October 20, 2021 - No. 97

Quebec Health Care Workers Step Up the Fight for Their Rights

Determined Actions to Abolish Untenable Mandatory Overtime

"MOT Is a Death Sentence for Healthcare Professionals"

Quebec Government Refusal to Recognize Breakdowns in Health Care Services
The Experience of Health Care Workers in Northeastern Quebec - Interview, Nathalie Savard

Quebec Health Care Workers Step Up the Fight for Their Rights

Determined Actions to Abolish Untenable
Mandatory Overtime

Health care professionals who are members of the Interprofessional Health Care Federation of Quebec (FIQ) are stepping up their actions to have mandatory overtime (MOT) abolished as part of their "MOT is a Death Sentence for Healthcare Professionals" campaign. FIQ's member unions held general membership meetings during the week of October 11 at which members discussed the federation's action plan. 

Several unions voted in favour of holding a weekend of work without mandatory overtime on October 16 and 17. Unions from the Capitale nationale, Mauricie-Centre-du-Québec, Outaouais, Laurentides, Bas Saint-Laurent, Centre-Sud-de-l'île-de-Montréal, Abitibi-Témiscamingue and many others participated. The FIQ provided full support to the member unions participating in the actions. In particular, it developed an FIQ Health App through which members can provide information and testimonials in real time on the overtime being imposed on them.

According to the FIQ, the weekend went well. Wherever the member unions decided to refuse mandatory overtime, during these two days, there was almost none. "No MOTs were announced this weekend. I didn't get any calls," said Karine d'Auteuil, Interim President, Union of Health Care Professionals for the Outaouais to the local press.

"It was to demonstrate that when we take the big step of announcing that we are refusing MOT, that we are ready to go before the Administrative Labour Tribunal, the employer redoubles their efforts to avoid mandatory overtime. They did this for 48 hours versus doing it year round. It's not the same work for them. Carrying out work reorganization for two days is less of an effort than doing it for 365 days. Providing services according to the guidelines we have in place should be done year-round," she said. "If we have to announce 365 days with no MOT, we'll do it to ensure that our care professionals have a work-family quality of life and can have the guarantee that when they finish their shift, they will be able to leave on schedule," she added.

The nurses are saying that MOT is in fact a management method used by the government and administrations to avoid having to improve their living and working conditions. It aggravates their health and safety problems, both physical and psychological, and destroys all chances of recruiting the thousands of care professionals needed to provide the population with essential care and services throughout Quebec. 

Nurses are saying outright that any measure to address the problem that relies on temporary financial bonuses for nurses to retain or attract them to the health system, such as the measures announced by the Quebec government, will not solve the problem. Working conditions have to be changed on the basis of the demands and solutions put forward by health care workers, and ending mandatory overtime work is a key demand in this regard.

"The current pandemic and the additional pressure it imposes on care professionals only adds to the already heavy burden of MOT and is causing more exhausted care professionals than ever to leave the CHU de Québec and the profession," said Nancy Hogan, President of the Union of Health Care Professionals at the Centre hospitalier universitaire (CHU) de Québec. "The ship is in serious danger of sinking and there is an urgent need to act. Our members have the right to work under adequate conditions and to live a normal personal and family life," she added.

On October 15, the FIQ sent letters of formal notice to the Minister of Health and Social Services and to management at healthcare institutions, demanding that they put an end to mandatory overtime by November 15. The letter sent to the Minister specifies that if nothing is done by then, the FIQ will undertake "any recourse deemed appropriate or required, without further notice or delay."

The federation has also filed a complaint with the Human Rights Commission, which states that it is currently impossible for nurses to have fair and reasonable working conditions that respect their health and safety. The FIQ is asking that the Commission study the problem and make recommendations to the government.

The federation has also requested the intervention of the Labour Standards, Pay Equity and Workplace Health and Safety Board (CNESST) and its prevention-inspection service in order to put an end to the use of mandatory overtime. It says that employers have a legal obligation under the Act respecting occupational health and safety to adopt work organization methods that respect the health and safety of health care workers, while the abusive and disproportionate use of MOT puts their physical and psychological health at risk by exposing them to work overload and the resulting psychosocial risks. 

The federation is demanding that the CNESST intervene through its prevention-inspection service in order to identify employer practices that are detrimental to the health and safety of care professionals and to impose, where necessary, corrective measures to eliminate the psychosocial risks related to MOT, in order to reduce and/or to control them.

Workers' Forum salutes these actions through which nurses and other health care workers are speaking out in their own name and taking the initiative to ensure that the crisis of the health care system is addressed on the basis of their demands and their solutions.

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Quebec Government Refusal to Recognize Breakdowns in Health Care Services

The Experience of Health Care Workers in Northeastern Quebec

Nathalie Savard is the President of the Union of Nurses, Licensed Practical Nurses and Inhalotherapists of Northeastern Quebec

Workers' Forum: At this time, when health services are at a breaking point in several regions of Quebec, the Minister of Health refuses to talk about a breakdown in services and instead is talking about a reorganization of services. What is the living experience of the residents in the region where your union is active?

Nathalie Savard: Indeed, the Minister of Health said at a press conference that on the North Shore and in James Bay, we are experiencing a reorganization of services. The fact is that for a period of time, there was a complete closure of the emergency department in Port-Cartier. There have been closures of services in the clinics. The Minister of Health says that these are not breakdowns in services. He claims that people will continue to have services, except that they will have to go elsewhere to receive them. 

So if I am a mother waiting to give birth and I have to be transferred because there are no obstetrical personnel left in Sept-Îles, I consider this a breakdown in services in my region, which is the North Shore. It is certainly a breakdown in services when the emergency room in Les Escoumins is closed and the person has to travel three hours back and forth to be treated in Baie-Comeau. 

Just recently, it was announced that a clinic in Minganie was closed due to a lack of personnel. This summer, several clinics in our region were partially closed. Patient follow-up, treatment, home care have all stopped and only emergency services have been kept. Dispensaries are very important health facilities in the villages. There are also some amongst Indigenous populations and they play a very important role.

Actually, we are constantly in a situation of a risk of breakdown of services. We are always on alert. We have staff putting in an incredible amount of hours to continue to provide services to the population and to keep services open. A few weeks ago, there was talk of closing maternal and child health centres in places such as Baie Comeau and Sept-Îles.

We have fought for a long time in the regions to have local services, full services, such as specialist care close to where people live. We've experienced the time when major services were only available in the major centres, whether it was Montreal or Quebec City. Those days must not return. We are in 2021.

When the government talks about reorganizing services, it is playing politics, it is trying to make itself popular, it's preparing for an election.

WF: The Quebec government has announced that it will introduce a health bill in the fall, based on what it refers to as efficiency of services. What is your take on this?

NS: It doesn't bode well. The theme of service efficiency is not new. It's a business vision. Managers, for example, make comparisons between the cost of treating a patient in Quebec City versus Sept-Îles. They look at it the way factory owners see their factories. They compare production costs. You can't run a society like that and most certainly not a hospital.

For example, there are many Indigenous communities around our emergency department in Sept-Îles with their own problems and difficulties. There are social problems and other difficulties within the communities. We must work with the circumstances in our district, with the community, as they are important partners. There are managers who tell us that we are not efficient, that they have compared us with the emergency department in Quebec City.  

In large centres, emergency departments have a gynecologist on site, a neurologist on site. In Sept-Îles, when a patient comes in, these specialists have to be contacted, sometimes in Quebec City. At times we also have to transfer patients and have to take the time to do this. The realities are not the same. You can't just compare numbers and conclude that we are not efficient. Talking about efficiency in that manner is to prepare the ground for more closures under the guise of a reorganization of services.

We need to put patients back at the centre of decision-making. We must take the time to care for them. And to do that, we must take care of the people caring for them. Managers need to listen to their teams. We need to find on-the-ground solutions to the problems people are experiencing. The health reform of the Liberal Party's [then] Minister of Health, Gaétan Barrette, created mega-institutions that are so big, so cut off from the base, that we are no longer able to sort out the day-to-day problems at the base, to relieve the people who provide services. 

The work to be done is not so complicated. We have to look at all the departments, analyze the problems in each one of them. We must examine the basic structure and re-establish an adequate basic structure with complete teams in terms of nursing, nursing assistants, attendants, housekeeping staff, etc. In other words, restore all that has been taken away from us over the years by successive governments. We must once again address the problems on the ground, and this must be done by the people on the ground. Services must be close to where the population lives.

Respect for health care workers must be restored. Take the issue of mandatory vaccination in the health network, for example. We understand the principle, and since the beginning of the pandemic we have been encouraging our members to get vaccinated. But now our members have gone from being called guardian angels to being called "patient killers." We were sent to war at the beginning of the pandemic with the vaccines coming much later. We were sent to treat people without being given protective equipment, without proper ventilation, having to travel from one facility to another. And now, because around five per cent of our members are not vaccinated, with some of them being off work, they are being called patient killers. It can't work that way.

The problems in the health care system are deep-rooted, deep-seated and cannot be sorted out through a piece of legislation from the Minister of Health. Obviously, the government has not spoken to us about the bill, let alone consulted with us. It seems that this is going to be yet another law drafted in an office by a handful of people.

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