During his appearance on the show Everybody talks about it, the Minister of Health, Christian Dubé, said he wanted to act differently, by focusing on a mode of “change management”. He also cited as an example his refoundation plan, but also the crisis unit he set up to solve problems in emergencies. Cell which, we would like to remind you, is made up almost exclusively of doctors, while the crux of the current crisis is nursing.
Like his predecessors and the governments of the past decades, Mr. Dubé refuses to recognize the expertise of nurses and to implement the solutions they propose. The nurses at Maisonneuve-Rosemont Hospital, for example, have been offering concrete solutions for years, as their colleagues do across Quebec: from Chicoutimi to Baie-Saint-Paul, from Nunavik to Gatineau.
Despite the sustained efforts of nurses to sound the alarm and propose structuring solutions, they still too often come to grips with the indifference, even hostility, of decision-makers at all levels of network governance. The current management system and its very narrow vision of what collaboration is — and especially who can take part in the decision-making process — instead demonstrate a lack of understanding on the part of the government and the senior management of the CISSSs and CIUSSSs of the problems encountered on field. The same applies to the solutions to be put in place to resolve the problem of nursing staff attrition.
Minister Dubé described the situation at the Maisonneuve-Rosemont hospital as “exceptional”. This qualifier seems inaccurate to us, considering that this crisis was foreseeable and, above all, avoidable. This umpteenth call for help rather testifies to the commitment of these nurses towards their patients and their courage in the face of the apparent indifference and hostility shown by their employer.
It should also be noted that research and evidence indicate that poor workforce planning that leads to a chronic understaffing in the field can lead to increased mortality rates. The extra time also entails risks in terms of the quality of care. In too many care settings in Quebec, the management method is detrimental to the quality and safety of care.
This is the case in the emergency room of the Maisonneuve-Rosemont hospital, where the situation has persisted for several years. Alerts from nurses are increasing and, faced with the absence of retention measures, the number of resignations is also increasing. It is high time to demand accountability and transparency in management decisions.
Finally, to use the slogan of the new advertising campaign of the Order of Nurses, nurses are more than arms. Indeed, they are professionals trained to have a global vision of the health of populations, to carry out in-depth assessments of the state of health, to participate in decision-making committees, etc. In short, they are experts in health and care.
This is also why we believe that solutions such as the transfer of personnel or the withdrawal of training necessary for the development of nursing skills, as proposed for example by the CISSS de Laval to reduce compulsory overtime, are worrying, because these are measures that go against the valuation of nursing work. These solutions are not permanent. On the contrary, they risk harming the retention of nurses.
On the contrary, we must increase training, establish mentoring programs, put in place a law for safe ratios, rely on a shared governance model, etc. Contrary to what Minister Dubé suggests, self-management of schedules is not sufficient on its own to solve network problems or recruitment abroad. These two measures are not new; they can contribute to the solution, but they are not THE solution.
The recent waves of denunciation and mobilization of nurses in Quebec and elsewhere, particularly in the United Kingdom and New York, give us hope, show that nurses are united and more determined than ever. Major gains were made in New York following the recent nurses’ strike.
The ball is now in the government’s court. We are asking Mr. Dubé to set up a genuine advisory committee that is representative of the composition of caregivers in the network, and therefore calls on researchers and experts in nursing care and health management. Without an authentic and representative nursing presence around the decision-making tables, regardless of the benevolence of the other actors involved, we cannot hope to resolve the crisis. Decisions that affect us should be made with us, not for us.