Nurses: No to TSO, want ratios installed

Shot of a young female nurse looking stressed out while standing at a window in a hospital

It happens every year, and some are worse than others.

The domino effect that unfurls as emergency rooms and clinics overflow with seasonal patients, nurses verge on burnout pleading for help, and healthcare authorities often demanding that those manning the front lines double their efforts.

It’s travail supplémentaire obligatoire, or TSO, a dreaded acronym for overworked staff crushed beneath the workload. TSO, or mandatory overtime is the bane of Quebec’s nursing population, prompting walkouts, refusals, and chronic anxiety among this vital cadre in the healthcare network.

Quebec nurses have had enough and the Fédération interprofessionnelle de la santé du Québec is calling on Quebec health minister Danielle McCann to move forward in the deployment of healthcare professional / patient ratios throughout the health network.

“The situation currently prevailing in Quebec emergencies shows that traditional management methods are no longer enough” said FIQ President Nancy Bédard in a statement. “While there is a broad consensus as to the beneficial effects of the ratios, it is hard to understand why the Ministry of Health and Social Services (MSSS) is not already hard at work to implement them as a priority.”

The call comes after it was reported ambulances were being turned away from east-end Maisonneuve-Rosemont Hospital, where growing numbers of patients billeted on stretchers in hallways has become more commonplace than ever before. In fact, as flu season peaks, frontline staff are being told to work double shifts and, in some cases, longer, a formula the union says endangers nurses and patients.

For many, coming to work for a 16-hour shift under stressful conditions, and in many cases short-handed, a sure-fire bludgeoning on morale, efficiency and overall quality of care, especially if it happens a few times per month. A nurse at MR told reporters gathered there earlier this month that “a strange thing happens. We cross a line in our head where we look at our patients and then ourselves and our family and realize we have to make a choice that no one else gives a damn about.”

Forced overtime and the burden faced by nurses is not a new issue. In 2018 some nurses at Laval’s Cité de la santé hospital refused to begin their appointed schedules without their shift colleagues present, thus a result forcing other staff to complete a second consecutive shift, many complaining that they were on the verge of sheer exhaustion and burnout.

Representing some 76,000 nurses, the FIQ is calling for the government to implement what it says are proven solutions found in 16 ratio projects launched in 2018 in several care categories and proving successful with available staff working in safe and supportive conditions. Of the 16 ratio projects cited, 13 local joint committees concluded that “ratios are relevant with impacts beneficial to both health care professionals and patients.” The MSSS says it has spent hundreds of millions to reduce workloads in the network and that analyses on the pilot projects are not yet completed.

The union also says ratios have been studied internationally and supported by years of scientific documentation. “Wherever safety ratios have been implemented, they have helped attract health care professionals, improve the quality and safety of patient care, and ensure better patient efficiency.”

The FIQ wants an end to forced overtime, already pledged by the government, and legislation limiting the number of patients cared for by a professional care team, with a plan for 2020 to address the most deplorable situations – emergency rooms and long-term care centres. “This is how we will attract health care professionals to the system, keep them healthy and allow them to provide quality patient care” said Bédard. “It won’t happen by snapping your fingers and it will take time, but there’s not a minute left to start this change.”

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