At the emergency room of the Baie-Saint-Paul hospital, we came close to disaster at the beginning of the summer, with a closure announced in the evening and at night. Five months later, the nurses in the region have succeeded in keeping the emergency room open… by managing their schedules themselves. And it continues. Self-management, a solution to remedy the shortage of nurses?
Even the head of the emergency department in Charlevoix, Donald Caron, cannot believe the success of this pilot project, adopted in a hurry and which was to last only one summer.
On a voluntary basis, emergency nurses at Baie-Saint-Paul and La Malbaie hospitals were invited to work 12-hour shifts for seven days, followed by a week of rest. Six months later, the formula is so popular with staff that nurses from both hospitals have just renewed the project for six months.
“Normally, I still had 25 to 30 unfilled shifts per week, and we fell to 10. We reduced that to a third. I even had surpluses sometimes for certain day shifts! »Emphasizes Donald Caron.
At the start of the summer, at least 320 unfilled evening and night shifts threatened to precipitate the closure of the emergency department at the Baie-Saint-Paul hospital. A disaster announced for the local population, not to mention the arrival of 100,000 vacationers expected for the summer season.
The Cadillac of hospitals
Hypermodern, the state-of-the-art Baie-Saint-Paul hospital and its urgency would make most Montreal hospitals green with envy. Yet the gleaming $ 250 million hospital, inaugurated in 2018, is experiencing an even worse staff shortage than that experienced in major centers.
To help it get through this crisis, the CIUSSS de la Capitale-Nationale called on the Living Lab Charlevoix team, a university project at Laval University intended to set up and test local solutions to problems. rural emergencies. Five fresh-eyed medical students spent several days surveying staff and concocting potential solutions.
“When employees have the power to set their schedules, they feel like they’re in control. We saw nurses coming home at 5 a.m. and coming out at 5 p.m. It was an original and complex logistics, but, for them, it was better than the TSO [temps supplémentaire obligatoire] », Explains Dr Richard Fleet, professor in the Department of Family Medicine and Emergency Medicine at Laval University and supervisor of the Living Lab Charlevoix.
The Charlevoix emergency director confirms that he has almost given his employees carte blanche to manage schedules. “At the beginning, the 12 hours, it was a blow to give, but it resulted in a drastic drop in OST. It reduced absences from work. I hardly have any last minute sickness absence, ”says Donald Caron.
When there are shifts left unfilled, the ER team uses communication rather than imposition. “We are appealing to everyone in our Facebook group. The texts get under way. The recall list is only used if there are still holes left in the schedule. It worked 90% of the time, ”says the head of the department.
In short, the staff prefers to choose their extra hours worked – with the bonus of a week off – rather than endure shifts, and having to manage the personal and family disorganization that follows, explains Donald Caron.
The Living Lab experiment, carried out during this crisis, allowed nurses to express without filter to medical students the problems experienced in their daily work. “Rather than finding management solutions, far from people, we went into the field to talk to nurses,” explains student Émeryck Plante-Belleau.
“We felt listened to and we understood that we could find solutions ourselves. So we sat down and innovated to avoid the closure, ”explains Charline, nurse at the La Malbaie emergency room.
” This is unheard of. The old recipes have all been tested. I have been doing 12-hour shifts since July. We are able to do more with fewer people, ”explains Mélanie, nurse at the Baie-Saint-Paul emergency room.
Magic, the 12-hour schedule? Adopted by several English-speaking hospitals, this working formula is not, however, a panacea, specifies Donald Caron.
“I have young employees who have children to pick up before 5 pm and who cannot afford 12 straight hours. Others do not have the physical capacity to work 12 hours. But about 75% of the nurses got on board, ”he explains.
For those who work evenings and nights, the 12-hour formula can also be quite demanding in the long term.
“It’s beneficial, because we save a lot of family time [avec les 7 jours de congé suivants]. But in terms of physical fatigue, it’s worse, ”concedes Mélanie, who works an evening shift.
Still, the bursting of traditional schedules seems to offer a possible solution in the current state of the labor shortage, thinks Donald Caron.
“If we want to open these types of positions, we really have to sit down with the union and be in innovation mode rather than rivalry. We are now thinking “out of the box”. We are even asked to move towards self-management of schedules. It already exists in some companies, ”he adds.
In Charlevoix, where a “7/7” schedule makes it possible to take full advantage of the outdoors and nature, the 12-hour shift has even become a factor in attracting staff, adds Mr. Caron. “We have never received so many CVs! “
Richard Fleet, who has been studying the challenges of 256 rural emergencies for ten years, says a major driver of staff shortages is the loss of power and autonomy felt by employees.
“This is not a crisis that will be resolved with a single solution. But small solutions can be applied quickly. Sometimes it gets blocked because we don’t want to create precedents, but autonomy is extremely strong. In Charlevoix, this led to an unprecedented collaboration between the nurses of the two hospitals. “