Don’t Look Up, nurses version

Given the current popularity of the film Don’t Look Up, the nurses who write these words hope to draw a parallel with this film and our increasingly desperate attempts to sound the alarm bells for our public health and social services network.

Natalie Stake-Doucet
Doctor of nursing sciences and spokesperson for the Association québécoise des infirmières et infirmiers (AQII), and nine co-signers, members of the AQII board *

This week, the Minister of Health announced that Quebec would again cancel caregivers’ vacations. In our view, this measure risks killing caregivers, not the pandemic. For years, the Association québécoise des infirmières et infirmiers (AQII) has been working together with researchers, unions, associations of physicians and social workers, community organizations, not to mention our numerous interventions in the public and media space. , our meetings with politicians and our coordination work with other nursing associations, with the aim of improving the health and social services network and the working conditions of caregivers.

We have voluntarily developed achievable and concrete recommendations that we have, by all possible means, tried to communicate to the government. We speak from experience when we say that this measure will harm the network and risk exacerbating the understaffing. What we know so far:

– Between March and December 2020 alone, 4,000 nurses resigned, an increase of 43% compared to the previous year. These final departures do not include the thousands of sick leaves.

– Quebec has one of the worst results in terms of its treatment of caregivers at the front. According to journalist André Noël, between the start of the pandemic and the month of June last year, more than 45,000 health workers were infected with COVID-19, more than a dozen of whom died. and many others have physical consequences. These infections are the result of the government’s stubbornness in neglecting the implementation of sufficient measures to protect healthcare workers from aerosol transmission, such as ventilation of workplaces and access to protective equipment. appropriate.

– We did not have the opportunity to recover from the trauma of the first murderous wave, let alone the waves that followed. The lack of organizational support and listening from caregivers as well as the mismanagement of the public health department have caused abnormally high rates of symptoms related to anxiety, post-traumatic stress, depression, insomnia leading to the development of suicidal ideation in more than half of the nurses.

From the start of the pandemic, for lack of sufficient strategies, we tried to organize ourselves. Colleagues dentists, pharmacy students and others mobilized to bring protective equipment to caregivers in CHSLDs and community organizations while the CIUSSS and CISSS removed them to accumulate them in hospitals. We wrote and shared the existing science with as many people as possible to come up with a different approach that could have made a difference.^⁠1-2. We have been ignored.

Disappointing premiums

Then, alarmed by the massive resignations of caregivers from the network last summer, we started this work again, because no decision-maker seems to be wondering why carers are leaving their posts, only how to impose a more unbearable workload on the caregivers who remain. We and several other groups are working to put this critical issue on the political agenda and to further develop realistic recommendations.^⁠3-4-5. In addition to writing, we participated in meetings with people appointed by the government. It is with bitter disappointment that we greeted the announcement of the so-called “revolutionary” bonuses by Minister Dubé. Of all the recommendations made by the groups involved, we were unanimous in saying that the bonuses would be the least useful.

So here we are this week, once again, working on recommendations to counter a measure that risks destroying our public network. If the care capacity of hospitals is largely influenced by the number of hospitalizations during a pandemic, the other aspect that influences hospital capacity is the presence of caregivers. The threats of service breakdown, which Mr. Dubé and his team invoke ad nauseam to justify their measures to “manage” personnel, are nothing new.

Long before the pandemic, service disruptions were common ^⁠6-7. We can blame the former Minister Barrette or the federal government as much as we want, but those in power at the moment ignore us just as much.

What to do now ? The government did not listen to our recommendations on protective equipment, on the organization of the workforce, on retention and attraction measures. We will do what we always do: continue to hammer them and try to make us listen despite indifference and political hostility. So, for the umpteenth time:

– Allow local flexibility for self-management of schedules in the CISSS and CIUSSS. Many local managers had succeeded in negotiating an increase in the availability of nurses while respecting their family obligations before the application of the decree. These agreements were thrown in the trash because of the decree, which led to resignations and absences.

– In establishments: stop invoking the Administrative Labor Tribunal (TAT) when nurses make sit-in. Each time, you are wasting a golden opportunity to collaborate with staff to find solutions. The sit-in are a cry for help, not a threat to your “authority”.

– The government (or while waiting after the government), the CISSS and CIUSSS must adopt a policy to regulate compulsory overtime (TSO). Of all the health issues, this was probably the one that led to the most resignations. Administrations must make themselves accountable for the TSO rather than having the right to impose it without constraints. Knowing that a manager has such great power over our lives and that abuse will never be punished is demoralizing for staff.

There are many more solutions. These proposals are just the tip of the iceberg of the tremendous work done in the past year and even before the pandemic. Suspending vacations and forcing full-time caregivers who are exhausted, traumatized and disillusioned will not help limit service disruptions. We must see further than next week; the nurse who is given full-time, OSI and taken vacation may be there next week, but will she be there next month? In six months? It is this kind of short-term management that has led us to the impasse we are currently in. The vicious circle in the health network is not the lack of personnel that leads to more OSIs, it is the chronic lack of listening to the solutions we offer. We have to break this vicious circle.

* Co-signers, members of the AQII board: Audrey bujold, nurse and doctoral student in family sciences; Marie-Claude Jacques, nurse and professor of nursing sciences; Kenza rahmi, licensed practical nurse and third year nursing student; Isabelle Wallace, community health nurse, Madawaska Maliseet First Nation; Eve-Lyne Clusiault, clinical nurse; Esther Carielus, clinical nurse; Caroline Dufour, clinical nurse; Alexandre Magdzinski, male nurse ; Alexandre emondclinical nurse