FIQ (Fédération Interprofessionnelle de la santé du Québec)

COVID-19

This page was updated on Jun 22, 2020 @ 10 h 21 min

A crisis unit has been set up by the FIQ to give its affiliated unions and their members the necessary support in facing the current health crisis. Over the coming days, you will find detailed information here answering the questions of concern to healthcare professionals. This information will be updated constantly as events unfold.

Occupational health and safety

Healthcare professionals currently working should ensure that:

  • All safety measures are implemented in their work environment.
  • All protective equipment against infections is available and accessible.
  • They have received training on the preventive and intervention techniques in case of contamination.
  • They have access to the information and that the procedures for handling samples and patients are posted.
  • They have access to the procedures in cases of contamination of staff.

Inform your union team about all missing information on safety and protective measures!

COVID-19 and mental health

Healthcare professionals will likely have to manage some challenging behaviours as part of the COVID-19 pandemic.

CHECKLIST

This checklist is intended to provide useful information for practicing during the COVID-19 pandemic, especially if you are asked to practice in a new centre of activities (including in a modular unit outside of the institution

Frequently asked questions

Select the subject you want to obtain more information about.

Impacts on professional practice

Frequently asked questions

In what conditions can a nurse issue an attestation of death?

If the nurse is called on to establish a death, she must first ensure that the following conditions are all met:

  • You practise in or on behalf of a public institution (see the previous section);
  • The person who dies is an adult;
  • The probable cause of death may be established on the basis of a known diagnosis, the death occurred following a deterioration or complications from a diagnosed illness;
  • The death does not appear to have occurred due to negligence or in unclear or violent circumstances;
  • You respected the policies and procedures that your organization implemented to govern this practice;
  • A physician is really not available within a reasonable time to do this;
  • You have the necessary skills to declare a death has occurred, based on generally recognized scientific criteria.

This possibility of a nurse attesting to a death, drawing up the attestation of death and filling out the death certificate will be permitted until the end of the public health emergency decreed by the government.

What are the standards for having an infection prevention and control nurse?

Infection prevention and control makes perfect sense in the context of a pandemic and should be prioritized at all times.

The Comité sur les infections nosocomiales du Québec issued human resources standards for infection prevention and control programs in 2004. It was recommended:     1 FTE in infection prevention and control/133 beds in a hospital and 1 FTE/250 beds in a CHSLD and stability in the infection prevention and control team. These standards must be increased in the context of a pandemic.

Support from the institution in setting up infection prevention and control programs in the institution was also required.

Useful link: https://www.inspq.qc.ca/publications/565

What are the new MSSS guidelines in the healthcare network, for CHSLDs, RI-RTFs and RPAs? (RI-RTF – Intermediate Resource-Family Type Resource; RPA – Private Seniors’ Homes)

The MSSS recently updated information on guidelines in the healthcare network, particularly for CHSLDs, RI-RTFs and RPAs:

“Because of the progress of the COVID-19 coronavirus illness in the world and increase in the number of infected cases in Québec, the care and services given in the health and social services network must be adapted to take into account this special context.”

We suggest you regularly consult the following links:

We understand that remote practice is preferred, whenever possible, in the current context. What do I have to keep in mind for telecare practice?

On March 24, the OIIQ issued guidelines for specialty nurse practitioners (SNP) practising telecare. The Order demands that professionals, before resorting to telecare, in keeping with their professional and ethical responsibilities:

  • Evaluate the pertinence of resorting to this based on the type of intervention or follow-up with the client required;
  • Ensure one has the skills required to use them safely so as not to cause any harm to the patient;
  • Obtain the client’s free and informed consent to give the care and use the technological means, and determine in partnership the terms and conditions of its functioning;
  • Assess the level of risk for data security (e.g.: secure computer network), use secure platforms and never use social media;
  • Evaluate the reliability of the means used (e.g.: measurement tools or mobile application for obtaining valid results identical to those obtained face-to-face);
  • Anticipate clinical and technical emergencies that can arise and make a plan to mitigate them (e.g.: access to other professionals, solutions for mechanical breakdowns or failures);
  • Evaluate the client’s capacity to use them or collaborate in their use by validating their skills and, if need be, sending them the necessary information on their use and risks incurred (e.g.: data integrity, limits linked to this mode of intervention)”.

On April 16, the OIIQ specified information on the prescription infirmière en télésoins . Assessment, clinical monitoring and follow-up and referral as needed to a SNP or physician remain important. Sending verbal prescriptions by fax or electronically is preferable.

The FIQ will update the content of this section if other professional orders issue guidelines on telecare.

https://www.oiiq.org/la-covid-19-directives-pour-la-pratique-a-distance-a-l-intention-des-infirmieres-et-ips

How has Chloroquine and Hydroxychloroquine changed the healthcare professionals’ practice?

In order to avoid a shortage of certain drugs, the INESSS has published a provincial collective prescription allowing pharmacists to stop using Chloroquine and Hydroxychloroquine temporarily for patients with certain chronic diseases. Therefore, nurses, particularly specialty nurse practitioners (SNP), must anticipate certain questions from patients whose use of these drugs has been temporarily stopped. The OIIQ also asks the SNPs to offer substitution therapy temporarily to these patients.

When was a nurse authorized to establish the death of an adult person?

Considering the increase in the number of hospitalizations and deaths related to      COVID-19, on April 10 last, the Minister of Health and Social Services decreed by ministerial order that this power would be expanded. This ministerial order (2020-020) temporarily permits, for as long as the emergency is in effect, a nurse practising her profession in or on behalf of a public institution within the meaning of the LSSSS or an Act respecting health services and social services for Cree Native persons or for the Régie régionale de la santé et des services sociaux du Nunavik, to:

  • Establish the death of an adult (18 years old and +);
  • Draw up the attestation of death;
  • Fill out the death certificate.

Structured assessment

Attesting to a death calls for a structured assessment process. According to the policies and procedures of your organization, it may be incumbent upon you to conduct this assessment and document it.

Certain conditions must be met to draw up the attestation of death and fill out the death certificate in the context of the public health emergency.

To learn if you are covered by this authorisation and if you meet the required conditions, read the web page Constat de décès par les infirmières et infirmiers en contexte d’état d’urgence sanitaire, produced by the OIIQ.

Before this, only a physician could, with few exceptions, draw up an attestation of death and fill out a death certificate.

Who is covered by this authorisation?

The government’s authorization only concerns nurses who work in or on behalf of a public institution:

  • A public, non-merged institution: CHU, IU and institute;
  • A CIUSSS or CISSS: CH, CLSC, public CHSLD, CPEJ, CR;
  • A public institution serving a northern and indigenous population.

On the other hand, the ministerial order does not cover a nurse who practices on behalf of one of the following settings:

  • Private, subsidized and non-subsidized CHSLD;
  • RPA;
  • RI-RTF.

The ministerial order authorizes a nurse working for a public institution, acting on behalf of the institution, to attest to the death of an adult person, draw up an attestation of death and fill out the death certificate when she practises in a non-covered setting.

The following page on the ministère de la Santé et des Services sociaux website explains and maps out the institutions and centres considered as public institutions and settings that are not: Portrait organisationnel du réseau

How does this ministerial order change practice?

You will have established the death, drawn up the attestation of death and filled out the death certificate on form SP-3 according to the policies and procedures of your organization. You will not have to call the physician to request he fill out the SP-3 form. However, you must inform him of the person’s death.

Attesting to a death

Attesting to a death refers to issuing an opinion that a person has died, based on a physical assessment. Attesting to the death calls for a structured assessment process that includes gathering data (death history, context of the death and clinical signs), interpretation and analysis of the data and writing up the findings from the assessment. The nurse who attests to the death must document this assessment process in the file.

Attestation of death

Mandatory under the Civil Code of Québec, the attestation of death states the name and sex of the deceased as well as the place, date and time of death. The attestation of death is the official proof of the person’s death and allows the embalmment and cremation of the deceased to proceed.

Death certificate

Mandatory under the Public Health Act, the death certificate is drawn up so the Minister of Health and Social Services can ensure continuous monitoring of the population’s health. It also enables the funeral director to take possession of the body, transport the deceased and carry out the necessary procedures for disposing of the body.

The SP-3 form – death certificate

Considering that certain information written on the Attestation of Death is the same as that written on the Death Certificate and for administrative convenience, the Attestation of Death and Death Certificate are incorporated in the SP-3 Death Certificate form. The nurse must fill out this form when a death occurs.

Should a nurse “attest to a death” in an unclear situation?

No. In these unclear situations (e.g.: unclear or violent circumstances or death that appears to have occurred due to negligence), the nurse must abstain from filling out the documents and refer to a physician or failing this, the coroner.

Remember that the “Attestation of Death” is a major legal act and the nurse must perform a clinical assessment based on generally recognized scientific criteria to certify that a person is clinically dead.

For more information, do not hesitate to contact your équipe syndicale locale (local union team) or the OIIQ.

Special authorisation – professionnal pratice in a health emergency context

The FIQ sincerely thanks all volunteers who will commit to supporting the other healthcare professionals already working on the firing line in the Québec healthcare institutions during this COVID-19 pandemic.

Your help is a vital gesture of solidarity and much appreciated by your colleagues, healthcare professionals and patients in Québec with COVID-19 or other illnesses.

THANK YOU from the FIQ and the people of Québec. We’ve got your back!

Who can apply for a special authorisation from a professional order to lend a helping hand in the network, thus responding to the Minister of Health and Social Services’ request?

The Minister of Health and Social Services has given the OIIQ, OPIQ, and OIIAQ the authority to issue a special health emergency authorisation (permit to practice) to students in addition to the people wanting to return to practising their profession. This permit is valid for the time the public health emergency is in effect and ends when the government lifts this measure.

Hereafter are the conditions issued in Order 2020-022 on April 15, 2020 to allow the professional orders to issue a special health emergency authorisation:

Application by nursing or nursing science or respiratory therapy technique students

  1. The student is registered in the college or university program whose diploma gives access to the OIIQ nursing permit to practice or OPIQ respiratory therapist permit to practice;
  2. There only remains the equivalent of one full-time semester to complete this program.

Nursing students should refer to the procédure de l’OIIQ for details on this procedure.

Note, “The person with a special health emergency authorisation for students has the same right to practice as that given to candidates to the practice of the nursing profession (CPNP), as defined in sections 10 and 11 of the Regulation respecting the professional activities which may be performed by persons other than nurses

Respiratory therapist technique students should refer to the procédure de l’OPIQ for details on this procedure.

Application by santé, assistance et soins infirmiers (SASI) students

  1. The student is registered in the SASI program giving access to the OIIAQ licensed practical nurse permit to practice;
  2. The student must have obtained competency units 1 to 26 in the SASI program.

SASI students should refer to the procédure de l’OIIAQ for details on this procedure.

Application to return to practice

  1. The person is under age 70;
  2. The person has not been a member of the order or is registered as an inactive member or member of a similar category for less than five (5) years.

*There is no obligation to follow an integration or training program. Section 35 of the Charter of the French language does not apply. However, the order may restrict the professional activities that the person returning to practice may perform or determine the following conditions under which they may perform them.

CAVEAT: The professional orders may have specific procedures, specifications or additional conditions related to the conditions in Order 2020-022. Therefore, it is important to refer to the said orders’ websites.

NURSES (OIIQ)

Only one of the two following situations may apply to you:

1- Special health emergency authorisation, if you:

  • Have not been a member of the OIIQ for less than 5 years;
  • Are under age 70.

2- Registration on the Roll (free), if you:

  • Have not been a member of the OIIQ for more than 5 years;
  • Are under age 70;
  • Are not registered on the Roll since April 1, 2019 or do not have an active employer in your file;
  • Have not been convicted of a criminal offense or prosecuted for an offence punishable by five years or more in prison (unless you have already declared this to the Secretary of the OIIQ).

OR

  • Are under age 70;
  • Have not been convicted of a criminal offense or prosecuted for an offence punishable by five years or more in prison (unless you have already declared this to the Secretary of the OIIQ).

Important note: You must wait for the confirmation email from the OIIQ authorizing you to practise activities of assessment, teaching and counselling related to COVID-19.

For more information on a return to the profession, refer to the site web de l’OIIQ, à la section : Retour à la profession infirmière en lien avec la COVID-19.

RESPIRATORY THERAPISTS (OPIQ)

The OPIQ has set up several of the measures facilitating the rollout of respiratory therapy personnel, to support the health and social services network in the availability of the necessary human resources in the context of a COVID-19 pandemic, ensuring the protection of the public.

A special health emergency authorisation will be issued free if you:

  • Are under age 70;
  • Are not registered on the Roll of the members of the Order for less than 5 years;

OR

  • Are registered, but inactive on the Roll of the members of the Order for less than 5 years;

For more information on a return to the profession, refer to the site web de l’OPIQ.

Source: Communiqué spécial de l’OPIQ aux anciens membres et aux membres non-actifs au Tableau suite à l’appel au retour à la pratique

Finally, for a former or inactive member, under age 70 and who has not practised the profession for the last 5 to 15 years, a restricted right to practice (free) may also be issued according to certain conditions. This right to practice will be restricted to general cardiorespiratory care, the Emergency Department and with stable clients.

For more information on a return to the profession, refer to the site web de l’OPIQ.

Source: Communiqué spécial de l’OPIQ aux personnes n’ayant pas exercé depuis plus de cinq ans, mais moins de 15 ans (inhalothérapeute inscrit au Tableau de membre non-actif ou ancien membre) – suite à l’appel au retour à la pratique

LICENSED PRACTICAL NURSES (OIIAQ)

A special health emergency authorisation will be issued free, if you:

  • Are under age 70;
  • Are not registered on the Roll of the members of the Order for less than 5 years;
  • And if your candidacy has been retained by a health and social services institution to help the health and social services network given the public health emergency declared on March 13, 2020.

For more information on a return to the profession, refer to the Procédure pour obtenir une autorisation spéciale d’état d’urgence sanitaire

Sources:

https://www.oiiaq.org/files/content/Devenir-infirmiere-auxiliaire/OIIAQ-procedure-autorisation-speciale6.pdf

https://www.oiiaq.org/files/content/Actualites/OIIAQ-demande-autorisation-etat-urgencev7.pdf

What special conditions apply to those with a special authorisation from the professional order?

A person granted a special authorisation:

  • May have restricted professional activities and practice conditions. For example, the right to practice may be restricted to assessment, teaching and counselling activities linked to the prevention and control of COVID-19, after receiving the training deemed pertinent by the employer.
  • Will not be considered a member of the professional order;
  • Is bound by the same code of ethics obligations and rules governing the practice of her profession;
  • Is exempt from taking the order’s insurance or joining the order’s group professional liability insurance plan contract if she practices her profession in a non-merged institution, a CISSS/CIUSSS, under the various laws Arrêté numéro 2020-022).

Lastly, a healthcare institution that hires a person with a special authorisation acts as guarantor, stands for and is financially liable for any fault committed by her in the practice of her profession.

A copy of each special authorisation issued by an order must be sent to the Minister of Health and Social Services. It is the same for any decision refusing to issue such a special authorisation or when the authorisation comes with a restriction or conditions.

Why can the professional orders issue a health emergency authorisation when healthcare professionals have to pay to renew their regular permit to practice?

The COVID – 19 pandemic is an unprecedented context for the Québec health and social services network. The government issued a Decree declaring a public health emergency and giving special powers to the Minister of Health and Social Services.

The health emergency special authorisation is issued temporarily by the orders to facilitate the arrival of reinforcements for the network for the prevention and control of COVID-19. It is an exceptional measure to remove an unnecessary obstacle to a return to work for qualified people under age 70 who have left the profession, including those who have not worked 500 hours in the past four years.

The professional orders will issue this temporary authorisation free and without an obligation for the holder to contribute to the order’s insurance fund or a group professional liability insurance contract concluded by the order.

However, contrary to the regular permit to practice from the professional order, note that the health emergency special authorisation does not automatically grant a full right to practice. In fact, to foster protection of the public, the professional order may restrict the professional activities to assessment, teaching and counselling in connection with the prevention and control of COVID-19.

On March 18, 2020, the alliance APTS-FIQ a confirmé vouloir négocier des mesures pour soutenir le personnel du réseau de la Santé dans le contexte de pandémie actuel. The FIQ will keep the healthcare professionals aware of this situation’s progress and support measures applicable.

N.B. We will update the information linked with our monitoring of the OIIAQ, OPIQ and OIIQ.

To learn more:

Arrêté du MSSS, du 15 mars 2020 et concernant l’ordonnance de mesures visant à protéger la santé de la population dans la situation de pandémie de la COVID-19

MSSS Order on April 15, 2020 regarding the issuance of special authorisation for students or people wanting to return to practice in a health emergency https://cdn-contenu.quebec.ca/cdn-contenu/adm/min/sante-services-sociaux/publications-adm/lois-reglements/AM_numero_2020-022.pdf?1587039154

Communiqué de l’OIIQ, du 17 mars 2020 intitulé « COVID-19 : l’OIIQ facilitera le retour à la profession infirmière »

Appel lancé par le ministère de la Santé et des Services sociaux pour obtenir des renforts

Communication spéciale aux responsables de service d’inhalothérapie

Processus mis en place par l’OIIQ pour que les personnes souhaitant effectuer un retour à la profession en vue de participer à la prévention et au contrôle de la COVID-19 puissent le faire facilement et sans frais.

IMPLICATION AU SEIN DES CLINIQUES DE DÉPISTAGE

The right to refuse

Don’t hesitate to call your local union team. They are best suited to support you during this Coronavirus crisis, answer your questions and help you in the steps to take with your employer.

Note: The following information refers to normal situations. We feel that it is important in the current rapidly evolving context to make a cautionary comment. The right to refuse must always be evaluated case by case. The FIQ is making its resources available to you to help and support you in exercising your right to refuse. Since the beginning of the pandemic, the FIQ has been actively making representations with government bodies to make the healthcare professionals’ specific needs known and defend their interests.

Frequently asked questions

Do I have the right to refuse to work if I suspect COVID-19 exists in my workplace?

In principle, yes. For this right to apply, here is what the CNESST says:

“According to the law, a worker has the right to refuse to perform particular work that presents a danger for her or for another person. She may not exercise this right if the refusal endangers the life, health or physical well-being of another person (e.g.: a firefighter on duty). She must immediately inform her superior (or an employer representative), and give the reasons for her refusal to work. She must remain available in the workplace, to perform other duties, if appropriate.”

This right to refuse must obviously be in line with the health professional’s ethical obligations, in normal times just like during the COVID-19 pandemic.

What conditions for the right to refuse?

The right to refuse cannot be exercised in an abusive manner or in bad faith. You must have reasonable grounds to believe that performing that work would expose you to a danger to your health, safety or physical well-being.

You have to stay in the workplace and be available to perform other duties that you are reasonably capable of performing.

The right to refuse must not put the life, health and physical well-being of another person in immediate danger (OHS Act, Sect. 13).

The conditions for performing the work in question must not be ordinary conditions for your kind of work.

The right to refuse is an individual right. However, when several workers refuse to perform a work because of the same danger, their situations may be simultaneously examined and be the subject of a decision that covers all of them. (OHS Act, Sect. 27).

Can the employer discipline me if I exercise my right to refuse?

The employer may not discipline you if you exercise a right to refuse. You may not be fired or given a disciplinary measure, unless you acted in an abusive manner.

Can the employer refuse to pay me if I exercise my right to refuse?

The employer must pay you your salary.

What are normal (ordinary) working conditions?

Case law has established certain criteria that define normal working conditions. These criteria were reported by the authors of the Traité de droit de la santé et de la sécurité au travail, in the form of questions:

  • Is the work performed according to the rules?
  • Is the risk inherent to the duties?
  • Have all generally accepted safety measures been taken to deal with this situation?
  • Is the equipment operating normally?
  • Does the worker’s physical well-being and health status permit her to perform these duties without representing additional risk for her or other people?

If you answered no to one or several of these questions, you can conclude abnormal working conditions exist. Moreover, it is not enough that the conditions under which the work is carried out have been the same for several years or that this same work is performed by other people to conclude that they are normal conditions.

If you are reasonably afraid of a danger, for you or others, from performing your work, what is the procedure for exercising a right to refuse?

Note: The following information refers to normal situations. We feel that it is important in the current rapidly evolving context to make a cautionary comment.

  1. You must inform your immediate superior and you tell her the reasons why you are refusing to perform the duty asked of you (OHS Act, Sect. 15)
  2. The immediate superior convenes your union representative (OHS Act, Sect. 16)
  3. The employer and your union representative analyze the situation and agree on the corrective measures that the employer must implement
  4. If the employer and your union representative cannot agree that a danger exists or on the corrective measures to implement, a request for the intervention of a CNESST inspector is filed by the employer, your union representative or yourself (OHS Act, Sect. 18)
  5. The inspector shall immediately determine if a danger exists. He may then order a return to work or prescribe temporary measures and require that corrective measures be taken within such time he may determine (OHS Act, Sect. 19)
  6. The inspector’s decision goes into effect immediately and must be applied (OHS Act, Sect. 191), even if the parties do not agree. The employer or you have 10 days to contest this decision. (OHS Act, Sect. 191.1)

 

Consult the CNESST page on the right to refuse

If the coronavirus is contracted at work

Don’t hesitate to call your local union team. They are best suited to support you during this Coronavirus crisis, answer your questions and help you in the steps to take with your employer.

Despite the protective measures in place, a healthcare professional may contract the Coronavirus on the job. For example, when there is an outbreak of this virus on her unit or if she has performed duties involving contact with a clientele presenting the same suspected or confirmed symptoms.

If you think you have contracted the Coronavirus, inform your employer quickly and don’t hesitate to call your local union representatives.

Frequently asked questions

Can I receive the income replacement indemnity (IRI) set out in an Act respecting industrial accidents and occupational diseases (AIAOD) if I get the Coronavirus?

Yes, if you are unable to perform your job because of the symptoms identified with the Coronavirus and you believe you contracted it at work, you can, under certain conditions, receive the income replacement indemnity (IRI) set out in an Act respecting industrial accidents and occupational diseases (AIAOD).

What should I do if I think I have contracted the Coronavirus at work?

It is essential that you see a physician to obtain a CNESST medical certificate establishing the link between the Coronavirus and your work.

It is preferable that this medical consult is completed as soon as possible. However, a later consultation does not necessarily cause an employment injury not to be recognized.

What should I do with the medical certificate the physician gives me?

Once the physician completes the medical certificate, you need to give it to your employer as soon as possible.

Will I receive an income replacement indemnity?

Upon receipt of the medical certificate, the employer must pay the corresponding IRI for the first 14 days of being unable to work, which is 90% of the net salary for every day or part of a day when you would have normally worked during this period, if you were not injured.

After ruling on the eligibility of an employment injury, the CNESST will decide on the right to an IRI after the first 14 days.

Which form do I give the CNESST for my claim?

You must complete the “Worker’s Claim” form and send it to the CNESST.

The CNESST will then render its decision, recognizing or not your viral infection (Coronavirus) as an employment injury.

The “Worker’s Claim” form can be completed on line.

Can the employer use my bank of sick-leave days while waiting for the CNESST decision on the eligibility of my employment injury?

In such a context, the employer cannot use the sick-leave days bank to pay you if the CNESST decision has not been rendered.

If the employer does so, a complaint under section 32 of the AIAOD can be filed in the 30 days following this decision by the employer, because you will then be penalized because you exercised a right stipulated in the Law.

Infection control handbook

Don’t hesitate to call your local union team. They are best suited to support you during this Coronavirus crisis, answer your questions and help you in the steps to take with your employer.

Note: The following documents are used in a normal situation. We feel it is important in the current rapidly evolving context, to give a warning to this effect.

 

Retirement and pre-retirement

The Minister of Health and Social Services has stated that retirees who come back to lend a hand in the network will not be penalized by Retraite Québec.

Frequently asked questions

 

Can employees on pre-retirement give more availability without penalty?

The Government and Public Employees Retirement Plan (RREGOP) covers most of the healthcare professionals. According to the plan’s rules, a retiree who returns to the work force, in the healthcare network or elsewhere, receives her pension and salary. On the other hand, the pension of a retiree covered by the Pension Plan for Management Personnel (PPMP) is reduced to take into account the salary earned during a return to work after her retirement.

Therefore, when the Minister announced that retirees returning to the network will not be penalized by Retraite Québec, she was obviously talking about management personnel.

Progressive retirement and an offer of additional availability

As we know, a progressive retirement is a way to reduce her working time without an impact on her pension.

According to the RREGOP Act, the amount of time worked cannot be less than 40% of full time work. The criteria on the time worked not being greater than 80% of full-time work and on an annual basis are criteria in the collective agreement.

At the union level, the FIQ has always supported that because a progressive retirement covers a reduction in time worked, an employee on a progressive retirement does not work more than the time established by the employer. However, it should be remembered that the agreed time worked, though established for most on a weekly basis, is on an annual basis according to the collective agreement.

Therefore, if an employee wants to offer availability during this pandemic, she can agree with her employer to increase her availability and adjust her time worked for the rest of the year.

If this time worked cannot be adjusted in the next year, it can be adjusted before she actually retires

Pregnant or breast-feeding healthcare professional

Don’t hesitate to call your local union team. They are best suited to support you during this Coronavirus crisis, answer your questions and help you in the steps to take with your employer.

FIQ’s position with respect to pregnant or breast-feeding healthcare professionals in the context of COVID-19

The FIQ subscribes to the principle of caution that guides the recommendations from the Institut national de santé publique du Québec (INSPQ). In this respect, in care settings, being in the same location (room, treatment room, etc.) with people under investigation or probable or confirmed cases of COVID-19 and all duties that involve close contact with this clientele constitutes a risk for pregnant healthcare professionals.

Following the INSPQ recommendations, the FIQ is demanding that the Ministry of Health and Social Services immediately remove pregnant, immunocompromised workers or workers with chronic diseases. The Ministry has not acceded to our request for now. However, some employers have themselves removed healthcare professionals from emergency departments.

Taken from the INSPQ website, the recommendations concerning pregnant or breast-feeding workers (care settings including dedicated medical clinics) are:

Recommendations regarding pregnant workers (dedicated or not dedicated hospital, medical clinic and isolation settings) (high or very high level)

During the entire period epidemic in Québec and in a context of local, regional or provincial sustained community transmission decreed by the public health authorities: the INSPQ recommends the immediate reassignment of the pregnant worker, regardless of her immune status regarding COVID-19, for the entire pregnancy in order to eliminate:

  • Close contact (less than 2 meters and without physical protection measures, such as a glass partition) with clientele and work colleagues;
  • Being in the same location (room, treatment room, etc.) with people under investigation or the probable or confirmed cases of COVID-19
  • Care, blood samples, medical examinations, para clinical examinations and treatments of people under investigation or probable or confirmed cases of COVID-19
  • Transportation of people under investigation or probable or confirmed cases of COVID-19;
  • Tasks related to cleaning and disinfecting the environment, equipment and personal effects having been in contact with a person under investigation, a probable or confirmed case of COVID-19;
  • Management of personal waste from people under investigation or probable or confirmed cases of COVID-19;
  • Contact, care or treatment of people under investigation or probable or confirmed cases of COVID-19 by confinement at home or in residential housing;
  • All duties in sectors or institutions declared in isolation for COVID-19 by the authorities of the institution involved.

Recommendations regarding pregnant workers in other work settings with close contact with clientele and work colleagues (moderate level) 

During the entire period epidemic in Québec and in a context of local, regional or provincial sustained community transmission decreed by the public health authorities: the INSPQ recommends the immediate reassignment of the pregnant worker, regardless of her immune status regarding COVID-19, for the entire pregnancy in order to eliminate:

  • Close contact (less than 2 meters and without physical protection measures, such as a glass partition) with clientele and work colleagues;

Recommendations regarding pregnant workers in the other work settings with close contact with clientele and work colleagues (low level) 

During the entire period epidemic in Québec and in a context of local, regional or provincial sustained community transmission decreed by the public health authorities: the INSPQ recommends the immediate reassignment of the pregnant worker, regardless of her immune status regarding COVID-19, for the entire pregnancy in order to eliminate:

  • Close contact (less than 2 meters and without physical protection measures, such as a glass partition) with clientele and work colleagues;

Source : Interim recommendations on preventive measures for pregnant or breast-feeding workers in the workplaces

Frequently asked questions

I am pregnant and I think that my work entails a danger of contracting COVID-19 for my unborn child or myself

Consult a physician to obtain a “Certificat visant le retrait préventif et l’affectation de la travailleuse enceinte ou qui allaite” (Protective Reassignment and Assignment of the Pregnant or Breast-Feeding Worker Certificate) attesting that your working conditions entail a danger of contracting the virus, for your unborn child or, because of your pregnancy, for yourself. This certificate will be issued after a consultation with the Public Health Department.

Note the changes regarding a protective reassignment preventive withdrawal on the CNESST site.

What document do I give my employer if my working conditions entail physical dangers of contracting the virus for my unborn child or myself?

A worker must furnish a medical certificate attesting that the conditions of her work include physical dangers for her unborn child or, because of her pregnancy, for herself.

Can I be assigned to other duties if my working conditions entail a danger of contracting the COVID -19 virus?

A worker who gives the employer a medical certificate attesting that her working conditions may be physically dangerous for her unborn child or herself may request to be assigned to duties involving no such danger and that she is reasonably capable of performing. Submitting this certificate is not a request to stop working.

What happens if my employer does not reassign me as soon as the medical certificate is submitted?

If the requested assignment is not carried out immediately, the worker may stop working until the assignment is made or until the date of delivery.

If my employer does not reassign me to other duties, what indemnities will I receive?

A worker is entitled to be paid her regular salary rate for the first five working days of a work stoppage.

At the end of this period, she is entitled to the income replacement indemnity to which she would be entitled under an Act respecting industrial accidents and occupational diseases.

Do I keep my benefits during my assignment to other duties or if I stop working?

If a worker has been assigned to other duties or stops working, she keeps all her benefits linked to the job she occupied before that assignment.

Will I be able to return to my position at the end of the assignment or work stoppage?

Ø The employer must return the worker to her regular position at the end of the assignment.

What recourses do I have if my employer does not respect the conditions in my protective reassignment certificate?

A request may be sent to the CNESST asking that they ensure that the conditions in the protective reassignment certificate are respected and to render a decision on this request.

Are the INSPQ protective reassignment (preventive reassignment) recommendations for pregnant women the same as for those who are breast-feeding?

No. According to the INSPQ, there is currently no evidence-based data on direct transmission of the infection through maternal milk. Therefore, the INSPQ does not recommend a protective reassignment (preventive reassignment) of the worker who is breast-feeding.

What recourses do I have if I am disciplined after exercising a right granted me under an Act respecting occupational health and safety?

Ø A complaint under Section 227 in an Act respecting occupational health and safety may be filed if the worker believes she has been disciplined after exercising a right under that Act.

What should I do to contest the assignment proposed by my employer?
  • Inform your local union team..
  • Obtain a Protective Reassignment and Assignment of the Pregnant or Breast-Feeding Worker Certificate from your physician identifying the working conditions with dangers for the fetus or yourself.
  • Once this certificate is submitted, the employer must assign you to duties exempt from all danger, including the COVID-19 virus.
  • If the employer proposes an assignment that does not comply with the dangers identified in your certificate, you can contest it by filing a written complaint with the CNESST.
  • If the CNESST decides the assignment does not comply, you will be removed from work with compensation, unless the employer proposes an assignment that complies.
  • If the CNEEST decision is against you, you can contest it in the 10 days following receipt of the decision. You can receive a first loan from the FIQ of $1,000 if needed.

To learn more about a protective reassignment for the pregnant or breast-feeding worker:

Note: The following documents are used in a normal situation. We feel it is important in the current rapidly evolving context, to give a warning to this effect.

 

Emergency daycare services

Frequently asked questions

I have to put my children in an emergency daycare service. What measures are taken to ensure their protection?

The MSSS issued instructions for those in charge of emergency daycare services.

Si vous constatez un non-respect de la mise en place de ces normes par les responsables des milieux de garde où sont gardés vos enfants, n’hésitez pas à contacter votre équipe syndicale locale.

Wearing a uniform and its proper daily care

Don’t hesitate to call your local union team. They are best suited to support you during this Coronavirus crisis, answer your questions and help you in the steps to take with your employer.

According to current scientific knowledge, the COVID-19 virus seems to spread predominantly by:

  • Droplets during close and extended contact with a sick person.
  • By direct contact with droplets from respiratory secretions from a sick person’s coughing or sneezing.

In the context of the health emergency, to avoid the spread of the COVID-19 virus and other pathogens that exist in the care settings, healthcare professionals are asked to follow the following recommendations on wearing a uniform when giving direct care to infected patients:

  • Work clothes should only be worn in the workplace. This means changing upon arrival and departure in changing rooms provided by your employer and leaving work wearing your regular clothes.
  • Change your work clothes every day.
  • Ensure that your work clothes are regularly and adequately maintained.

This basic preventive measure is also to reassure the population.

Reminder of the OIIQ recommendations on the nurses’ dress code

Personal protective equipment

Don’t hesitate to call your local union team. They are best suited to support you during this Coronavirus crisis, answer your questions and help you in the steps to take with your employer.

CAVEAT FOR N95 MASKS

The FIQ is aware of the risk of a shortage of protective equipment and urges leaders to organize the province’s capacity to produce equipment based on a precautionary approach. This shortage must in no way reduce the protection of healthcare professionals because of the low anticipated equipment availability.

Questions/Answers on the single-use APR N95 masks (or the equivalent)

It is important to note that Québec experts address the use of N95 (APR N95) masks using these four criteria:

  1. Extended use
  2. Reuse
  3. Disinfection
  4. Use of expired masks

 What personal protective measures should the healthcare professionals use when they interact with probable or confirmed cases of COVID-19 or people under investigation?

Since COVID-19 is an emerging infectious disease, the measures announced by the MSSS should be considered as the minimum measures to respect:

Frequently asked questions

Can N95 masks (or the equivalent) be disinfected and sterilized?

Research is underway around the world to do this. The INSPQ says: (free translation)

“[…] As of April 2, 2020, disinfection procedures have not yet been approved in Canada by a regulator and do not meet recognized best practices. However, this approach is in line with the desire to identify alternative and additional strategies to the already available measures in order to give the best protection possible to workers in case of a shortage. Therefore, alternative control measures to those usually accepted may need to be implemented alone or in combination. These measures are unprecedented and highlight the urgent need for the various bodies to develop immediate solutions to respond proactively to a real shortage of N95 masks. In this context, the CINQ (Comité sur les infections nosocomiales du Québec) issued interim recommendations on the reuse of N95 respirators during the COVID-19 pandemic (Avis CINQ, N95). A step to disinfect the masks can eventually be added when the masks are reused according to the CINQ recommendations.

This evaluation puts into perspective the advantages and limits of every identified disinfection procedure based on current knowledge. It also presents the steps taken by the manufacturers of these technologies to validate such an approach.”

https://www.inspq.qc.ca/sites/default/files/covid/2971-options-desinfection-n95-covid19.pdf

In a document on the disinfection of single-use N95 masks, the INSPQ has clarified this with guidelines for disinfecting single-use masks in the event the practice is safe: (free translation)

“The purpose of this document is to describe the guidelines to follow for disinfecting the single-use N95 respirator masks in order to:

  • Ensure the personnel’s safety.
  • Ensure the infection prevention and control (IPC) measures associated with disinfection activities are respected and implemented.
  • Ensure that the procedures for disinfecting single-use N95 masks in the manufacturer’s instructions for the technologies used in the disinfection are respected.
  • Standardize the process for disinfecting single-use N95 respirator masks”

https://www.inspq.qc.ca/publications/2965-desinfection-n95

Moreover, in a La Presse article, “[ ] researchers at Duke University in the United States insist that the current disinfecting techniques by vaporized hydrogen peroxide permeate all layers of the mask and kill all pathogens – including viruses – on it, without damaging the mask.”

The FIQ is waiting for access to the research protocols that these experiences are based on before taking a position. When in doubt, don’t hesitate to consult your union team, because the precautionary principle should apply at all times.

In the event the healthcare institutions procure new APR N95 masks, the FIQ believes they should be used first. The FIQ reminds everyone that disinfection is an alternative of last resort.

What personal protective measures should the healthcare professionals use when they interact with probable or confirmed cases of COVID-19 or people under investigation?

Since COVID-19 is an emerging infectious disease, the measures announced by the MSSS should be considered as the minimum measures to respect.

 

What is the procedure for putting on and removing personal protective equipment

The N95 mask and its alternatives

These are the videos that deal with the procedure for putting on and removing personal protective equipment during an intervention in an isolation room using airborne, droplet AND contact precautions:

CIUSSS Centre-Ouest

INSPQ

https://www.inspq.qc.ca/nouvelles/covid-19-procedure-d-habillage-deshabillage-en-milieu-soin

Posters produced by the ASSTSAS for putting on and removing PPEs:

Putting on: | Removing:

Is it possible to reuse or extend the use of “single use” N95 masks?

Yes, according to the latest INSPQ opinion: “[…] in the context of a COVID-19 pandemic and a real or feared shortage of N95 respirators, it is possible to reuse a N95 respirator if it is dedicated as the exclusive use of a health worker. The measures to take are:

  • Clearly identify the container with the name of the person using the respirator.
  • Discard the storage container (if single use like a bag, for example) after each use or disinfect it before putting the respirator in it.
  • Avoid touching the interior and exterior of the respirator. In the event of accidental contact, wash hands.
  • Wear a pair of clean gloves (non-sterile) when you don a used N95 respirator.
  • Do a fit test before each use.
  • Take off the gloves and discard them.
  • Wash hands.”

Reference: Réutilisation des respirateurs N95 – COVID-19

The ASSTSAS, has also answered this question in point 4 of its FAQ (in French only) issuing several recommendations on reusing the N95 mask (or the equivalent). It is important to note that the ASSTSAS favours extended use of a N95 mask instead of reusing it.

Reference: ASSTSAS – FAQ – Protection respiratoire – Réponses

The FIQ has several concerns. The employers should never deviate from the INSPQ and ASSTSAS recommendations. These recommendations are to be considered as the minimum, followed to the letter and only used as a last resort. The high risk of touching a contaminated part is significant. A N95 mask must be removed carefully to avoid any cross contamination and to avoid this risk, personal protective equipment must always be donned and removed under the supervision of a person used to wearing this type of protection.

What are employers who keep soiled N95 masks for eventual reuse thinking?

The precautionary principle applies here too. The storage conditions for mask must be safe and able to guarantee the protection of health workers. The stored masks must not go into circulation for reuse before the evidence-based data confirms their effectiveness.

Can expired N95 masks be used?

According to the INSPQ, “[…] if there are not enough masks that are not expired, it is possible to use expired N95 masks in the context of the COVID-19 pandemic under certain conditions:

  • The straps or nose bridge of the masks may degrade and influence their seal. The filter material of some mask models may also degrade. Therefore, it is important to visually inspect the mask and verifier the seal of expired masks;
  • The mask storage conditions are checked. They must comply with the manufacturer’s recommended storage conditions;
  • The employer must have a respiratory protection program that respects OSHA requirements.”

Reference: Utilisation des masques N95 expirés – COVID-19

Can a Fit check replace a Fit test for N95 masks?

No. A Fit test must be conducted when a N95 respirator protective device is given to a worker while a Fit check only verifies if the respirator protective device is positioned correctly on the face before entering a danger zone. When in doubt, talk to your local union team.

To find out more:

OIIQ’s exams for CPNPs and SNP Candidates postponed

The FIQ, through its Organization of Work and Professional Practice Sector, is watching the professional orders’ activities in line with COVID-19 every day and may update the pertinent information on its web site based on this evolving situation.

Frequently asked questions

Are the OIIQ’s exams for CPNPs and SNP Candidates postponed because of the COVID-19 pandemic?

Yes.

In fact, the Ordre des infirmières et infirmiers du Québec announced that the entrance exam for the profession for CPNPs and SNP certification exam for SNPs candidates originally scheduled in March and postponed to April 27, 2020, will be held on Monday, September 21, 2020.

The OIIQ pointed out that the postponement of the exam makes candidates available to help in the prevention efforts and battle against COVID-19.

Source: https://www.oiiq.org/covid-19-fil-d-actualite (March 25, 2020)

For candidates to the practice of the licensed practical nurse profession (CPLPNP), The Ordre des infirmières et infirmiers auxiliaires du Québec also announced the March 2020 exam is postponed to a later date.

According to the provincial provisions of the collective agreement, candidates to the practice of the nursing profession (CPNP) and the licensed practical nurse profession (CPLPNP) will remain candidates until they pass their professional exam and obtain their permit to practice.

Despite these additional delays because of COVID-19, the FIQ wants to point out the important contribution of the CPNPs CPLPNPs and SNP candidates in the current health crisis.

The collective agreement stipulates the CPNP who passes the OIIQ exam and the CPLPNP who passes the OIIAQ exam and is waiting for her permit to practice to be issued, receives, once her permit is obtained, her salary as a nurse or nurse clinician or licensed practical nurse retroactive to the date of her exam or the date she started work if she started after the date of her exam. She must have completed all the required internships.

The FIQ, through its Organization of Work and Professional Practice Sector, is watching the professional orders’ activities in line with COVID-19 every day and may update the pertinent information on its web site based on this evolving situation.

Get involved

The FIQ demands that all possible measures be implemented to guarantee healthcare professionals have:

  • Safe working conditions for themselves and their patients
  • Protection of their health and that of their loved ones
  • Improved working conditions recognizing the exceptional effort that they will have to make over the coming weeks, even months, to respond to the population’s needs during this unprecedented health crisis.

In this respect, I feel that this petition is directly linked to the Federation’s demands and I encourage all healthcare professionals and the population to sign it.

Nancy Bédard

President, Fédération interprofessionnelle de la santé du Québec—FIQ

The healthcare professionals’ exceptional work in this context of a pandemic has to be pointed out and duly recognized.

Essentielles comme jamais!

News