Six months after the last collective agreement between Quebec and public-sector nurses expired, strike talk is ratcheting up in the province’s largest nurses’ union.

The Fédération interprofessionelle de la santé du Québec (FIQ) representing 80,000 workers has been in talks with the provincial government since January to work out a new agreement, where it hopes to make big gains for nurses in terms of salary, workload, and work-life balance. But despite the growing number of nurses leaving the public sector for better working conditions elsewhere, FIQ president Julie Bouchard says that Quebec has not shown a willingness to compromise on key issues.

“We are past the point of putting bandaids on the problems. Right now, we need real political will to make a move in the healthcare system,” Bouchard says.

The last collective agreement expired in March of this year.

FIQ members entered into a new phase of pressure tactics this month, holding a demonstration to disrupt rush-hour traffic in downtown Montreal and in the city’s metro system on September 6, protesting the lack of progress in the negotiations. About 500 nurses, nursing assistants, respiratory therapists and clinical perfusionists took part in the mobilization, handing out leaflets and wearing black uniform tops bearing the negotiation slogan “Y’a des limites” (There’s a limit).

Members are being encouraged to wear these uniform tops on the job every Tuesday, and the FIQ’s communications with its members allude to a possible strike in the fall. The Administrative Labour Tribunal approved a list of essential services that will be required to keep running should the union strike.

“Our members are telling us that they won’t accept the unacceptable,” Bouchard says.

“There are two choices: either the government has a real desire to work with us to find a solution that is beneficial to the 80,000 care professionals in the public health network, or they simply decide to say ‘We won’t get along.’ At that point, the feedback from our members is that they are ready to go as far as the ultimate pressure tactic: a strike.”

The union’s demands include an initial six per cent salary increase followed by a 12 per cent increase over three years, double pay for overtime hours, implementing a law on safe healthcare professional-to-patient ratios, a mechanism to gradually eliminate the use of labour from private-sector agency workers, and bringing an end to mandatory overtime, barring serious and exceptional circumstances.

“Mandatory overtime is used as a management method now to compensate for the shortage of healthcare professionals that has plagued the system for a very long time. What that means is that nurses, instead of doing normal 8-hour shifts, they regularly do 16-hour shifts,” says Bouchard.

Indeed, nurses say that the worsening staffing shortages are making bad conditions worse, prompting a cycle in which more and more nurses think about getting out of the public sector altogether.

Bouchard says that the province’s counter-offers, such as a roughly 9.5 per cent salary increase over five years, are not accepted by FIQ members, and compromises will be needed on the government’s part to satisfy a burnt-out workforce.

A healthcare system on the brink

“It feels like a bit of a sinking ship situation,” says Elle (not her real name), a nurse working at a hospital in Quebec’s public healthcare system. She asked to remain anonymous out of fear of reprisal at her place of work.

“People are leaving all the time, the whole hospital is hemorrhaging nurses.”

Elle says that she and her colleagues discuss how the job has changed: the patients come in sicker now and the nurse-to-patient ratio has grown over time, adding significant stress. Meanwhile, salaries have not kept up with inflation.

“I can’t have a job that’s this hard and then come home to a life of financial worries too,” Elle says. “It’s not worth the impacts on my own health.”

Many of those who leave the public sector find work at one of the private agencies, where they get a better salary, nights and weekends off, and increased scheduling flexibility. The public healthcare system has been bringing agency nurses into hospitals and clinics to fill the gap, creating an environment where public workers and private workers have different salaries and working conditions within the same workplace.

“I don’t blame them, because the conditions are just so bad and you’re so underpaid in public. At some point, you’re not a martyr. You do have to think about yourself too,” says Elle.

Quebec tabled Bill 10, “an Act limiting the use of personnel placement agencies’ services and independent labour (IL) in the health and social services,” earlier this year, which passed in April. The FIQ welcomes the focus on reducing this practice but wants more effort put in to eliminate it entirely.

“There’s always another person to see, there’s always another person waiting for help or medication. If you’re not seeing a nurse in a while, I only ask that you assume that’s because we’re with someone else,” says Beth (not her real name), a nurse in a hospital in Quebec. “We’re trying our best with what we have.”

Beth also asked to remain anonymous to protect her employment.

“I worry that’s the whole point of letting the public system fall like this. I don’t know if the government wants us to go all private and become a private health care system, but it’s too easy I find to just go work for private,” Beth continues.

In a written statement to Ricochet, President of the Treasury Board Sonia LeBel, who is holding the negotiations with FIQ, said that she is hopeful negotiation talks can be sped up to find a solution as soon as possible.

“We are talking about more flexible and predictable schedules and more leave for full-time nurses. We also suggest schedules with enhanced salaries for those who voluntarily choose to work from Friday to Monday (unfavourable shifts),” reads her statement.

“These are concrete, realistic and quick to implement, but above all: they meet important union priorities.”

Strike talk begins

Emergency department nurses staged a walkout at Maisonneuve-Rosemont Hospital in Montreal in January, protesting the hospital’s use of mandatory overtime. Emergency services were reduced as a result and the head of the department was reassigned.

“Those nurses were a big inspiration for sure. They’ve had enough, they need people to know that they’ve had enough and they can’t continue to work in these conditions,” says Beth.

Bouchard says nurses are prepared to follow that trend if the situation at the bargaining table doesn’t improve.

“We want to ensure that the entire population of Quebec has access to health care and, above all, to safe, quality care. But we also want to ensure that those who care for people on a daily basis have interesting working conditions to be able to do so, creating attraction and retention. For that, we may have to go to the ultimate means of pressure. It’s not just for us, it’s really for the people.”

But Elle is worried that the public won’t be so understanding if nurses resort to striking.

“As nurses, it’s harder for us to fight for our own wage increases,” she explains. “If you walk off the job, you’re going to get criticized as an evil nurse who abandoned her patients. So it’s not so easy for us to fight for our own wage increases. But if the public doesn’t start caring about that, then we’re just going to run out of nurses.”