This text is part of the special booklet Defining priorities on the large table of commitments
Sometimes everything happens in a fraction of a second in certain areas of a hospital, whether it’s the intensive care unit, the emergency room or the cardiology department. When it is judged that one nurse can do the work of two or when the number of patients is increased to take care of, vigilance is no longer the sameme and the scale of the task, increased tenfold.
A clinical nurse since 2001 at the Institut universitaire de cardiologie et de pneumologie de Québec, Jérôme Rousseau had long noticed that the pace was accelerating, that “the workload exceeded the capacity [qu’il était] able to give. At the time, the question of ratios was not yet on everyone’s lips; the terms were not the same, but described a situation that was not going in the right direction. After two years of pandemic, galloping inflation and numerous economic uncertainties, many believe that it is not likely to improve.
This is not the conviction of Jérôme Rousseau, and he intends to change things, defending the question of ratios since his entry into the Fédération interprofessionnelle de la santé du Québec (FIQ) in 2017. For this vice-president, determining such standards in this sensitive sector is obvious. “We saw it this summer at airports. There are safety rules to follow, so if we don’t reach a certain number of flight attendants depending on the number of passengers, the plane won’t take off. Same thing in early childhood centers: would someone come up with the idea of entrusting 20 babies to a single educator? Nobody could imagine it. But in hospitals, there are no regulations. »
Count on him so that the word “ratio” is not only in the vocabulary of healthcare professionals, but that it goes well beyond intensive care units, “where it is almost unanimously accepted”. To do this, he does not hesitate to draw attention to foreign initiatives where ratios have become a constructive response to the shortage of personnel. He cites as examples California and Victoria, in Australia, where the introduction of ratios is enshrined in law, transforming “health networks offering good conditions with an acceptable workload, which has had the effect of bring back into the public sector. Even New York State and South Korea are beginning to take an interest in this strategy”.
However, at the moment in Quebec, it is not the time for the great return to the public, if we judge by the figures from the Ministry of Health and Social Services. They testify to an explosion of the costs for the engagement of private labour, often employees of agencies remedying the lack of personnel; both nurses, managers, respiratory therapists and maintenance employees. From a bill amounting to $201 million in 2017-2018, it rose to $875 million in 2021-2022.
However, the health sector is not in shortage of human resources, but in shortage of good working conditions, insists Jérôme Rousseau. The Order of Nurses of Quebec has 82,271 members, but since the start of the pandemic, many have fallen in battle in the face of workload, compulsory overtime and accidents, making the daily management of teams more hazardous. . And as in the teaching environment, 30% of healthcare professionals leave within the first five years of their career.
How could the ratios correct the situation? This will first be done in stages, recognizes the vice-president of the FIQ. After rallying other organizations to this cause in a vibrant plea, Jérôme Rousseau is convinced of its benefits, relying among other things on pilot projects carried out in 2018 which converged on his aspirations for his colleagues: a clear framework, a promotion of the profession, a reduction in absenteeism and vacant positions, as well as standardization of health care in Quebec. “A law on ratios would oblige all establishments to respect it, regardless of where they are located in the territory,” wishes Jérôme Rousseau.
Why not include the ratios in a future collective agreement? “The quality and safety of care cannot be negotiated,” he says confidently. It should be obvious that the government and the Minister of Health establish the law and can guarantee it as much as possible. It’s not for tomorrow, but Jérôme Rousseau is already ready to knock on the door of the new government as of October 4th.
30% This is the proportion of healthcare professionals who leave within the first five years of their career.