights. Or it can rotate, which means the same nurse works some day shifts and some night shifts. The nurses’ letter, as the Bangor Daily News described it, named pressure to rotate. Caron told WAGM-TV the hospital is “having nurses rotate shifts from day to night/night to day” and “changed the way scheduling was handled.”

The reports do not say when the rotation started, how many nights it asks of each nurse, or why the hospital chose it. The hospital did not speak to the rotation in anything we read. So we cannot say whether the rotation was a cause of the departures or a response to them. What the math does show is that the fewer permanent nurses a small ER has, the bigger each one’s share of the nights. Our guide to night shift coverage at a small hospital covers how night coverage is usually set up.

Why Should a Texas Critical Access Hospital Care About a Maine Emergency Room?

The count depends only on how many nurses you keep on duty, not on the state. Every critical access hospital has to keep emergency services “available on a 24-hours a day basis” under federal rules (42 CFR 485.618). That rule does not say how many nurses the ER needs. But if your ER also keeps two nurses on around the clock, your week has the same 28 twelve-hour or 42 eight-hour shifts, and the same 14 nights.

We are not saying Texas hospitals face this dispute. We are saying the count is the same, and it is worth knowing how far your full-time roster is from it.

Texas adds one rule that matters when a gap opens. Texas Health and Safety Code Chapter 258 bars a hospital from requiring a nurse to work extra hours or extra days beyond their schedule, and a nurse may refuse. Once the schedule is set, an extra shift needs a nurse who agrees to work it.

The exceptions in section 258.004 are narrow:

• a disaster that affects your county or a neighboring county
• a declared federal, state or county emergency in your county or a neighboring county
• an unforeseeable emergency, after a good-faith try, as far as possible, at volunteers, per diem or agency nurses
• a nurse in the middle of a procedure who must stay until it is finished for the patient’s safety

What to Do This Week

1. Count your ER’s shifts for one week. Multiply nurses per shift by shifts per day by 7. Next to it, write how many of those shifts your full-time nurses cover at their normal hours. The difference is what per diem nurses, overtime and agency nurses fill today. Bring both numbers to your next staffing meeting.
2. Count nights per nurse for the last eight weeks. Pull the posted schedules and tally night shifts by name. Circle anyone well above the average, and anyone who works none. Ask whether that split is something you chose or something that happened.
3. Write down how your hospital shares out nights. If you rotate nurses between days and nights, write the rule down. Say how many nights each nurse works, how much notice they get, and how many days off follow a switch. Then ask two of your nurses whether that matches the schedule they actually work.
4. Before you cut a night position, list its tasks (check-in, for example) and name who will do each one.

Frequently Asked Questions

Q: Is the Northern Maine Medical Center emergency room still open?

Yes, as far as the reports we read through October 12, 2026 show. None said it had closed or turned patients away. The hospital says it “maintains a staffing model designed to provide safe, continuous emergency care 24 hours a day, seven days a week.”

Q: How many nurses does it take to keep two nurses on duty in an ER around the clock?

At least 10 nurses on three 12-hour shifts (28 ÷ 3 = 9.3, rounded up) or at least 9 on five 8-hour shifts (42 ÷ 5 = 8.4), before time off. Once vacation and sick time are counted, our staffing guide puts it at about 10.6 nurses on 12-hour shifts, or 9.6 on 8-hour shifts.

Q: What is a day and night shift rotation?

It is a schedule where the same nurse works some day shifts and some night shifts, instead of only days or only nights. It is one way to share out nights. Others are night-only jobs and extra pay for nights.

Sources

1. John Forbes, “Half of emergency room nurses in northern Maine hospital quit,” The Maine Monitor, October 1, 2026. The June roster of 13 nurses, the departures, the three contract nurses, the September 6 clerk cut, the night team, the dropped one-nurse plan and the hospital’s statement. themainemonitor.org
2. Kathleen Phalen Tomaselli, “6 emergency nurses at Aroostook hospital resign amid dwindling morale,” Bangor Daily News, October 1, 2026. The 25 beds, about 7,000 visits a year, and the hospital’s account of why each nurse left. bangordailynews.com
3. Kathleen Phalen Tomaselli, “NMMC emergency nurses blame toxic work environment for mass resignations,” Bangor Daily News, October 2, 2026. What the nurses’ letter listed. bangordailynews.com
4. “Six Emergency Department Nurses Leave N.M.M.C.,” WAGM-TV, October 6, 2026. The hospital’s press release on travel nurses. wagmtv.com
5. “NMMC Nurse Speaks Out on Recent Nurse Departures,” WAGM-TV, October 12, 2026. The board’s statement and Terry Caron’s account of the rotation and the mid-shift nurse. wagmtv.com
6. Centers for Medicare & Medicaid Services, Hospital General Information, released August 13, 2026. Northern Maine Medical Center is listed as a Critical Access Hospital with emergency services. data.cms.gov
7. 42 CFR 485.618, Condition of participation: Emergency services. Cornell Law School LII
8. Texas Health and Safety Code, Chapter 258: sections 258.002 and 258.003 on mandatory overtime for nurses, and section 258.004 on its exceptions. texas.public.law and section 258.004

A note on who wrote this. We build nurse scheduling software for critical access hospitals in Texas. Nothing we sell would have settled this dispute or filled those shifts, and we are not going to pretend otherwise. If you want to know what we actually do, start with how it works, or read our background pages on critical access hospital scheduling and AI nurse scheduling.

Pradeep Pandey is the co-founder of SimpleScheduleAI, an AI-native nurse scheduling service built for Critical Access Hospitals in Texas. He serves as Deputy General Manager of Operations at Apollo Hospitals and holds an MBA from IIM Trichy. LinkedIn →