In February 2018, three years after the implementation and failure of the Barrette reform, more than 50 nurses and nursing assistants submitted to the CISSS in their region “The Black Book of Outaouais Emergencies”. This collection of testimonies denounces the deterioration of working conditions and the practice of the nursing profession (increase in mandatory overtime, exodus of healthcare professionals, etc.) as well as the threat to the quality and safety of patient care in the Outaouais region (increase in incidents and accidents, explosion of nurse-patient ratios, etc.).
This was followed by a denunciation movement in Outaouais orchestrated by nurses and nursing assistants that pushed the Liberal government to implement a ratio project at the Hull emergency room. However, while the ratio projects of the Fédération interprofessionnelle de la santé du Québec have proven their effectiveness (reduction of mandatory overtime, reduction of sick leave, improvement of the work climate, etc.), they were never implemented by the CAQ government. Furthermore, in the months and years that followed, nurses and nursing assistants spontaneously organized several sit-in to denounce the lack of staff and the abusive use of compulsory overtime in the emergency room, but also in several departments of medicine and surgery.
But again, during the pandemic, the ministerial orders adopted by the CAQ government will allow collective agreements to be suspended and full-time schedules to be imposed for all shifts (day, evening and night) and in all units for nurses and nursing assistants, regardless of their expertise and skills. As a result, they will contribute to the exodus of healthcare professionals to the Ontario region and placement agencies. Finally, remember that these numerous resignations led to the partial closure of the Gatineau emergency room on June 28, 2021, for more than six months.
According to the latest report on nursing staffing (2022-2023) produced by the Ordre des infirmières et infirmiers du Québec, the Outaouais is the region with the fewest direct care nurses per 1,000 inhabitants, at 4.96, while the provincial average is 7.74. This situation is highly worrisome, but not new since it has long been denounced by nurses and nursing assistants, as demonstrated above.
Stubbornness
However, there seems to be stubbornness on the part of governments, which successively refuse to give credibility to nursing denunciations and who have a stubborn obstinacy in refusing to implement the solutions they propose. On the contrary, the Coalition avenir Québec demands “mobility” and “flexibility” on the part of nurses, as during the pandemic, which could lead to a worsening of the shortage and a deterioration in the quality and safety of patient care.
Once again this year, a collective of nursing experts proposed a “ Toolbox for the retention of nursing staff”. This free, scientific and online document is available to governments and would allow them to implement measures to retain and improve the professional lives of nurses. It is time to be consistent; if nurses are portrayed as “holding the public health system together”, their expertise in the management and implementation of sustainable and effective solutions to improve their working conditions and, consequently, the health network must be truly recognized.
The new hospital in Outaouais will not resolve a deeper problem, namely the chronic devaluation of care work (care) and the lack of recognition given to those, since they are mainly women, who provide it.
*Also signing this letter: Sophie Mederi, nursing student and trainer on the trauma-informed approach; Carolie Daniel, clinical nurse; Khawla Hassan, candidate for the practice of the nursing profession; Alexandre Magdzinski, clinical nurse; Natalie Stake-Doucet, nurse; Denis Marcheterre, president of Action santé Outaouais; Catherine Habel, primary care nurse practitioner.