February 7, 2023 - No. 2

Defend Public Health Care

Rally Outside First Ministers' Meeting

Tuesday, February 7 -- 12:00-1:00 pm
Gather at Wellington and Metcalfe Sts.

Organized by Canadian Health Coalition
For information click here

Quebec Health Care Workers Wage Valiant Battle Against Untenable Conditions in Health Sector

Nurses' Action at Maisonneuve-Rosemont Hospital Defends Patients' Lives

Montreal Union Leader Explains

Nurses Take Action in Seven Hudson Bay Communities

Nunavik Nurses' Union Denounces Government's Response

Concrete Improvements to Working Conditions Required to Rebuild Network

– Interview, Julie Bouchard, President, Interprofessional Health
Care Federation of Quebec –

Quebec Health Care Workers Wage Valiant Battle Against Untenable Conditions in Health Sector

Nurses' Action at Maisonneuve-Rosemont
Hospital Defends Patients' Lives

There is an acute crisis at Maisonneuve-Rosemont Hospital's (MRH) emergency room (ER) in Montreal's east end. MRH is the only major hospital in the east end and serves nearly one third of the city. The shortage of nurses is such that Montreal East's Integrated University Health and Social Services Centre (CIUSSS) took the measure of calling on nurses from all over the network to come and help. Approximately 25 per cent fewer ambulances are now being sent to the hospital's emergency ward and many patients are being redirected to clinics in the region or to family physicians. In the midst of this situation, many people are also deciding not to go to the hospital. None of this, however, addresses the basic problem of the completely inadequate number of nurses at MRH's ER.

On Friday, January 13, nearly 100 nurses threatened to resign en masse from MRH if the imposition of mandatory overtime is not stopped. Not only has mandatory overtime become a hospital management tool but the data regarding it is distorted, because if a nurse agrees to work overtime, under the blackmail that otherwise patient care will be seriously jeopardized, it is considered voluntary overtime. Radio-Canada reported that 400 compulsory overtime hours were worked during the first weekend of January and that the vast majority of nurses were called into work.

On Monday, January 16, nurses refused to work their night shift because they were being forced to work with understaffed teams, which puts patients' lives at risk. Throughout the night, ambulances were diverted from that hospital's emergency department to other hospitals' ERs, except in life-threatening cases. In the week before the nurses' action, MRH administration informed that the ER occupancy rate had fluctuated between 94 and 141 per cent.

ER nurse Annie Fournier told Radio-Canada, "This is our dilemma. Do we lose our licence because we refuse to work, or do we lose our licence because we are going to kill someone?"

Health Minister Christian Dubé spoke provocatively to the press about the situation, saying that his role was not to "put out fires" but to develop "structural solutions." He declared that the situation at MRH is an issue of scheduling at the local level, as if the problem is a disagreement between CIUSSS management and the union, and appointed a conciliator as if it is a matter of bringing "the two sides" together.

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Montreal Union Leader Explains

At the time the working conditions of nurses at the Maisonneuve-Rosemont Hospital (MRH) had reached a new low in January, Workers' Forum spoke with Denis Cloutier, President of the Union of Health Care Professionals for Montreal East (SPS-ETIM), about the situation.

Contrary to Health Minister Christian Dubé's assertion that the workers and management are at cross purposes and the matter is merely one of scheduling, Cloutier explained that the workers do not have any communication problems with management, Montreal East's Integrated University Health and Social Services Centre (CIUSSS). "The Minister appointed a conciliator and we, along with general management, met with her. She quickly realized that we are able to talk to each other. However, there was no Ministry representative at the meeting. Yet the issue is at the Ministry level.

"The problem is that we don't have enough staff in the emergency room," he added. "If you don't have enough people, juggling schedules isn't going to solve the problem. Besides, the shortage is hitting us particularly hard. We cover a very large territory that serves a constantly growing population. MRH is one of the key hospitals covering such a large population and territory. The hospitals that are part of our CIUSSS are obsolete. Some environments are more attractive than others. Just think of the Montreal University Hospital Centre (CHUM) which is brand new, air-conditioned, directly connected to the metro. Maisonneuve-Rosement is an old hospital without ventilation and poorly served by public transportation. There are a lot of factors that contribute to our being short-staffed. Attracting people to a hospital like ours is difficult. Additional incentives must be put in place to attract employees to such settings. There needs to be the political will to sort out the problem but we don't see it. The problem cannot be solved at the local level, as we don't have the budget to do that.

"Our nurses care about their patients," he concluded. "They are grappling with their conscience and feeling that they are unable to provide quality care. The Minister must take up his responsibilities to ensure that the workforce is well distributed so that health care is provided to all throughout Quebec's territory."

In a recent interview, Cloutier summarized the developments that have taken place since the nurses' action.

He said that MRH continues to receive about 25 per cent fewer ambulances than it normally does. The conciliator is in discussion with CIUSSS management and the union so that steps are taken internally to alleviate the situation. Nurses from other institutions have come to assist in the emergency room, and the union is very grateful to them for having volunteered. Some came for one shift, others for more. It has not yet been determined how long these reinforcements will last.

He added that some of the hospital's emergency nurses have left the department to work in other institutions, as their situation was untenable.

"In addition to the fact that we are understaffed in the ER, with only 30 per cent of the night shifts and 50 per cent of the evening shifts being staffed, we have lost expertise, including losing the ER triage nurse," he said. "You have to have worked in the ER for a long time to be in triage. The situation there remains extremely fragile and precarious."

With regard to the union's requests that the situation be corrected, he said: "We have taken some steps in terms of work time arrangements, offering nurses work schedules such as seven days on, possibly with overtime, followed by seven days off, so that they have seven days to recover. However, the Ministry has not responded favourably to our requests for incentives to attract nurses. It's not that we believe that money can solve everything, but there are places where it is more difficult to draw in staff, such as at our CIUSSS hospitals in the Laurentians, in Montérégie, in Nord-du-Québec. There are outdated hospitals that are unable to attract staff, with services being maintained through mandatory overtime. The government seems to fear that if they provide incentives, that we'll use this in our national bargaining to offer them to everyone."

The Quebec government has given no sign that it intends to take up its responsibilities and improve wages and working conditions, and especially to implement the solutions put forward by health care workers. The example of Maisonneuve-Rosemont Hospital shows how the government is using the argument of decentralization and local management to avoid its responsibility and force workers to fend for themselves while it dictates conditions that make life unbearable for staff and destroy services. As far as the offers it has made for the renewal of collective agreements in the public sector are concerned, they're insulting and will only increase the problem of attraction and retention and they show a refusal to negotiate with those who provide the services.

Nurses, like all public sector workers, have firmly rejected these offers and put forward concrete demands in defence of their rights and of services.

(Quotations translated from original French by Workers' Forum.)

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Nurses Take Action in Seven
Hudson Bay Communities

On Thursday, January 19, nurses from the seven villages on the Hudson Bay coast in Nunavik in Northern Quebec held a sit-in to protest their untenable working conditions and the severe shortage of health care workers in their region.

At the end of the day shift at 5:00 pm, nurses from the seven communities refused to take on-call calls during the night. They were replaced by doctors, managers and agency nurses. In Nunavik, clinics are open during the day, but from 5:00 pm onwards, on-call nurses triage patients over the phone. The nurses are members of the Union of Nurses of Hudson's Bay (SNIIBH-FIQ).

The Inuulitsivik Integrated Health and Social Services Centre (CISSS) in Puvirnituq is the main service hub for the approximately 7,000 Nunavik residents living in the seven communities on the Hudson Bay Coast: Ivujivik, Salluit, Akulivik, Puvirnituq, Inukjuak, Umiujaq and Kuujjuarapik, where the sit-ins took place. Nunavik is the Inuit region of Arctic Quebec and is accessible only by plane, or by sea lift when there's open water.

Nurses are the backbone of the health care system in the region, especially in villages with no resident physician. Normally, 30 enlarged role nurses need to be in place, distributed between the Hudson Bay communities. But at times in summer 2022, the number of nurses dropped to as low as 13. An enlarged role nurse is a nurse with special training. The training allows them to work in rural and isolated areas and do things like make patient assessments and other actions that nurses wouldn't normally do.

On January 18, the nurses emailed upper management of the CISSS complaining about a situation that has been going on for years, notably the lack of staff, the disastrous impact it has on nurses and services, and the inaction of management. They had warned the Health Centre that if they did not receive a quick and adequate response to their demands, they would take action, which they did the next day by refusing to work their night shift. Among the most urgent demands was the elimination of shifts that can run up to 32 continuous hours, and often extend to 24 hours with barely eight hours of rest between shifts. The Hudson Bay coast is experiencing a severe shortage of health care staff, which is creating an extremely high workload for the remaining staff.

Instead of listening to the nurses' demands, CISSS management immediately went to the Administrative Labour Tribunal to force the nurses back to work. The administrative judge issued an order to return to work Friday overnight.

The SNIIBH immediately denounced the CISSS management for following the path of criminalizing the voice of nurses rather than seeking solutions with them that would improve their conditions and the services.

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Nunavik Nurses' Union Denounces
Government's Response

Nurses from different regions of Quebec take to social media expressing support for the nurses in the communities on Hudson's Bay.

In a statement issued by the Union of Nurses of Hudson's Bay, President Cyril Gabreau wrote:

"Nurses are fed up with their working conditions and the severe staffing shortages that have gone on for too long. Last night, nurses from seven Hudson Bay coast villages wanted to send a clear message that they want management to make a commitment to change things. They are exhausted, overworked and demotivated. They feel, and rightly so, that it is no longer possible for them to provide quality and safe care. The employer's response? Go to the Administrative Labour Tribunal and force them to return to work. How disappointing and revolting."

He added:

"Many avenues of solution have been proposed to the employer and unfortunately, they are not being considered. It's the status quo, all the time! But it is not possible to let things go this way. We are not asking for a revolution! We are asking that the employer listen to the care professionals who want to offer health care to the community. We have avenues of solution. The situation is serious and if we want to attract and retain care professionals, it is no longer acceptable to ask them to work 32 hours in a row, nor to have a minimum of 8 hours of rest per 24-hour shift, for example."

The Nunavik nurses and their union declared that they will continue their struggle for their rights and for services to the communities.

(Quotations translated from original French by Workers' Forum.)

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Concrete Improvements to Working Conditions Required to Rebuild Network

– Interview, Julie Bouchard, President, Interprofessional Health Care
Federation of Quebec –

Action at Quebec National Assembly, December 13, 2022.

Julie Bouchard is President of the Interprofessional Health Care Federation of Quebec (FIQ). The FIQ and the FIQP (FIQ-Private Sector) represent more than 80,000 nurses, nursing assistants, respiratory therapists and clinical perfusionists working in health care institutions throughout Quebec.

Workers' Forum: On January 18-19, at their special national negotiating council, the representatives of the unions affiliated with the FIQ and FIQP rejected the government's offers presented on December 15. Can you tell us more about this?

Julie Bouchard: First of all, everything that was offered on the monetary side was totally unacceptable. We are talking about a nine per cent increase over five years, which is far below inflation. For us, this offer is unbelievable.

Also, in the employer's offer, there was a lot of talk about holding forums. For us, the forums for the renewal of the collective agreement is something we've had before and, unfortunately, they are useless. These are discussion sessions to buy time. Often, those who are at the table have no decision-making power, and you end up with a large group of people representing different types of jobs. It's hard to arrive at a consensus so that everyone feels good, so that it benefits all the members we represent respectively. It seems that this is done to delay certain discussions even though we already have our demands, whether on retirement, wages, the Quebec Parental Insurance Plan, and the other unions also have their demands on these subjects. We don't need to be in a large group, so why not use the bargaining table to get through these issues?

There is also a big setback in the offers regarding retirement. The current criteria of 35 years of service and 55 years of age to retire with a full pension is now replaced by 35 years of service and 57 years of age, which means that care professionals will have to work two years longer. The government is also proposing to reduce our income from the Government and Public Employees Retirement Plan [RREGOP ] income, because of some recent improvement made to the Quebec Pension Plan.

WF: What are the FIQ's main demands for the renewal of the collective agreement?

JB: The three main areas for which our 80,000 members have mandated us to negotiate with the government are remuneration, personal life-work balance and workload.

First of all, there's the issue of remuneration, which is extremely important. With respect to wages, we are asking for a four per cent yearly increase for a three-year agreement, in addition to a permanent annual wage adjustment mechanism in the collective agreement to ensure the protection of our members' purchasing power. Inflation concerns all Quebec citizens and therefore, our members as well.

With regard to personal life-work balance, which is also an unavoidable issue, we must work together and find solutions so that care professionals can have a family life, even if they are required to deal with the workload they have. For example, we want the work schedules to be known at least two weeks in advance and to cover at least three months. It's not normal that schedules come out weekly or every two or three weeks. Scheduling an appointment when you don't even know if you're working or not becomes even more complex.

When we talk about work overload, of course we're talking a lot about the issue of professional-patient ratios. For us, this is a way to reduce the workload as well as create attraction and retention within the network. The more care professionals recover and the more we succeed in training new ones, the more we create a movement, attract and retain those who are already in the network. But for this to happen we need good working conditions. The more staff we have in the departments, the more balanced the workload will be, rather than a workload which includes far too many patients for the quality of services needed.

In that regard, we have asked for the tabling of a law on safe professional-patient ratios. We have included this as a demand in the current negotiations. This requires a detailed analysis of each activity centre. What must be examined is the exact patient load so that the right number of care professionals are there to ensure not only safe care, but also quality care given by the right person.

We know very well that such a law cannot be adopted tomorrow. It's a medium to long-term project. We're not going to end up with the same ratios for the entire public network from one day to the next. It's a set of continuous evaluations that must be carried out and little by little, ratios will emerge that will contribute to creating a form of attraction and retention.

We are also asking for the elimination of the use of private agency personnel. We are asking for additional accumulated vacation days. Currently, after 15 years of seniority, an additional day of vacation is accumulated each year, of up to one week. We are asking for additional days because the need for rest is even more present than it was and it is the only time for care professionals to be able to rest both physically and psychologically.

We are also asking for the addition of a statutory holiday for the National Day for Truth and Reconciliation, to demand justice for Indigenous Peoples. This is part of the fight against the systemic racism that we believe exists in Quebec.

Also, and this is new, we are putting forward the demand, which all workers and their health care unions are also asking for, that 10 days of paid leave be granted to victims of domestic violence.

WF: Do you want to add anything in conclusion?

JB: For us, this is the negotiation to bring about hope. For far too long we've seen the network slowly fall apart. In 2023, we need a big push, with concrete actions, to improve working conditions.

(Translated from original French by Workers' Forum)

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