Organizing the work to ensure the healthcare professionals’ and patients’ health and safety
Moral distress, physical injuries, exhaustion, violence, patient falls, the list is long and growing even longer. The harmful effects from the cuts in the healthcare system are pervasive and last a long time. The undermining of organization of work has existed for two decades.
The healthcare professionals want to provide safe, quality patient care. However, the frantic work pace and chronic staff shortage force them to take decisions on the priority of the care they will give which results in omitted care for the patients. They are forced to act in this way. The patients then suffer the repercussions, for some, extending their hospital stay. The system’s decision-makers can no longer ignore it, the reports and studies are growing on this subject. All come to the conclusion that there is a link between the healthcare professionals’ workload and the patients’ health outcomes.
The healthcare professionals have been able to catch their breath a little with the ratios projects and they have given a glimmer of hope in the settings where they have been tried. Significant benefits have been seen at both the clinical and human resources levels, consistent with scientific publications and international experiences. With this in mind, the FIQ believes that implementing real measures that would cost money at first, but would save money for the Treasury Board in the long term, needs to be at the heart of these negotiations. The health and social services system needs to be a healthy and safe environment for both patients and healthcare professionals
Targeted courses of action
- A reasonable and safe workload.
- Safe healthcare professional-to-patient ratios.
- Stabilizing the work teams.
- Eliminating the use of mandatory overtime as a management method.
Enhancing the healthcare professionals’ practice and expertise
The employers’ reorganizations over the years have destabilized and disorganized the work teams, thus increasing the workload and modifying the healthcare professionals’ roles and duties. Added to that is the expected effects from Bill 90 which are still not forthcoming today. Such as a more autonomous practice or even occupying the entire scope of practice.
Acknowledging the healthcare professionals’ expertise for what it is worth is an issue. Moreover, few employers promote or consider it. It is clear that the whole health and social services system would benefit from its best use by fostering satisfaction at work, a healthy work environment and attraction and retention of caregiving staff.
The FIQ believes that the wise use of all available resources would reduce the insecurity of some job titles, reduce the workload, and enhance each profession, in addition to ensuring quality care in sufficient amounts.
Pistes d’action visées
- Bill 90 and the scope of practice.
- Healthcare professionals’ autonomy.
Accessing quality positions
The extreme flexibility required by the employers has led to unattractive positions and fostered mobility, even an exodus of staff. Experience has shown that no one takes multisite and multi-shift positions and they create major dissatisfaction. About 50% of available positions, for all job-titles groups combined, are part time causing inadequate care delivery at all times (24⁄7), an excessive workload, mandatory overtime and a staff shortage. This job structure generates a perpetual vicious circle.
Letter of Understanding No. 6, negotiated in 2015, was supposed to breathe life into the health and social services system as well as the healthcare professionals by offering more positions that are full-time. It is clear that its joint implementation has faced challenges.
Moreover, many healthcare professionals, incumbents of full-time positions, are leaving them because of the exhaustion caused by the workload and mandatory overtime. It is difficult for them to balance personal life and work, as they have no control over the use of their time. They then opt for a part-time position to preserve their psychological health and family life. Holding a full-time position should be the norm and not the reverse.
In the current context, the FIQ believes that it is important to move towards job offers that allow the healthcare professionals to have a balanced life both at work and in their personal lives. With the persistent staff shortage, the health and social services system cannot afford to lose even one more healthcare professional or a part of her availability.
Targeted courses of action
- Part-time positions providing stability.
- Reinvent full time to make it attractive.
Restoring work-personal life balance to preserve the healthcare professionals’ psychological health
The demands at work are such that the healthcare professionals no longer manage to perform all their associated duties. They feel the repercussions in both their professional and personal life: the balance sought is broken, work encroaches on private life and psychological health is severely affected.
Despite the employers’ obligation, under an Act respecting labour standards and clause 31.02 of the collective agreement, to provide a workplace without psychological harassment, it is clear that the healthcare system’s workplaces are not currently psychologically healthy and safe.
The FIQ believes that the managers must be leaders on their centres of activities. They have to be able to evaluate the real workload and give their team clear and realistic goals. They have to support and work with every healthcare professional when necessary. They need to include the healthcare professionals in decision-making. The healthcare professionals’ autonomy and initiatives should be encouraged. By valuing the healthcare professionals’ work, managers give meaning to their work.
The FIQ believes that prevention in occupational health and safety goes through appropriate mechanisms. Concrete measures must be taken in this direction.
Targeted courses of action
- A psychologically healthy and safe workplace.
- The battle against stress.
- Accessing various days off.
- Control over the schedule.
- Organization of work time.
Equipping the teams to respond better to the healthcare professionals’ needs
The healthcare professionals’ voice with the employer is the union. The Labour Code imposes this duty to represent. Besides this duty, the union representatives have the members’ well-being at heart and want to be able to offer all the necessary support to represent them well. To properly fill their union role, the FIQ believes that the employer party must understand and collaborate in order for the healthcare professionals to receive the required support from their union.
To be able to effectively resolve the healthcare professionals’ problems, union rights and all the procedures related to contesting the employer’s decisions, by grievances or other procedures (Labour Relations Committee, grievance arbitration, medical arbi-tration and the procedure for modifying the job titles list) must be addressed first. The slowness and complexity of the administrative and legal system are part of the prob-lem. The FIQ wants to review these procedures to simplify and speed up the handling of personal or group files.
In an unhealthy work context where an increasing number of healthcare professionals are getting physically and psychologically sick, the FIQ wants to obtain a commit-ment that the healthcare professionals’ rights will be properly respected by facilitating access to salary insurance benefits, real support for rehabilitation and a return to work. They can then be able once again to give the patients quality health care.
Targeted courses of action
- Assisting the healthcare professionals.
- Preserving the healthcare professionals’ rights.
- Simplifying and speeding up handling of contentious cases.
Frequently asked questions
By having more people working full time, there will be more healthcare professionals available to do the different tasks and thus reduce everyone’s workload. Working full time gives several monetary benefits, in addition to the premium, that a part-time employee does not get, including the calculation of the pension annuity.
Full time will stabilize the work teams and reduce overtime, mandatory or not, and workload. This will improve well-being at work. It will take effort from everyone and the best way to motivate that effort is by adding a premium. The FIQ and FIQP are proposing a premium of 12% for incumbents of full-time positions or assignments. The goal is to convert this premium into a paid day off, which would be the employee’s choice.
This demand aims to create quality full-time positions without rotation in a single site.
Yes, the premium is paid to all employees incumbents of full-time positions or assignments, regardless of their shift.
For several years, the FIQ has talked about the ratios as one of the preferred solutions to resolve the problems in the health network, by reducing the workload. The impact of the COVID-19 crisis in the CHSLDs only worsened a situation that was already unacceptable. The staff shortage and grossly deficient healthcare professional-to-patient ratios have undeniably contributed to the high rate of people with COVID-19 in CHSLDs, both staff and residents. Without talking about the residents’ mortality rate. Therefore, let’s quickly begin with gradually rolling out the ratios in CHSLDs. Then roll them out in emergency departments and medicine-surgery. The key word is gradually. Let’s begin now.
The objective of implementing safe ratios through a law remains a FIQ and FIQP demand. That is the best way to ensure the respect of ratios everywhere and at all times.
By standardizing the workweek, the number of hours the healthcare professionals care for patients rises. For many, this work time is already done by shortening their break times and meal periods. By recognizing these hours in the basic salary, they can be recognized in pension calculation. For many healthcare professionals, this means fair recognition of the work they do, particularly for respiratory therapists or healthcare professionals working in a CLSC. It also facilitates implementing safe ratios and increases the compensation of the healthcare professionals involved.
It is also a measure of fairness for all our healthcare professionals and facilitates schedule management, as everyone works on the same hourly basis.
No. The objective of the negotiations is that all healthcare professionals work 7.5 hours a day instead of 7 hours or 7.25 hours. This measure affects as many incumbents of full-time positions as those who work part time. It will raise the number of hours of care given to patients, while recognizing the work done.
Healthcare professionals want to work in a safe work environment. It is their physical and psychological health at stake. Therefore, preventive measures need to be put in place now, especially in remote regions. The healthcare professionals have waited 40 years and we don’t understand why the CNESST is incapable of moving. The COVID-19 crisis only aggravated this already existing problem. An Act respecting occupational health and safety must be fully applicable to our sector, like in the construction sector, for example.
It is currently the institution’s choice to supply or not a uniform. By making this demand, the FIQ and FIQP are ensuring consistency in the practices across the health and social services network.
The FIQ and FIQP demand is that the employer reimburse the fees. The terms of this reimbursement will be determined in the next phase.
The demands made by the FIQ and FIQP replace and improve what currently exists in a letter of understanding in the collective agreement. The amounts set out in the letters of understanding have not achieved the objective of attraction and retention and are not sufficient. This is the reason for the FIQ and FIQP demand to implement a premium of 8% for all employees who work in a CHSLD or with clientele presenting severe behaviour disorders (SBD). This premium would be included in the collective agreement.
Examples of typical cases
With a 37.5-hour week for everyone, there will be 30 more minutes of care a day for the healthcare professionals in home support. That will, for example, allow one more patient to be seen or complete various follow-ups and thus better balance the workload over the week.
Ending the obligation for a nurse clinician to work 40 hours a week before being paid overtime will resolve this problem. Moreover, implementing 37.5 hours for everyone means everyone will be paid overtime after the regular workweek.
Contrary to what the government claims, healthcare professionals do not have the latitude to manage their schedule as they want. In reality, it is difficult for them to take back their overtime hours and this does not add any care hours.
There is currently a problem in applying the rotation premium. This is the reason why one of the FIQ sectoral demands is to simplify the application of this premium so that more healthcare professionals can benefit from it.
With the purpose of correcting a long-standing problem, the FIQ and FIQP are demanding that an employee in the health and social services network who becomes a CPNP or CPLPNP cannot be paid a lower salary than that she was paid in her former job title. Therefore, it will be beneficial for a beneficiary attendant following a licensed practical nurse course to become a CPLPNP and be able to use the new skills she will have acquired.
Based on the principle of fairness and with the purpose of recognizing the academic fair value and contribution of nurse clinicians in northern clinics, the FIQ is demanding the creation of new job titles of assistant-head-nurse in a northern clinic, nurse clinician in a northern clinic and nurse clinician assistant-head-nurse in a northern clinic.
The FIQ is negotiating the intersectoral matters at a common table with the Alliance du personnel professionnel et technique de la santé et des services sociaux (APTS).
Over three (3) years
- Maintain the standard of living – 3.2% x 3 year
- Catch-up of the accumulated deficit – 4% x 3 years
Salary differentials are widening and this is what happens:
- The APTS and FIQ members are paid 20% less than those in other public services
- The total remuneration differences (salaries and benefits) amount to 24.9% less than those in other public services
- The APTS and FIQ members are paid 13.2% less than the other Québec employees in the public and private sectors combined
- Help for parents of young children and children with special needs
- Improved leaves during pregnancy
- Better protection of working conditions for parents during leaves linked to parenthood
- Keeping experienced professionals at work longer and in favourable conditions
- Better preparation of the transition to retirement (improve progressive retirement)
- Reduce the costs of early retirement
Sectoral vs Intersectoral
In these negotiations with the government, the FIQ is tackling two matters: sectoral and intersectoral. Here is a summary of what these two matters contain.
The sectoral matters are those specific to our sector of activity. They are negotiated with the Ministère de la santé et des services sociaux (Ministry of Health and Social Services):
- Working conditions
- Occupational health and safety
The intersectoral matters affect all the sectors of activities (health, education, civil service, etc.). They are negotiated with the Conseil du trésor (Treasury Board) :
- Parental rights
- Regional disparities