After a surge in “compulsory overtime” last summer, the CISSS de Laval set about reducing the use of forced labor by implementing its “zero TSO” plan. Since August, the TSO has melted by 70% in the emergency room, supports the management.
“We said to ourselves: what more can we do? explains the director of human resources, communications and legal affairs, Julie Lamarche. We had a difficult summer in terms of TSO, we don’t want to live that anymore, it’s not tenable for [les employés]. »
The summer season has been busy with the holiday period combined with a new wave of COVID-19. July was a month marked by the use of TSO, particularly in emergencies. The obstetrics and neonatal departments were not spared either. At least 100 compulsory shifts were applied only to emergencies from July to mid-September, management reports.
This difficult episode was a trigger for the establishment’s approach, it is said.
It should be noted that last July, the Arbitration Tribunal also severely blamed the CISSS, after the filing of a grievance, for having “exercised its right of management in an abusive manner and contrary to the collective agreement” by resorting to the TSO in a “systematic way”.
The establishment therefore wanted to take a new “turn of the wheel” to establish and improve the measures in place in order to avoid OSI, which should only be used as a “last resort”, according to the Ministry. . The “zero TSO” plan was born in September.
“Our goal is zero [TSO]. It’s not there yet, but we really have a marked improvement, ”says the director of nursing, Élaine Cardinal.
For the period from August 14 to September 10, the CISSS recorded 180.75 hours worked in TSO. From December 4 and through December 31, the volume melted to 54.75 hours TSO. This is a reduction of 70% in four months, despite certain variations, welcomes the establishment.
The establishment is delighted with its performance at the start of the year when emergency rooms are in high demand throughout Quebec. The TSO was required during the night shifts of January 7 and 9 for a total of 8.42 hours.
It should be understood that the “zero TSO” plan also aims to ensure that the mandatory overtime shifts are as short as possible. Thus, on January 9, only 1.17 h was imposed in TSO. Usually in the network, we talk about shifts of 4 to 8 hours.
An “organizational priority”
A list of steps to take before ordering OSI has been developed by the CISSS de Laval, which makes the elimination of compulsory overtime an “organizational priority”.
“It gives weight [à nos actions] », Illustrates Mme Cardinal.
PHOTO ALAIN ROBERGE, LA PRESSE ARCHIVES
Josée Sylvestre, Élaine Cardinal and Julie Lamarche, in the emergency room of the Cité-de-la-Santé in Laval
Among the measures of the “zero TSO” project, the establishment provides for the reassignment of its own team (or flying team) in the sectors where there is a shortage of personnel. We also allow the voluntary transfer of a resource from another service to the emergency room, for example.
On-site managers and clinical nursing advisors are also called in to help prevent an OSI.
” [Le gestionnaire] will not take care of patients himself, but he will be in the field with the head of sector, “says Mme Cardinal.
A clinical adviser who was supposed to give training, for example, will not give it, she will go into the field. Everyone participates.
Élaine Cardinal, Director of Nursing
The use of beds is also reviewed with the objective of “reducing labor requirements”. We will avoid, for example, opening an overflow section if the staff is not in sufficient number, it is said.
The establishment also says it has a “care centre”, that is to say a bank of nurses and nursing assistants who can be moved from one sector to another during evening shifts and night. “It’s really something that we developed in Laval”, specifies the coordinator of replacement activities, Josée Sylvestre.
To promote the attractiveness of personnel in the more difficult shifts, the establishment maintains that it no longer advertises only daytime positions, but rather “rotation” positions by committing to ensuring that at least 50% of the hours worked are carried out during the day.
Self-management of schedules, a project dear to the eyes of the Minister of Health Christian Dubé to reduce the TSO, is in the process of being deployed in 22 departments of the CISSS de Laval, including emergencies.
The union remains cautious
Although it welcomes management’s desire to reduce the use of the OSI, the Union of Nurses, Respiratory Therapists and Auxiliary Nurses of Laval (SIIIAL-CSQ) claims for the time being that it has not observed any “marked changes” since the TSO comes “in waves”.
“It is a request from the members to want to cancel the TSO. We see that senior management is working hard to try to find solutions because we also have to think about retention, ”explains President Déreck Cyr, who points out that 894 members left the CISSS between 2020 and 2022.
“It’s good, we can’t be against virtue,” he assures us. A measure that targets the movement of personnel, however, raises eyebrows at the union, which recalls that the movements must be voluntary and respect the collective agreement. “As for the rest, we think there are good ideas [dans le plan “zéro TSO”] “, concludes the union representative.
In short
Compulsory overtime must be imposed as a last resort and forces an employee to remain on the job after his usual shift due to a shortage of manpower and in the face of a risk of service disruption.