What is behind the rejection of the agreement in principle for the renewal of the nurses’ collective agreement?
Why did the members of the Fédération interprofessionnelle de la santé du Québec (FIQ) vote 61% against the agreement last week, when their union considered it reasonable enough to suggest they support it?
Short answer: a lot of confusion and a serious lack of trust.
Slightly longer answer: Quebec is asking for more flexibility from nurses to provide better care to the population. The nurses are not against it, but they are afraid that their boss will end up forcing them to do the splits.
What worries them most is that they are asked to work in another department where they feel incompetent.
What exactly is it?
Quebec reiterated that the trips would be voluntary. This is true, but only if a nurse is asked to work outside her center of activity (her department, if you prefer).
According to the agreement, those who voluntarily agree to lend a hand elsewhere receive a bonus of $50 if they travel less than 100 kilometers or $100 if they go further. Their mileage is also reimbursed.
So far, no problem.
However, the agreement also provides for the possibility of merging activity centers to gain efficiency.
For example, we could merge an operating room and a recovery center, so that a nurse present during the operation can ensure monitoring. We could merge two CHSLDs, or two floors of the same establishment, to better distribute forces if there is a shortage of staff.
Good ideas, then.
But after a merger, a nurse could be moved within the expanded center of activity, as long as she has the training to do the job. She couldn’t object. She would not receive a bonus. But his mileage would be reimbursed… unless we changed his “home base”, that is to say his main place of work.
By giving 30 days’ notice, the employer could, in fact, change the home base of a nurse, within the same center of activity, provided that she is not found further away only 35 kilometers (25 kilometers in Montreal).
This is where things start to get tricky. Especially in big cities, because of road congestion and the complexity of public transport. Imagine the nightmare if we asked a nurse who lives on the South Shore to go work at the Lakeshore General Hospital instead of the Maisonneuve-Rosemont hospital, after a merger.
This is perhaps what explains the very contrasting result during the vote on the agreement in principle which was supported in several remote regions, but strongly rejected in Montreal, Quebec and Trois-Rivières.
If the nurses are nervous, it is because the agreement in principle does not provide clear guidelines regarding the distance or the nature of the care offered by the centers that could be merged.
However, we must not believe that we are going to merge all of Quebec and send nurses from one end of the province to the other, unceremoniously! The objective is to promote better organization of work and increased access to care for patients. The employer must justify it and consult the union.
But a reorganization of the CIUSSS de la Mauricie-et-du-Centre-du-Québec, in 2023, caused a lot of excitement. All nurses in the region are now called upon to work one weekend out of three.
We have often heard that these changes caused a wave of departures. But in reality, 335 nurses left their positions in 2023 for various reasons (retirement, relocation, promotion, reorientation, etc.), a number similar to that of the previous year.
What has been less said is that the reorganization made it possible to reduce “mandatory overtime” (TSO) by 46%, which is a real nuisance. This causes an exodus of exhausted nurses and puts even more pressure on those who remain.
The reorganization made it possible to rebalance the burden between nurses who have a day schedule, from Monday to Friday, and those who provide care 24/7, such as in the emergency room or the CHSLD.
When a nurse who provides mental health home care finds herself in the psychiatric emergency room, things are going quite well. But when a school nurse ends up in a CHSLD, there are tears and gnashing of teeth. The CIUSSS had to adjust.
Even with training, nurses are not pawns that can be moved to any square. Quebec is right to seek solutions to better organize the work of nurses. But if he wants to gain the trust of nurses, he will have to explain his strategy in a clearer, more transparent way.
After eight days of strike and long and arduous negotiations, no one wants to rewrite the agreement from scratch. The challenge is therefore to identify arrangements that will reassure nurses, without distorting the government’s objectives of increased flexibility.
Nurses can be flexible, but they’re not contortionists either.