Nurses in Quebec are detailing the dismal work conditions that are prompting them to leave the public sector in droves, departures that have triggered a staffing crisis at emergency rooms across the province.
They are also pushing the provincial government to take more drastic steps to address the situation before it deteriorates further.
The nursing shortage has already been blamed for the looming closure of hospital ERs in Montreal's east end.
Other hospital ERs in the province have been forced to close temporarily, curtail hours or are operating at more than 200 per cent capacity, also due to a lack of personnel.
Nathan Friedland, an ER nurse working at Lakeshore General Hospital in Montreal's West Island, described nurses' working conditions as "barbaric." He cited poor scheduling, overflowing ERs and a threat of sanctions for speaking out against management.
"I will not do forced overtime," Friedland said of the common practice health-care workers have called organizational violence. "I think that any manager that imposes forced overtime on a nurse should be fined."
Some nurses are being forced to work 16-hour shifts with minimal days off, an issue even before the pandemic. Other issues plaguing workers include insufficient pay, high stress environments and burnout.
"There's no way I can do my job properly," Friedland said of occupancy rates at Lakeshore, which have been well over capacity for weeks. He says operating this way puts both his licence as a registered nurse and his patients' lives in jeopardy.
The West Island health authority, which oversees Lakeshore hospital, says the situation in the ER remains fragile but will improve soon.
"We have every reason to believe that the situation will stabilize for the better in the coming weeks with the arrival of new nurses. An intensification of clinical support and training is also underway," the health authority said in a statement.
'We're in crisis mode'
Late last week, provincial Health Minister Christian Dubé asked general practitioners to start seeing more patients again in person, even if they're presenting symptoms of COVID-19.
He also wants clinics to provide more hours of service, including on nights and weekends.
The goal is to alleviate mounting pressure on Quebec's overburdened ERs and combat the chronic nursing shortage, the government said in a letter to the province's network of family medicine groups (FMG) on Thursday.
But for Natalie Stake-Doucet, a registered nurse and president of the Quebec Nurses' Association (QNA), the term "nursing shortage" is a misnomer.
WATCH | President of Quebec Nurses' Association explains why the province's nurses are quitting:
"It's kind of ridiculous to say, 'Oh, I have a shortage of water' when you have a giant gaping hole in your bathtub," she said.
The pandemic has exacerbated long-standing problems with scheduling and working conditions for health-care workers, particularly nurses, Stake-Doucet says.
"We have a shortage of respect, dignity and working conditions that keep us safe," she said. "There is no reason for us right now to stay in the health-care system. Not only is there no reason, it's actually dangerous for our health."
We have a shortage of respect, dignity and working conditions that keep us safe. - Natalie Stake-Doucet, president of the Quebec Nurses' Association
Last month, Statistics Canada reported that in the first quarter of 2021, Quebec's health-care and social-assistance sector saw a larger year-over-year increase in job vacancies (5,900) than any other sector in the province.
For Roberta Bomba, treasurer of the province's largest nursing union, the Fédération interprofessionnelle de la santé du Québec (FIQ), this is due to workplace culture.
"Forcing overtime, no days off, no vacations. For people, at one point, it's a question of survival. So [nurses] make the choice to resign," he said. The FIQ represents 76,000 health-care workers, including nurses and nurse practitioners.
In May 2020, the Ministry of Health instituted premiums for health-care workers when they worked full time. Bomba said the ministry removed these incentives a few weeks ago, despite the staffing problems, but has since reversed course.
"They will be reinstating these incentives starting July 18, but only in emergency, medical and surgical units and obstetrics," he said.
"We're in a crisis mode this summer. They should be installing these incentives throughout all sectors."
Criminalize forced OT, nurses say
Stake-Doucet says recruitment of nursing staff starts with making the job more attractive for students. She proposes offering more nursing scholarships and paying students for their clinical rotations.
More immediate solutions include criminalizing forced overtime, implementing a system where nurses can collectively create their own schedules, as well as monetary and time incentives, Stake-Doucet says.
"Nurses and health-care workers need to know there's a light at the end of the tunnel, which we don't have right now."
Friedland, the ER nurse at Lakeshore hospital, says mandating a rigid nurse-to-patient ratio would lead to "a lot less problems" in hospitals. He also says creating a proper orientation program for new nurses is crucial to retaining them.
"The [program] is frankly a joke," he said, recalling a situation two weeks ago where he was juggling nine patients while trying to orient a nurse on her first day.
"She sees a chaotic environment where I'm trying to keep everybody alive in an unsafe situation. What's that going to make her think? She's not going to want to stay there and work there. So what happens? She quits after two days."
'We were guardian angels at one point,' nurse says
While Dubé is confident his short-term solutions will shore up the health-care system, front-line workers remain sceptical.
Naveed Hussain, a nurse at the McGill University Health Centre, wants to see more than just "Band-Aid solutions." He called for real investment in Quebec's health-care system and more nurse empowerment.
"We were guardian angels at one point, you know, we were called many great things," Hussain said, referring to the term used by Premier François Legault at the outset of the pandemic.
"But after the pandemic or, when things calm down, things just go back to normal again. It's disheartening."
He said there hasn't been enough emphasis on promoting other health-care resources that are available to the public, such as InfoSanté 811, CLSCs and super-clinics.
For Stake-Doucet, people at all levels of the health-care system need to be held accountable for their role in what's brought the province's health network to a breaking point.
"[Nurses] have been holding this health-care system up for decades now," she said. "We can't be responsible for everything."