FIQ (Fédération Interprofessionnelle de la santé du Québec)

The COVID-19 pandemic has put a serious strain on the health and safety of healthcare professionals, both psychologically and physically. The crisis has posed a daily threat to workers who’ve been keeping the network afloat for months, exposing them to hazards of an unprecedented scope. In addition to having to deal with the suffering of others and the feeling of having no control over the situation, nurses, licensed practical nurses, respiratory therapists and clinical perfusionists have been thrust into an environment that has become more harmful than ever before.

How can healthcare professionals feel protected when it seems like the world is falling apart? How can they keep it together when they have no idea what is going to happen or what will be done to protect and enable them to keep providing care? How can they perform the role their profession requires when everything leads them to believe they have no choice but to make do with the situation at hand?

There are a great many occupational health and safety issues. Consequently, it becomes even more important to take care of those who, day after day, dedicate themselves to the population, often at the expense of their own health.

It’s no longer time for rainbows, thank yous and pats on the back. It is time to show concrete recognition for what healthcare professionals do. To admit that without them, nothing would be okay. This recognition cannot be merely symbolic: It must take the form of concrete actions specifically aimed at collectively tackling prevention.

How can this be done? What lessons can be learned to put an end to unacceptable conditions and ensure they do not reoccur?

For the Occupational Health and Safety Committee, it is crystal clear that healthcare professionals’ experiences must be taken into greater consideration, that what they have to say must be recognized. It is high time they were listened to and urgent that their health and safety be taken seriously. The way to achieve this: collective action.

Recognition: more than wishful thinkingx 

The government has showered health network workers with thank yous on countless occasions. As if these words were enough to repair the damage caused by the pandemic and to get decision-makers and employers off the hook for their responsibilities. So many situations bear witness to the lack of recognition: organization of work that doesn’t take into account the constraints healthcare professionals must navigate, hazards they are exposed to on a daily basis, the lack of support, the work overload or difficulty in obtaining required protective equipment, and so on. Occupational health and safety has been highly neglected which exacerbates existing problems during a pandemic.

Recognition for healthcare professionals should not be wishful thinking, it should be shown as serious concern for their health. It must be demonstrated through the employer’s concrete actions, through truly considering factors that threaten healthcare professionals’ integrity and mental and physical health and safety. It must be shown as respect for their knowledge, know-how, skills and the importance of their contribution to occupational health and safety prevention.

Showing recognition also means giving healthcare professionals a voice. It means giving them the opportunity to express their views, to denounce situations, and to rise up against unacceptable situations. It means breaking the code of silence that reigns too often. It means respecting their professional judgement, listening to their solutions and taking action to resolve the hazards in their environment before it’s too late. It means learning from them in order to prevent situations that occurred during the pandemic from reoccurring or continuing and ensure they do not become the norm in an already destructive environment.

In honour of the OHS week, the FIQ and FIQP are suggesting ideas that can help healthcare professionals take collective OHS action. The employer needs to move from symbolic recognition to concrete recognition.

Protecting our most precious resource

The FIQ and FIQP have always actively fought to promote prevention in occupational health and safety. They multiplied their union interventions to get healthcare professionals’ solutions heard. Now, faced with the findings, it is time to take our demands even further to protect our most precious resource: our health.

We must denounce everything that poses a threat to it. With collective action, we will be able to make our message heard. We must use our collective power!

Prevention is not a luxury, our rights are precious.

In view of the findings, the risks and hazards to healthcare professionals’ health and safety must be identified, assessed, and addressed. There is an urgent need for preventive action to allow healthcare professionals to continue to do their jobs.

Prevention is clearly not always on the menu. OHS is often seen as an expense rather than an investment. However, every step taken to protect the health and safety of healthcare professionals counts. It is a matter of maintaining the jobs and health of the staff who run the network and the quality and safety of care the population receives.

It is not a luxury to demand a healthy and safe work environment for healthcare professionals. And it is definitely not a luxury to demand respect for their rights and interests when the risks are omnipresent and pose a constant threat. The FIQ and FIQP’s affiliated unions constitute a vital tool in enabling healthcare professionals to take collective action for prevention.

The FIQ and FIQP are proud to represent their members

To protect their members’ health, the FIQ and FIQP have multiplied their political interventions since March 2020. They have used every platform possible to amplify healthcare professionals’ voices and to draw attention to the occupational health and safety issues they face on a daily basis.

While the following list might not be exhaustive, it gives a glimpse of the efforts made

  • Starting in February 2020, before the official declaration of the health emergency in Quebec, the FIQ contacted the Public Health Agency of Canada about obtaining recognition of the potential airborne transmission of the virus, applying the principle of precaution, and recommending that respiratory protection be worn.
  • Starting in April 2020, the Federation contacted the CNESST about sending out inspectors to healthcare institutions, ensuring fit tests were conducted, and that all workplaces were equipped with the personal protective equipment healthcare professionals needed to work safely.
  • In June 2020, inter-union requests were sent to the CNESST to restart joint committees’ work in occupational health and safety within the network institutions. Furthermore, to ensure those involved in prevention were given complete, reliable data on employment injuries (physical and psychological) related to COVID-19.
  • On June 26, 2020, the inter-union sent a letter to the provincial public health director, Horacio Arruda, requesting that prevention measures be strengthened in the health network.
  • Throughout fall 2020 and spring 2021, the FIQ repeatedly contacted the CNESST about holding meetings to clarify its new position on the wearing of N95 masks and to raise issues about the confusion around interpreting and applying the new rules.
  • On October 16, 2020, the FIQ submitted a brief to the Ombudsperson to pinpoint the impacts of the COVID-19 health crisis on care quality for CHSLD residents and to propose solutions.
  • On November 26, 2020, the FIQ sent a letter to Christian Dubé, Quebec’s Minister of Health and Social Services, to request that he cancel the provincial public health director’s order from June 8 restricting the wearing of protective respiratory and eye equipment. On January 12, 2021, a second letter was sent to Minister Dubé repeating the request.
  • On April 15, 2021, as a complement to its brief, the FIQ sent a letter to the Ombudsperson denouncing the CNESST’s decision to promote the INSPQ’s recommendations over the notices and recommendations of the main organization specialized in occupational health and safety, the IRSST.
  • On May 10, 2021, the FIQ met with the Minister of Labour, Employment and Social Solidarity to discuss the important distinction between Public Health and occupational health and safety rules and to demand the preponderance of the latter.
  • On June 26 and June 14, 2021, the inter-union sent two letters to the CEO of the INSPQ, Nicole Damestoy, criticizing the INSPQ’s role and interventions during the health emergency, especially its recommendations on wearing personal protective equipment.
  • The FIQ participated in the OHS–COVID joint work group (MSSS). This work group, led by the CEO of the Association paritaire pour la santé et la sécurité du travail du secteur affaires sociales (ASSTSAS) is composed of representatives from the Ministry of Health and Social Services (MSSS), the Comité patronal de négociation du secteur de la santé et des services sociaux (CPNSSS), and all of the health network’s unions. This committee worked to analyze the available data, to come to a common understanding, and to issue recommendations to the decision-making bodies to improve the effectiveness of COVID-19 prevention measures.
  • The FIQ’s OHS Sector actively participated in the COVID FIQ–CPNSSS Provincial Labour Relations Committee’s meetings. The committee was created after the sectoral agreement on the public health emergency measures to discuss and ensure information was communicated efficiently and to mitigate the specific labour relations and occupational health and safety problems during the pandemic.

Examples of collective actions in occupational health and safety

Healthcare professionals are not only on the front lines battling COVID-19, they are on the front lines defending their occupational health and safety rights. To protect what is most valuable, their health, FIQ and FIP members are mobilizing on the ground, showing solidarity and carrying out collective actions. Without healthcare professionals’ collective actions, it would be impossible to make political progress in OHS.

Here are some of the many battles fought by FIQ and FIQP members in the last year and a half. These examples demonstrate that the collective action of healthcare professionals and their union teams makes OHS victories possible.

Protecting immunosuppressed healthcare professionals at the CISSS des Laurentides

At the beginning of the crisis, public health took too long to issue guidelines on the preventive withdrawal of pregnant and immunosuppressed workers. Many of them had to work in a hazardous environment with exposure to the virus.

Early on, the FIQ began representations before the authorities to immediately withdraw pregnant and immunosuppressed workers from high-risk workplaces. However, faced with employers’ failure to react quickly enough, the Syndicat des professionnelles en soins des Laurentides (FIQ-SPSL) rolled out an action plan to support its members.

Then in March 2020, the FIQ-SPSL held a meeting with all of its union representatives to communicate information related to applying the rights set out in the Act respecting occupational health and safety (AOHS). With this information, the union representatives contacted the pregnant and immunosuppressed members. The union created tools to inform members about their rights under the AOHS, as well as the importance of contacting their union for guidance on the most appropriate recourse.

Right to refuse

The right to refuse is an individual right set out in section 12 of the AOHS. It allows a worker to refuse to perform work if they have reasonable grounds to believe this work exposes them to hazards to their health, safety or physical integrity. It is however important to note that the right to refuse does not apply if exercising it puts the life or safety of another person in immediate danger. Furthermore, this right must not be abused and in the event that it is, the employer may enforce disciplinary sanctions. If you believe you are in a situation where you must exercise your right to refuse, contact your union team immediately.

The right to preventive withdrawal

The right to preventive withdrawal set out in section 32 of the AOHS allows a worker exposed to a contaminant that puts their health at risk to be reassigned to tasks without that exposure. The worker must request the protective reassignment from the employer and provide a medical certificate attesting that they are exposed to the contaminant in the performance of their duties and that the exposure is dangerous for their health. This is the case for some immunosuppressed workers exposed to the COVID-19 virus in the course of their duties. If the employer cannot reassign the worker to other safer tasks, then they can be withdrawn from work. If you believe you are in a situation where you could exercise your right to preventive withdrawal, contact your union team immediately.

On March 30, a sectoral agreement regarding the public health emergency measures was reached between the FIQ and the MSSS. This agreement stipulated that all pregnant and immunosuppressed healthcare professionals are to be withdrawn from work if the employer is unable to set up remote work or provide a safe reassignment.

Despite this agreement, the CISSS des Laurentides tried to recall immunosuppressed healthcare professionals back to work, even when public health maintained its guideline for their withdrawal. Many healthcare professionals therefore had no choice but to use the mechanisms set out in the AOHS so that the employer wouldn’t put them in a situation that is dangerous for their health. Healthcare professionals used seven recourses under the AOHS that the CNESST also deemed valid. The employer undertook actions to contest the CNESST’s decisions but, faced with the members’ determination and the FIQ-SPSL’s support, the employer finally decided to withdraw its challenges.

While refusing and denouncing a dangerous assignment can create uncertainty, stress and fear, the healthcare professionals who dared to do so saw the CNESST recognize the hazardous work they were asked to do. Healthcare professionals used their power and succeeded. They were also able to stop the employer’s dangerous practice.

Healthcare professionals have rights and it is important to ensure they are respected. As such, for any OHS-related problem, it is important to contact your union team as they have the expertise needed to guide you. Recognition of individual rights can have a collective impact. With their union’s support, healthcare professionals in the Laurentian region fought for their right to exercise their profession without it putting them in danger. Thanks to the healthcare professionals’ resistance and the CNESST’s recognition of their legitimate recourses, the CISSS des Laurentides finally stopped its abusive practice. It is a great example of solidarity and collective action through union action.

The complaint filed with the CNESST and the occupational health and safety inquiry led by the CHSLD Lionel-Émond healthcare professionals

Right from the first few weeks of the crisis, the healthcare professionals from the CHSLD Lionel-Émond du CISSS de l’Outaouais noticed that the employer’s preventive measures in their workplace were ineffective and insufficient. Remember that at that time, employers were frequently moving staff between facilities, were not keeping teams within their assigned warm and hot zones–when those zones were even in place–and were also denying the risk of airborne transmission.

The first confirmed COVID-19 case was a CHSLD worker in April 2020 and the outbreak wasn’t resolved until July. Overall, 41 healthcare workers contracted COVID-19 and two died of it. 14 residents died. Healthcare professionals’ concerns turned to fatigue and distress. Jérémie Grenier, a licensed practical nurse working at the CHSLD Lionel-Émond said that “The CISSSO, INSPQ and MSSS failed in their duty to protect healthcare professionals’ physical and psychological integrity. I no longer have faith in these bodies, as they prefer to steer blindly rather than apply simple principles of precaution.”

As a result, healthcare professionals at the CHSLD and the Syndicat des professionnelles en soins de l’Outaouais (FIQ-SPSO) team took matters up with the CNESST. They filed an official complaint after their first colleague died and a CNESST inspector was finally obliged to go on site. However, in the inspector’s June 2020 report, she denied that the employer had shown negligence. The inspector blindly followed the INSPQ’s recommendations and deemed the measures in place sufficient. And yet, by that time, a large number of healthcare professionals had already contracted COVID-19 and one of the workers had died.

The members, supported by their union, didn’t stop there. They decided to contest the inspector’s report. A methodical inquiry was conducted in close collaboration with the care team. The union developed data-collecting tools specifically for COVID-19 outbreaks in CHSLDs. The healthcare professionals took rigorous union action in collecting data and built a case that was solid enough to obtain a review of the CNESST’s inspection report.

For the FIQ’s legal team, obtaining specific and reliable information from the institution was key to building a good case. What may seem obvious to healthcare professionals isn’t as clear to a judge who isn’t familiar with healthcare environments. And so, by closely collaborating with the local union, lawyer and FIQ union consultant, healthcare professionals were able to provide clarifications on the organization of work, impacts of the pandemic on care, the layout of the rooms and toilets, patient mobility, members of the team, etc.

This challenge filed against the CNESST’s inspection report at the CHSLD Lionel-Émond, alongside similar actions taken by the Professionnelles en Soins de Santé Unis (FIQP-PSSU) in other institutions, were finally brought before the Administrative Labour Tribunal (TAT) in December 2020. The work to document the situation at the CHSLD Lionel-Émond played an important role in the ruling of this case. Healthcare professionals and other healthcare workers’ statements before the TAT were also essential.

In March 2021, the TAT deemed the conclusions in the inspector’s report invalid and stated that public health did not have the authority to determine the protective measures for care units. The TAT ruled that the CISSS de l’Outaouais was obliged to provide protective equipment against airborne transmission (N95 masks) to all health workers working in hot and warm zones.

ON THESE GROUNDS, THE ADMINISTRATIVE LABOUR TRIBUNAL: (…)

 ALLOWS in part the appeal filed by the Syndicat des Professionnelles en Soins de l’Outaouais-FIQ (FIQ-SPSO), the Union;

ALTERS the decision of the Commission des normes, de l’équité, de la santé et de la sécurité du travail rendered on July 16, 2020, following an administrative review;

RULES that the Employer Centre intégré de santé et de services sociaux (CISSS) de l’Outaouais (Centre d’hébergement Lionel-Émond) must provide all workers working in warm or hot zones with residents who have or are suspected of having COVID-19 with an N95 respiratory protective device;

RULES that the Employer Centre intégré de santé et de services sociaux (CISSS) de l’Outaouais (Centre d’hébergement Lionel-Émond) must provide all workers who have to wear an N95 RPD with a Fit-Test; (…)” (unofficial translation)

This TAT ruling was decisive for the whole health and social services network because the CNESST was obliged to quickly change its position on the necessity of wearing N95 masks due to airborne transmission.

This victory was made possible by the collective action of healthcare professionals at the CHSLD Lionel-Émond, who decided, with their union, not only to get the CNESST to intervene, but also to continue the fight by challenging its inspection report. The data collected by the healthcare professionals, with the help of the union team, provided the TAT with decisive proof and was pivotal in the resulting legal victory in March 2021. The union action of the healthcare professionals at the CHSLD Lionel-Émond helped to protect all healthcare workers in Quebec who now have access to N95 masks in warm and hot zones.

Access to respiratory protection in warm zones—the action of Lanaudière healthcare professionals

From the outset of the pandemic, healthcare professionals at the CISSS de Lanaudière faced several outbreaks. When healthcare professionals contacted the CNESST, before April 2021, it was unfortunately systematically echoing the employer’s arguments. In this case, the CISSS de Lanaudière was refusing to be accountable for its lack of organization in dealing with the crisis. It claimed that the responsibility for the outbreaks fell primarily to the employees who, it claimed, did not follow the infection prevention and control rules (IPAC). However, at the same time, the employer was refusing to provide healthcare professionals with respiratory protective devices.

The tables turned though in March 2021 when the TAT ruled that it was necessary to provide N95 masks or superior protection to workers in warm and hot zones. In April 2021, the CNESST finally corrected its position on the matter. Since then, it requires employers to provide N95 masks to all people working in warm and hot zones.

Just after the CNESST reviewed its position, there was an outbreak at the CHSLD Saint-Antoine de Padoue. Several healthcare professionals immediately contacted the Syndicat interprofessionnel de Lanaudière (FIQ-SIL) to denounce the situation. Despite the TAT’s ruling and the CNESST’s new position, some healthcare professionals were still being refused access to N95 masks in warm zones and the employer was not conducting fit tests. The employer alleged that the N95 mask wasn’t necessary in all warm zones, more so in hot zones or when healthcare professionals in warm zones were in contact with visibly symptomatic patients. As for fit tests, the employer claimed that it was obliged to provide the means, not the results. The employer believed its actions were sufficient. However, at the time of the outbreak in April, patients and staff tested positive in warm zones and the employer still refused to provide N95 masks.

The CNESST finally went on site. With the information provided by the healthcare professionals working at the CHSLD Saint-Antoine de Padoue, the union team was able to respond to all of the CNESST inspector’s questions and to counter the employer representative’s arguments. The union team conducted research ahead of time to prepare for the visit and provide the inspector with sources for in-depth union arguments.

Immediately after the inspection, the CNESST issued a corrective notice on the spot: the employer was ordered to immediately conduct fit tests for all healthcare professionals who had to wear N95 masks, including those in warm zones. This meant the employer now had an obligation to achieve results and had to demonstrate in a very short time that the fit tests were properly conducted. A few days later, the CNESST inspector confirmed in writing that, despite what the employer claimed, N95 masks were required in warm zones.

This victory was made possible thanks to the healthcare professionals who participated and contacted their union to denounce unacceptable situations. The preparation for the CNESST inspector’s visit was key to the inspector then issuing corrective notices and the employer correcting preventive practices. The CHSLD healthcare professionals played an essential role in the preparation.

Occupational health and safety is not only vital for construction and industry workers but for healthcare professionals as well. Some of the disastrous occurrences during the pandemic could have been avoided had occupational health and safety principles been followed over public health recommendations and if the precautionary principle had been applied. Employers’ disorganization and the shortage of personal protective equipment were largely responsible for the high infection rate among workers.

The FIQ and FIQP’s victory with the TAT would’ve clearly been impossible without the mobilization of the healthcare professionals from the CISSS de l’Outaouais who denounced the situation at the CHSLD Lionel-Émond. Once the TAT’s ruling was rendered and the CNESST’s directives adjusted, it took healthcare professionals’ mobilization to correct employer practices. As was the case for the Lanaudière healthcare professionals.

As a team, healthcare professionals can identify the risks they are exposed to. Of course, all workplaces have their share of risks. That said, healthcare professionals clearly normalize some risks because they have grown accustomed to them being part of the job. It is often the case for work overloads and employers’ systematic use of MOT.

Once the OHS hazard has been identified and assessed by the work team, it’s time to contact the FIQ or FIQP union. Then, it’s time to develop a collective action strategy together. The union has resources and expertise to guide teams of healthcare professionals who have to fight to make their workplaces safe. Moreover, the union can go before various tribunals with healthcare professionals’ messages: it can question the employer’s representative in charge of health and safety matters and call a meeting of the Joint Occupational Health and Safety Committee (CPSST). To increase the likelihood of success, union efforts must be supported by member mobilization and participation. The collective action of healthcare professionals is the best tool for getting the employer to take fast OHS action and consider the union and healthcare professionals as a stakeholder in reducing and eliminating risks.

Examples of collective OHS action:

  • Helping to collect data required for an eventual visit from a CNESST inspector.
  • Collecting signatures for a petition denouncing a risk to the employer.
  • Collectively participating in the CPSST handling the denounced risk. The CPSST is usually just for the employer and union.
  • Wearing a visibility object to denounce a risk.
  • Informing the public about the risk you are facing and the impacts on care quality.
  • Collectively demonstrating solidarity for colleagues who are fighting the work overload at other centres of activities in your facility. Examples: flash petitions, wearing buttons, distributing tracts to patients/visitors, collectively signing a letter addressed to the employer or local media, protesting in solidarity in front of the building, etc.).
  • Working with the union to prepare arguments for a discussion with a CNESST inspector.
  • Alerting our colleagues that there is a risk that is normalized but should be denounced.

What is important to remember about the FIQ and FIQP’s political and legal battles and the local collective actions described, is that when healthcare professionals show solidarity, they have the power to make their workplaces much safer. Occupational health and safety is both the employer’s and workers’ responsibility. To get employers to take action to improve OHS, healthcare professionals can identify risks, show solidarity, work with their union and identify solutions.