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System Failure: The Reality of Being an ER Nurse in Québec

Christopher Boa

Science and Environment Editor

Image VIA Chiasson, Paul from The Canadian Press.

If you happen to be on the sixth floor of Dawson’s B wing, you will more often than not encounter some students clad in blue. This area happens to be one of the few at the College where classrooms and laboratories are mainly devoted to our hands-on Nursing Program. Here, students are stimulated through their exposure to real clinical settings and professional equipment early on. But how well does this fuelled fervour hold up in light of the management crises and subpar working conditions that plague healthcare institutions across the province?

On the 16th of January 2023, the nurses of Hôpital Maisonneuve-Rosemont staged an overnight sit-in, effectively paralyzing its emergency room. The vast majority of its nursing staff had threatened to quit within the next few days if immediate changes were not made to its establishment.

This outcry came as no surprise to Mélanie Boisclair, a well-rounded nurse from the Laurentides region of Québec. “When I started as a nurse 25 years ago,” she says, “there was already a [labour] shortage, but it got much worse with time.” Having worked in both rural and urban medical establishments, she recalls that the province’s public healthcare system was already in “really bad shape” long before the COVID-19 Pandemic. The shutdown of this East-End ER was only a small fissure in the system’s greater framework, whereby managerial cracks and job vacancies penetrate as deep as the foundation.

With experience in the emergency room, Ms. Boisclair asserts that the working conditions at Maisonneuve-Rosemont “must have been extreme for the staff to make such a drastic decision,” as they are trained to be fully aware of the dangers that any shortage of caregivers in the ER poses on both the patients and the nurses themselves. Reducing the emergency nursing staff exponentially increases the likelihood of serious mistakes occurring “due to fatigue,” as well as “the risks of being harmed” on duty. “When nurses have to decide which of their patients is more endangered to prioritize their care, it’s insanely stressful,” she adds.

Nevertheless, the mediocre working conditions that underlie demonstrations such as this sit-in are by no means the exception; they are the rule. Not even the province’s private sector is exempt from the labour shortage. As ERs, among other departments, acquired certain notoriety as being extremely busy and disruptive to the life of their employees, they became “less attractive options for nurses to apply to.” This gradually culminated in the vicious cycle of applicant hesitancy toward such underserved nursing positions that we observe today. Consequently, Québec boasts a virtually insatiable amount of job opportunities in this profession, a reality that may not necessarily have positive implications for our prospective nurses at Dawson.

“When I first started, I was passionate and young,” shares Ms. Boisclair regarding her tenure in Québec. “Even if it was a really busy and unstable department, I loved it. I learned a lot.” These words surely resonate with the passionate, blue-clad Dawson students that experience the realities of local healthcare institutions as a part of their third-year internship. As the years progressed, however, a lot of Ms. Boisclair’s colleagues began to transfer over to the Ontario healthcare system. In addition to their proximity to the provincial border, these employees were enticed by a policy that capped the patient-to-nurse ratio at 5:1, half the maximum amount allocated to each nurse in Québec hospitals at that time.

That was ten years ago.

In today’s post-pandemic world, Ms. Boisclair admits that “the shortage of nurses [has become] as bad in Ontario as it is in Québec” to the point where a significant number of her colleagues have left the profession altogether. Despite this new reality, she explains that she ultimately decided to make the switch to the Ontario system. “The context in my facility was getting worse,” she explains. “[There were] a lot of service cuts, enough to scare me for the future. So I decided to leave my Québec job and never regretted it. The salary was and still is substantially higher, the conditions were much better at the time, too.”

Even if the situation has also deteriorated in Ontario in recent years, Ms. Boisclair shares the ways in which their healthcare system has made innovative progress to lessen the load on nurses, particularly those working in emergency units. “The hospital where I work was very proactive with new methods to relieve the waiting time in ER, [such as] by putting up a respiratory virus clinic,” she says. “Also, when there is a car accident and the weather conditions are good, there is a company named ‘ORNGE.’ They work with the 911 line and can fly a helicopter directly to the accident site to transfer the patients to a trauma facility without having to occupy another emergency room. It decreases the time between the accident and access to acute care. These are just a few examples where Quebec could learn how to help the health system [function more efficiently].”

Choosing between working in Québec or beyond may be a decision Dawson’s soon-to-be graduated nurses have to inevitably make. Unfortunately, without a government-level reevaluation of the entire healthcare system, we can only expect more retaliatory measures from emergency rooms province-wide until innovative changes benefiting both the patients and their nurses are implemented here, too.



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