The Minister of Health, Christian Dubé, has set up a “crisis unit” to find solutions to the emergency crisis. While commendable, this initiative does not include the expertise needed to find lasting solutions.
This cell is mainly made up of doctors (12 out of 20), managers and two nurses. The absence of nursing directors is disconcerting. The president of the College of Physicians is included, but no other professional order.
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When we know that one of the central problems is the network’s inability to attract and retain nurses, union representation would be in order. We excluded specialist nurse practitioners and researchers. The composition of this committee seems rather to reflect the problems of the network; relying on medicine to manage problems that are not medical. Without enlarging the committee, a composition more representative of the expertise in the field would be preferable. In Quebec, we have 82,000 nurses for some 22,000 doctors.
Patient partner Désirée Nsanzabera also reminded me of another glaring lack of expertise: patients. Mme Nsanzabera has been part of an MSSS Committee as a user partner since 2020. She learns about the problems of patients, especially those without a family doctor who often find themselves in the emergency room. I share his concern; difficult to have “patient-centric” solutions without patients.
Improving conditions for nurses
Let’s come back to nurses, because that’s my area of expertise. The Minister, like many managers, looks at the problem upside down. We are talking about a shortage of nurses, while Quebec has more nurses than ever. Agencies are demonized, whereas it is the network itself that makes life easy for them. If we continue to articulate the problem in terms of “shortage” we will not find lasting solutions. There is no shortage; there is a retention crisis.
We have enough nurses in Quebec, but they refuse, with good reason, to work in miserable conditions where everything is constantly questioned, even their right to eat and sleep. Developing work-life balance policies and removing the TSO from the managers’ toolbox would be a good start.
Several circles have decided to ban the TSO, and are doing better for it. OSI is one of the main causes of the departure of nurses; in many settings, it is every day that they are required to leave their children and their families behind because we have not taken the trouble to plan the staffing. The TSO is far too easy to use; the total absence of responsibility in its use opens the door wide to abuse.
Second, agencies, while indeed aberrant in a public network, are only a symptom of the crisis. You can ban agencies all you want, as long as the settings refuse to treat nurses as human beings, they will continue to leave whether there are agencies or not.
Solutions
We cannot continue to bet on “solutions” that will increase the burden on nurses. It doesn’t work, with the consequences we see today. But, to think about innovative solutions, we need a perspective that allows us to see beyond the stubborn myths of the network and, for that, we need more nurses and varied perspectives that allow this crisis unit to examine the network as a whole.
Natalie Stake-Doucet
Nurse, teacher, doctor of nursing
