The pandemic has highlighted the shortcomings of our health system, in particular by the overload of emergencies and intensive care. Andrée Simard, wife of former Premier Robert Bourrassa, died in a Montreal hospital without being able to benefit from palliative care adapted to her health condition, which sparked harsh criticism of our health system. . How many people die in Quebec without having received palliative care or comfort care because our system is overloaded and disorganized? The Maisonneuve-Rosemont hospital emergency room is currently demonstrating this, through the speaking out of nurses who refuse to work compulsory overtime (TSO).
First, there is a problem of financial and human resources. With regard to financial resources, hospitals do not receive budgets allowing them to respond adequately to the needs of users. Note that doctors are paid by the Régie de l’assurance maladie du Québec (RAMQ), they are not employees of health establishments. On the other hand, all other health professionals who work in a hospital setting are employees of the establishment.
Let’s not investigate why there aren’t enough psychologists or physiotherapists in the hospital setting, or why the nurse to patient ratio has increased over the years, like part-time jobs. Public system nurses are fed up with OST, which is associated with more absences, more sick days, and more medication and other errors. In fact, they are exhausted when they do OSI, which corresponds to two eight-hour shifts, which constitutes 16 consecutive hours of work. The use of TSO has become a management method over the years. In no other profession would such working conditions be accepted.
Many nurses suffer from moral distress, which has been the subject of numerous studies in many countries. They want to do well and respond adequately to the needs of the patients for whom they are responsible, but they are prevented from doing so by administrative and institutional constraints. When a nurse has too many patients in her charge, she is unable to apply what she has learned, that is to say, to respond to needs according to a global approach to care.
The case of M.me Simard is not isolated. I remember an emergency nurse who didn’t have time to care for a dying lady with her husband. This nurse was deeply disturbed when she realized the death of the lady, who had not had the care required by her state of health. It had prompted her to enroll in an ethics course.
However, it is not taking a course or changing a dispatcher, giving bonuses or raising salaries, investing heavily in renovations or building new hospitals that improve working conditions. In fact, one of the factors of moral distress among nurses comes from the feeling of not being able to change anything in the traumatic situation which has been repeated continuously for years.
This is why some nurses focus on physical care and techniques while neglecting the psychosocial aspects which would require more time. Some change institutions to avoid OSI, others leave Quebec for Ontario, the United States or Switzerland, and still others leave the profession altogether.
These problems are not easy to solve. Certainly hospital budgets could be increased, which would encourage hospitals to hire more staff, thereby lowering nurse-to-patient ratios. To this end, health transfers from the federal government, which have already shared health costs up to 50% and which are currently around 26%, could help solve the problem. In this regard, the 35% claimed by the provinces is not exorbitant. Moreover, private hospitals are not a solution, since they are prohibited by the Canada Health Act; Alberta has already paid the price, with lower transfer payments.
From a management perspective, a recent union agreement obliges hospitals to hire full-time 80% of their nursing staff who work in the emergency room and 70% of the nursing staff who work in other areas of hospital practice. The future will tell if these positions are more attractive than the private agencies, to which the establishments appeal to make up for the lack of staff.
In addition, hospitals have found ways to avoid OSI by offering nurses the option of working 8-hour and 12-hour shifts, granting more time off to those who agree to work 12-hour shifts . That said, it is the structure of our health care system that needs to be changed. Our system is centered on the hospital, and the emergency room is the gateway to all types of services.
Our health system needs decentralization in order to develop better local services, home care and community services adapted to the needs, in particular to the needs of people who suffer from mental health problems, those who need care extended care, rehabilitation or simply palliative care at home. Sweden is a model in this regard.