Source: Kevin Crane-Desmarais/Twitter

On the evening of Jan. 16-17, 2023, the emergency room nurses at Maisonneuve-Rosemont Hospital (MRH) staged a sit-in and courageously refused to work under the unacceptable and dangerous conditions imposed on them by management. The increase in mandatory overtime and overwork due to staffing shortages had become intolerable. Management’s contingency plan for understaffing was endangering emergency room patients by critically overloading the nursing staff. Nurses recognized that the quality of care was being severely compromised to the point of creating a higher risk of death as a result.  

On top of this, the unit manager had created such a toxic atmosphere that ninety per cent of ER nurses signed a petition calling for her resignation. 

Hypocritically, the government and management responded by saying that they recognized the “difficulty of the situation” (in the words of Health Minister Christian Dubé), without providing any concrete solution. 

Collapse of the healthcare system

The Quebec healthcare system is in a deep crisis and the consequences are serious. We are seeing bed closures, delays in surgeries, constantly overflowing emergency rooms, and even emergency rooms closures due to understaffing. 

Some still blame the pandemic for the crisis, but these problems started many years ago. In fact, MRH nurses had already staged a sit-in in 2019 to protest the misuse of mandatory overtime. Since then, the problem has only gotten worse with no solution in sight.

On the contrary, the government has encouraged privatization. Its catastrophic management of the health network, including ministerial orders that allowed managers to cancel leave and vacations without notice, has caused thousands of nurses to quit the public sector to work for private placement agencies instead. The use of mandatory overtime has exploded since the CAQ was elected, even though it had promised to address the problem. In Quebec City, mandatory overtime increased by 75 per cent in the last two years.

Spread the struggle now!

In this context, it is not surprising that the sit-in at MRH found an echo elsewhere. Indeed, at the same time, nurses at the Jonquière Hospital were also staging a 15-minute sit-in to denounce their working conditions.

The struggle at MRH generated a wave of solidarity from other nurses. For example, nurses from the Cité-de-la-Santé Hospital in Laval sent them a solidarity letter that reads: “[We] want to show you our respect and support in the ordeal you have been going through for several months now. It is essential that we form a common front in the face of adversity and that is why our hearts go out to you.”

Two days later, on Jan. 19, 2023, Hudson Bay nurses, in the North of Québec, also held a sit-in, refused to work and threated to resign en bloc to denounce their working conditions. The work stoppage was declared illegal by the Tribunal admnistratif du travail (Administrative Labour Tribunal), showing that state institutions are not on our side. But it is clear that the nurses are ready and determined to enter the struggle, they only need a plan of escalation.

The day after the sit-in at MRH, hospital administration announced that the abusive manager who the nurses complained about had been removed from her position in the emergency room. This is a first gain that shows how much pressure health-care workers can put on the employer if they refuse to work. However, it is interesting to note that no one dared to call these actions by their name: refusing to work as a means of pressure is to go on strike. The use of strikes has been taboo for the Fédération interprofessionnelle de la santé du Québec (FIQ, the nurses union) leadership for a long time. It is not an accident that this spontaneous strike was not initiated by the union.

The struggle of health-care workers is not over and the movement must continue if we really want to improve working conditions and eliminate mandatory overtime. The FIQ must launch a call to extend the sit-ins and work refusals to the entire province, to demand an immediate end to mandatory overtime, an increase in salaries to at least match those of nurses working for private placement agencies, as well as self-management by the nurses themselves of schedules and shift assignments. This is in addition to the demands for double-time for overtime, and the implementation of safe nurse-to-patient ratios in all healthcare settings. There has never been so many registered nurses in Quebec, but they are either leaving for private agencies or leaving the profession altogether. Until such urgent measures are put in place, they will not return to the public sector and the crisis will continue.

However, given the government’s stubbornness, sit-ins and threats of mass resignations may not be enough. The FIQ leadership must abandon its opposition to strike action and launch an escalation of pressure tactics up to and including a general strike. 

Socialist solutions for the healthcare system

Ultimately, to stop the constant deterioration of the health-care system, we must end the privatization of healthcare once and for all.

This requires the nationalization of private institutions such as family medical groups, private medical clinics, seniors’ residences, etc.; as well as a massive reinvestment in the public health-care system to improve wages and working conditions. In order to abolish private employment agencies, significant improvements in the public network are required. This is the only way to stop the exodus of nurses to the private sector. 

Salaries must be massively increased and indexed annually to the cost of living. The FIQ is asking for a six per cent raise to compensate for wage losses due to inflation in 2022 and a four per cent increase over the next three years. These demands are particularly weak when one considers that the FIQ was demanding 21.6 per cent over three years during negotiations in 2020, well before the inflationary wave began. The current demands are not enough. As mentioned earlier, wage increases should at least aim to match the wages of nurses working for private agencies, normally between $65 and $75 an hour.

But we can’t trust the CAQ to make these improvements. Nurses and other health-care workers should have the power to control their workplaces and make the decisions to address overwork once and for all. 

Capitalist management of the health-care system, budget cuts, attacks on health-care workers and the increased privatization of healthcare are the main causes behind poor working conditions. This is clear not only in Quebec, but also in the rest of Canada, the United States and Europe. Everywhere, governments are laying the groundwork for the privatization of health-care systems by under-funding and sabotaging them, and this leads to a deterioration of working conditions for health-care workers.

The struggle against mandatory overtime and for good working conditions in healthcare is part of the general struggle against privatization and against capitalism.