WHY NURSES ARE LEAVING
As Montreal's east-end hospitals consider desperate solutions to a worsening nursing shortage, Michelle Lalonde looks at what's driving the exodus.
Mandatory overtime is like a gangrene on the health system. People are becoming really fed up with that situation.
Quebec's nursing crisis has been developing for decades, but the pandemic has exposed a widening disparity among hospitals that has some administrators taking desperate measures.
Administrators of Montreal's eastern health region, for example, are trying to sell a controversial pilot project to replace experienced OR nurses with hastily trained high school graduates. The plan was met with outrage and even tears when it was announced last week at a morning staff meeting of OR nurses at the Maisonneuve-rosemont Hospital.
And though administrators have tried to calm fears by postponing the job postings and promising to consult employees in coming weeks, there are no signs the pilot project has been abandoned.
Since the plan was announced, almost 50 OR staff have signed a letter to the hospital's chief of surgery vowing to resign the day that one of these “technical assistants” shows up in an operating room. A similar protest is reportedly underway at Santa Cabrini Hospital. It is the only other hospital in the CIUSSS de l'est de l'île de Montréal, a regional health centre that serves more than 535,600 people — roughly equivalent to Quebec City's population, which is served by half a dozen hospitals.
The hospitals cannot afford to lose any more staff, Dr. François Marquis, critical care chief at the MRH, has been saying publicly for months. Marquis said he is constantly warning his staff about “areas of vulnerability” in his intensive care unit that are bound to lead to bad results for patients.
“There will be an error,” he said. “There will be patients (at risk).”
During the worst periods of the pandemic, the hospital has been forced to transport critically ill patients from its ICU to other hospitals solely because of a lack of nurses and respiratory therapists (RTS). “It is risky to transport these patients,” Marquis said. “It is one thing to have to transfer patients because we don't have the technology to treat them, but when we are transferring them because there are not enough beds, because we've lost staff to other hospitals, there is something wrong with the system.”
The MRH is not the only hospital in a staffing crisis, but it is representative of what happens when efforts to retain and recruit nurses fall short. One issue is that the MRH is old and dilapidated, and a $1.8-billion plan to refurbish it is 10 to 15 years away from completion.
“We are the worst hit … and one of the reasons is that many of our staff have moved to the CHUM or the MUHC because those hospitals are new and beautiful. Here, they are working in an ICU that is very sombre, it's old, not practical. The rooms are too small, there is very little room to work, there are not enough computers. At the CHUM, for example, each nurse has a computer, each patient has a room that is larger than two of our rooms combined, they receive their lab work on their cellphone, everything is computerized.”
Marquis said he would like to see quotas brought in for nurses and RTS, so that some hospitals and health centres can't hire more than their fair share. “I'm not saying the CHUM and the MUHC … don't do good work. But they have too big a piece of the pie.”
Pierre-david Gagné has been a nurse for 18 years, most of them at the MRH, where he is now assistant chief nurse of night surgery. Over the years, he has watched colleagues leave for greener pastures, but never at the rate they have in the past year.
A big issue has been private placement agencies luring away hundreds of nurses from the public system, offering better pay for nurses just starting out, promising no mandatory overtime and no weekends or night shifts. The strapped hospitals then have to hire nurses from these private agencies to fill shortages. This has meant hospital nurses sometimes find themselves working side by side with former colleagues who are now being paid more — and for more reasonable hours. So more nurses leave, which means remaining staff members are increasingly required to do mandatory overtime, a problem unions have been denouncing for years.
“This is really what is destroying the health system right now,” said Gagné. “More and more people who leave are heading to the private placement agencies or for other facilities that are less affected by this issue. Mandatory overtime is like a gangrene on the health system. People are becoming really fed up with that situation. Many quit, and by quitting they create a need for more mandatory overtime, and that brings more departures. So it's a vicious cycle that means things are endlessly worsening.”
He says the solution is not hiring quotas at hospitals, which he sees as just another coercive measure. He advocates for a system of incentives for nurses and RTS to stay at hospitals that are experiencing severe staff shortages. He suggests the province colour code its hospitals — red for those in the most difficulty, just as it has for regions during the pandemic — and pay staff higher overtime rates if they work in red facilities.
More than 4,000 nurses resigned from their jobs in the public system between March and December of 2020, including retirements from the profession, according to data obtained by La Presse earlier this year. About 2,800 had left during the same period a year before.
Add to those departures the more than 7,668 members of the FIQ — the largest union representing nurses and respiratory technologists — who were on sick leave at the end of last year, and you start to get a sense of the magnitude of the problem. That is fully 10 per cent of the FIQ'S membership of 76,000.
Denyse Joseph, vice-president of the FIQ, says the union made the government very aware of the situation during the last round of contract negotiations five years ago. Nurses, along with other public sector workers, have been without a contract for more than a year. An agreement in principle was reached in December on working conditions and holidays, but other issues, such as salaries, retirement and regional disparity, remain on the table.
The past three governments have made major cuts in the health-care system, she notes. “The result today is that we need to invest a lot of money and we need to hire a lot of staff. In order to recruit and retain staff, we need to look at their workload because if we continue like this, more people will be leaving.
“We have people resigning, taking early retirement, and others who say, `I've had it. It was my dream to be a health-care professional, but I am finding no satisfaction in that field anymore because of the working conditions and non-recognition of my work.”
The fact that Premier François Legault has thanked nurses and called them “guardian angels” at his pandemic news conferences has rung false for many, she said. They have seen their holidays cancelled by government decree. Mandatory overtime has increased. And the reassigning of nurses to different facilities or hospital departments against their will has been a particular bone of contention.
“We went to school, most of us have a degree … not to mention the work we do to specialize. For example, if you are a doctor who specializes in oncology, tomorrow morning you are not going to be asked to become a gynecologist. Your specialty is oncology. Well, it's the same thing for nurses, licensed practical nurses or respiratory therapists working in a specific field for 20 years. You become an expert in that field. You are effective with your patients because you see the signs and symptoms and you know what's going on and you can prevent things.”
She said nurses understand that certain transfers had to be made during the pandemic, from hospitals to seniors' homes for example, but this moving around of nurses “as if we are pieces of furniture” has been going on since well before the pandemic, she said.
Part of the problem is a lack of respect, or an outdated idea that because those in the so-called “caring professions” are mostly women, they can be underpaid and taken for granted. As if, like the nuns who once ran Quebec's hospitals and schools, they are practising a vocation, rather than a skilled profession.
“They think because we are health-care professionals, that we are like the nuns: no life, no kids, no husband, no family. But we have kids and families and our own lives. A lot of us have older parents or grandparents at home. No consideration. They came with ministerial decrees and it was like a punishment. You have to work full-time hours, some places 12hour shifts, no more time off, no more vacation, not allowed to request a day off to be with family or children, or for medical appointments. Everything was refused,” she said.
These conditions led to more illness and burnout. Sick leaves jumped by almost 30 per cent in 2020 over 2019, according to numbers provided to the union last summer, she said, and the numbers for this year are likely to be worse.
The government recently tackled, at least temporarily, the problem of private agencies with a decree issued March 30. The agencies must now wait 90 days before hiring a worker who has left the public system. Hospitals will no longer be allowed to move their own employees to night and weekend shifts to replace them with these independent workers.
A spokesperson for Health Minister Christian Dubé said the government is well aware of the labour shortage, noting the recent budget included $23 million over three years to train more nurses.
“It is clear that nurses are essential partners in providing safe and quality care to Quebecers and we will continue to promote them through the network,” said Marjaurie Côté-boileau.
But Joseph said hiring more nurses is not enough. The government must increase pay and improve conditions. The unions have been asking for a 12.4-percent pay increase over three years, to bring nurses' salaries in line with those of other provinces and with increases granted to male-dominated professions. The most recent government offer was five per cent.
“I don't think we are close to having a contract. We will never accept an offer of five or six per cent,” Joseph said. “It's totally ridiculous, especially with what the pandemic has shown to the population and to the government. This is a total insult to health-care professionals. The government really has to look at our particular situation and do something.”