When cries of indignation and sensible speeches are no longer enough to convince that a situation is untenable, what do nurses do with an emergency department that is overflowing with patients and compulsory overtime? He threatens to take his clicks and his slaps to go elsewhere to see if the air is breathable. By wanting to paralyze the emergency department at Hôpital Maisonneuve-Rosemont, the hundred or so nurses ready to resign en bloc succeeded in attracting attention and forcing action.
It is not normal that after so many signals sown upstream it had to come to this. In a petition submitted last Friday to their managers, almost all the nurses in the emergency department urged the hospital to change things as soon as possible, failing which, they would resign. The contingency plan presented by the management not satisfying them, they continued their sit-in Monday evening, forcing the closure of the emergency room of one of the largest hospitals on the island of Montreal for a whole night. It was serious.
But can we blame them? For months they have been vociferating and railing against compulsory overtime (TSO), this diabolical invention forced by a shortage of personnel and the increasingly reduced capacities of the public network to retain staff, for lack of decent working conditions. In Maisonneuve-Rosemont, the OSI rate supplants the Quebec and Montreal average. The hours added on top of a “normal” working day are constantly increasing. Nurses fed up with having to sacrifice their family life, their sleep, their health for the benefit of days that never end have seen that words were no longer enough. We had to take action.
The threat worked: the Minister of Health Christian Dubé had to get involved, a head of unit targeted by the employees was reassigned, a conciliator was appointed to bring the employees closer to the managers, all against a background of research of solutions. This isn’t the first time that Maisonneuve-Rosemont has found itself in the eye of the storm: what’s wrong?
It seems that several ingredients have intertwined to form an explosive recipe: first, this important hospital in the east of Montreal receives, in the opinion of all, more than its capacity in patients tumbling to the emergency room. A nursing clinic just opened in the area with the avowed aim of relieving congestion in the surrounding emergency rooms has apparently not yet delivered the promised results. Then, to add to an emergency management problem affecting the Quebec network, and for which the Quebec government created a crisis unit last October, it appears that a latent conflict between the person in charge of the emergency and his staff made matters worse. The local management of schedules so dear to Minister Dubé—this form of self-regulation of working hours carried out by the nursing staff themselves—did not impose itself here as a miracle solution. On Monday, the nurses were still furious to see that the solution found by the hospital was to eliminate the OSI without reducing the patients, which imposed an overload burden on each of the nurses on duty. They rightly claimed that patient safety was at risk.
Whose fault is it ? It’s tricky to pinpoint the culprits when we know that the problem of overcrowded emergency rooms has been undermining our health network for decades, and that in addition, there is no doubt that the shortage of nursing staff is one of the most cries that stimulates this crisis. This week’s surge is the perfect illustration of this.
Whose responsibility then? The arrival of a conciliator is a good omen because the two parties, literally embarked on a negotiation, must come up with solutions that will not harm the health of the patients or that of the nurses. OSI is a defect and a serious dysfunction of our health system; introduced urgently and exceptionally, it is in the process of imposing itself as the normal extension of a working day, which makes no sense. The leaders of the hospital and the CIUSSS de l’Est-de-l’île-de-Montréal as well as the union and the employees must develop a plan that will hold water and that will prevent patients from being taken hostage.
Caught up by reality, the Minister of Health finds that he is not only the architect of a major reform but also, in his spare time, the fire chief. And it is his responsibility. It is not a defect but a necessity to have a minister who puts his talent at the service of (yet another) overhaul of structures, which we hope brings hope, but also to the implementation of a solid problem solving plan. The Maisonneuve-Rosemont episode shows that caregivers have the big end of the stick. If they threaten to slam the door, it is no longer a crisis that we are close to, but rather paralysis.