Maisonneuve-Rosemont Hospital has shuffled out the head administrator of the hospital's emergency room, after the unit was closed to all but the most urgent cases overnight Monday due to a sit-in by ER nurses.
The nurses, who said the working situation had become untenable at the overcrowded ER, had threatened to resign en masse if changes were not made to the unit's management team.
The ER head has now been moved to a different position within the regional health board, the CIUSSS de l'Est-de-l'Île-de-Montréal, its CEO Jean-François Fortin Verreault told reporters Tuesday afternoon.
The nurses had refused to follow their manager's newly proposed contingency plan to avoid the continued use of mandatory overtime — which the nurses say they were being asked to do on a regular basis.
"I told the nurses it wasn't that person's fault that the hospital is receiving more patients than it can handle and that that person deserves to be treated fairly, but it's undeniable that the connection with the team just wasn't there," Fortin Verreault said.
The staffing shortage and resulting forced overtime had created a situation "just waiting to explode," said one auxiliary nurse, Louise Fotheringham. "You come in and see the nurses turn grey from working so many hours."
"The emergency situation at HMR is currently untenable, I am aware of that," Quebec Health Minister Christian Dubé said on Twitter Monday night. "Our priority is to ensure the safety of all patients."
Outside the hospital Tuesday, Dubé told reporters a mediator has now been appointed to help balance the nurses' demands and maintain the hospital's capacity.
"The situation puts us in a very, very difficult place … but I'm happy solutions are on the table," he said.
The ER nurses have offered up more than 100 potential fixes to their unit's understaffing problems, Fortin Verreault said.
That understaffing is acute, made worse by the hospital's geographic location as the only major hospital in Montreal's east end.
Over the past week, the ER occupancy rate has fluctuated between 94 per cent and 141 per cent, said Fortin Verreault — and those numbers are lower than what the hospital usually sees at this time of year.
The Jewish General Hospital, closer to downtown, receives about 35 ambulances a day, Fortin Verreault said. By comparison, 45 ambulances a day will be sent to Maisonneuve-Rosemont, which has 100 fewer ER beds than the Jewish.
"The labour shortage has hit the east very hard," said Martine Leblanc, the head of physical health programs for the CIUSSS that oversees Maisonneuve-Rosemont Hospital.
There are only enough health-care workers in Maisonneuve-Rosemont's ER to cover 30 per cent of what's required on night shifts and 40 per cent on evening shifts, Leblanc said.
'Worst of the worst'
"I started in the ER in February 2020, and I'll admit it wasn't as bad back then," said emergency nurse Amélie Richard after her shift Tuesday morning.
"This is the worst of the worst I've ever known here at Maisonneuve-Rosemont Hospital. I spoke with my colleagues with more seniority, and they've told me it's worse than ever."
In a petition signed last week and obtained by Radio-Canada, nurses in the hospital's ER demanded the immediate resignation of their unit head and pledged to resign en masse Wednesday.
About 90 per cent of the 110 workers on the team signed that petition. They blamed management for a failure to retain staff, a hostile atmosphere and poor working conditions.
Richard said she signed the petition because staff "didn't feel respected or supported, and there were some low blows."
Forced overtime a sore point
Sources have told Radio-Canada that more than 400 compulsory overtime hours were worked during the first weekend of January and that the vast majority of nurses were called into work.
Health-care workers have long denounced the imposition of mandatory overtime whenever there is a staffing shortage.
"I'm covering for two or three nurses, and I won't be out until 8 a.m.tomorrow morning because tonight, the problem is that we're missing eight nurses," said nurse Annie Bourgeois on Monday.
Her colleague, ER nurse Annie Fournier, said the use of compulsory overtime should be an exceptional measure, but it is being used on a regular basis — hampering their ability to offer adequate care.
"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?" she said.
WATCH | Staffing shortages and forced overtime go back decades
Leblanc told Radio-Canada's Tout un matin Tuesday that staff shortages are at the heart of the ER's problems and that the CIUSSS needs to hire more nurses so everyone can have an equitable workload.
"We have to avoid [compulsory overtime] at all costs.… No one wants to force people to stay in unplanned ways. We are very conscious that it affects people's lives," she said.
"People aren't enticed to join our teams, and we need to find a way to reverse that … with a more balanced workload."
In Quebec, some 30 hospitals have successfully implemented a local schedule management system that helps reduce the use of compulsory overtime. But Maisonneuve-Rosemont isn't one of those.
Dubé said last week that hospital was one of the establishments that has had "the most difficulty in implementing measures."
"But despite all that we have a great ER, great doctors, a wonderful team," said Richard.
"We have everything to keep people, but the working conditions are inadequate. But we need people to do that."
Pierre-David Gagné, assistant chief nurse of night surgery at the hospital, said he congratulates his colleagues for realizing "they have the bigger end of the stick."
"The ratio they wanted to give nurses defied all safety measures: it's inhumane to give 50 patients to two or three nurses and expect quality care," he said.
"It's better to close an ER than give care of that calibre."
Liberal health critic André Fortin said the closing of Maisonneuve-Rosemont's ER was "foreseeable for months."
"After five years of [Coalition Avenir Québec] government, not only has the emergency situation not improved, but our health system is cracking everywhere," he said.
"Dubé, who says he wants to be an employer of choice, is moving away from his objective. Rather, he offers deplorable working conditions that compromise the quality of care and staff efficiency."