“The conditions that we work in are the conditions that the patients are in”

The Fédération Interprofessionnelle de la santé du Québec (FIQ) is one of the last remaining Quebec public sector unions which has yet to ratify an agreement with the CAQ government following last year's Front Commun strikes. The fall and winter of 2023 saw over 480,000 public sector workers in the province go on strike in one of the largest labour actions in North American history.

On March 19, the FIQ, which represents more than 80,000 nurses and healthcare workers, announced a tentative agreement had been reached with the Quebec government, the content of which has not yet been disclosed by either side. Union members and patients alike will be paying close attention to one issue in particular: that of compulsory transfers. At the negotiating table, the CAQ has been pushing hard to require nurses to accept reassignments to units and institutions where they may have little or no experience.

To understand more about compulsory transfers and what they mean for nurses and patients, North Star spoke with Natalie Stake-Doucet, a Registered Nurse and Assistant Professor of Nursing at the University of Montreal.

"There's a lot of fear and worry regarding that particular measure, and it's one of the main reasons why nurses haven't settled yet with the government. [...] When you don't have experience in a certain specialty, it's really dangerous to force somebody to go there without any orientation or any kind of preparation beforehand, and we don't want to work in dangerous conditions. We realize our work is hard enough as it is. We want to have the tools that we need to be able to offer proper care."

A major message of the Front Commun was the link between working conditions in the public sector and quality of services for the public. Stake-Doucet had much to say on this subject: 

"For me, this dichotomy that the government is really pushing that somehow our working conditions are one thing and the care for patients is another thing is very frustrating because the conditions that we work in are the conditions that the patients also are in. So, any demands that we make on our working conditions are also demands that we make to be able to provide better care. [Compulsory transfers] are terrible for patients because when you force people to move around, you lose continuity of care, and you lose stability in teams, and you lose a lot of experience."

Stake-Doucet explained that compulsory transfers have a direct impact on the wellbeing of nurses. She describes working in an environment which doesn't provide nurses the tools to do their jobs well as "painful and distressing" and says that it leads to burnout and mental health issues. This is a major issue in a profession that has such trouble retaining workers. 

As nurses leave the profession, "[Healthcare institutions] are forced into this cycle of attrition, basically, where there's bigger and bigger nurse turnover, and they're consistently in a state where they don't have enough nurses for every shift. That's because nurses are leaving. It's not because there aren't enough nurses. [...] Quebec has never had so many registered nurses in its history. Our problem is not with an absolute number of nurses. It's our complete incapacity to retain nurses within the public health care system."

The effect of mandatory displacement of workers are already well-known to Quebec's nurses, many of whom were deployed to unfamiliar work environments in the early days of the COVID-19 pandemic. 

"I knew people who had barely been nurses for a year or two in pediatrics or the new neonatal ICU, and then they were forcibly transferred to a long-term care home where they had to be head nurse," recalled Stake-Doucet. "These were nurses with no management experience, no experience in geriatrics, which in and of itself is a specialty. A lot of those nurses aren't nurses anymore in the healthcare system. That was brutal for a lot of us."

She believes the deterioration of the health care system and the proposal of harmful measures like compulsory transfers is a result of the government not listening to the people who know the system best: nurses. "If you don't have the perspective of the biggest group of healthcare professionals in the healthcare system, then it's almost impossible to make the correct decisions with taking everything into account." 

Given the serious issues on the horizon for health care and its workers, Stake-Doucet has noticed a renewed sense of struggle and resistance among nurses. "I've really seen a change in my colleagues and even my students in terms of the value they give themselves and the worth that they feel that they have for the healthcare system. [...] I think the pandemic has changed a lot of our fears and worries into anger, and I'm very for leaning into that anger, because it is righteous."