The recent economic report from the Montreal Economic Institute (MEI) paints a worrisome picture of the situation for nurses in this country. Like the Fédération interprofessionnelle de la santé du Québec–FIQ, the MEI notes the deterioration of working conditions, increased stress and mass departure of young professionals. These findings leave no doubt: our public healthcare network is facing a retention crisis. Where our paths diverge is on the solutions proposed.

The MEI is pleading for more flexibility, meaning further opening to the private sector, employment agencies and subcontracting. However, far from a solution, this approach worsens the current crisis. It is precisely because the government allowed for the multiplication of private agencies that the public network has been drained of its staff. It created an artificial shortage: we don’t have a lack of professionals, they are just leaving a system that has become unbearable.

In reality, there have never been more qualified nurses in Quebec, but too few choose to stay. The explanation for the exodus to the private sector and to other provinces is mainly due to untenable working conditions: overload, mandatory overtime, lack of recognition, lack of stability, poor work-personal life balance.

In 2023-2024, 16.4% of nurses and nurse clinicians left the network in their first year of practice despite restrictions on the use of agencies. As long as we don’t tackle the root of the problem—the feeling that you can no longer provide care the way you see fit— no measure will keep healthcare professionals from leaving.

The FIQ promotes a structural approach, proven effective in systems that are experiencing the same challenges as in Quebec: the implementation of safe healthcare professional-to-patient ratios. This measure isn’t an ideological demand, but one that is founded on evidence and scientific data.

In April 2023, British Columbia became the first province to introduce minimal ratios that can be increased, including nurses and licensed practical nurses, to counter the shortage and improve working conditions. The agreement between the union and the Health Ministry stipulates gradual implementation supported by a budget of $750 million by 2026, plus $237 million for retention and recruitment.

Since spring 2024, Nova Scotia set in its collective agreement a maximum number of patients per nurse in hospitals, using an approach based on nursing-care hours per patient per day. Over 1,000 nurses from other provinces have already obtained a temporary permit to work there.

International experiences are similar. In California, since ratios were adopted in 1999, the number of nurses has increased by 10,000 per year, the rate of vacant positions has dropped by 69% and staff turnover has dropped below 5%. In Australia, the announcement regarding the implementation of ratios was enough to bring 2,300 nurses back from the private sector in one year, and 7,000 over six years. These numbers speak for themselves: ratios attract, retain and stabilize staff because they promise time and fully staffed teams for providing care.

The results from the pilot projects carried out in Quebec confirm these trends. There has been a decrease in stress and burnout, an improvement in the work environment and sense of pride, and a marked decrease in short-term absenteeism, which fell from 59% to 28% at Sacré-Cœur Hospital. There has also been an increase in the position occupancy rate, from 68.5% to 78.5% at the Hull Hospital, and, most importantly, a 15% increase in the intention of professionals to remain in their positions.

But the benefits of ratios do not stop there: for patients, they translate into fewer falls, medication errors and infections, faster recovery and better maintenance of independence. In care units where ratios are applied, patient satisfaction increases significantly, as does the perceived quality of care. These positive effects are felt throughout the entire network: fewer avoidable hospitalizations, fewer complications and more efficient use of public resources.

These results are clear: ratios are key to attracting and retaining staff. They ensure sustainable workloads, safe and high-quality patient care, and restore dignity, stability and hope to healthcare professionals so that they can provide proper care.

Rather than focusing on privatization or deregulation, we must invest in sustainable, promising and essential solutions: safe ratios, which benefit both patients and those who care for them. That is how we will truly restore hope in our public network.

Julie Bouchard

President