Inhuman patient ratios

The staff shortage is hitting CHSLDs hard, while employees find themselves with “inhuman” patient ratios, up to 155 residents for a single nurse in Estrie.

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“It does not make sense to end up with this quantity of patients there”, reacts Sophie Thériault, interim president of the local union of nurses of the Eastern Townships (FIQ). “A big drama is going to happen. It’s clear. ”

The patient-employee ratios in long-term care centers (CHSLDs) in Quebec are sometimes very high, noted Le Journal in an access to information request made in July.

About twenty residences have a single night nurse for more than 100 patients. At the CHSLD Youville in Sherbrooke, a nurse was managing 155 patients at night this summer. According to the Integrated Health and Social Services Center (CISSS) of Estrie, the workforce had been reduced due to vacations.

Night beneficiary attendants (PAB) also have more than 50 users in their charge.

“It’s completely crazy, the workload of these people, reacts Philippe Voyer, professor at Laval University, specializing in CHSLD ratios. It puts nurses at risk for their health and that of their residents. […] It is no longer defensible. “

Several factors influence a safety ratio, but Mr. Voyer believes that a nurse should not have more than 24 residents in charge (day or evening). As for the PABs, they should take care of five users.

However, our data shows that day nurses were managing more than 80 residents this summer.

“It becomes inhuman. They cannot provide the minimum of care, ”laments Françoise Ramel, president of the nurses’ union (FIQ) of the Center-Sud-de-l’Île-de-Montréal.

Falls, wandering, discomfort: night workers deal with all kinds of situations, and often on the run. When alone, the nurse has heavy responsibilities: assessing patients and deciding whether to administer medication or call the ambulance.

“I’m under stress all the time,” says a nurse.

According to Ms. Ramel, these already high ratios are not even always respected since absent employees are not replaced.

Despite everything, the Ministry of Health and Social Services (MSSS) does not impose a maximum quota of patients. CHSLDs must provide “sufficient staff to meet the needs of residents”, one writes. Several CISSS responded to the Journal that the ratios are adapted to the degree of autonomy of the residents.

However, the MSSS requires the presence of a nurse at all times, which is not the case at night in several CHSLDs on the North Shore, noted The newspaper.

The CISSS de l’Estrie refused the interview request of the Journal, but writes that the workforce meets the needs of the clientele. A return to usual ratios is expected shortly, despite the labor shortage. Thus, a second night nurse will be added to Youville and Leclerc.

The union retorts having been advised that the downsizing will continue this fall, and that other positions will be cut.

A promising MSSS safety ratio pilot project was carried out in CHSLDs in 2019, but it has not been sustained since.

Shortage in CHSLDs

Worst night nurse ratios

  • Youville (Estrie): 1 in 155 *
  • Leclerc (Estrie): 1 for 141 *
  • Champlain (Montreal): 1 in 136
  • Rimouski (Bas-Saint-Laurent): 1 for 128

Worst nighttime PAB ratios

  • East Angus (Estrie) : 1 for 71 *
  • Saint-Marc-des-Carrières (Capitale-Nationale): 1 for 55
  • Weedon (Estrie) : 1 for 51
  • CHSLD Alphonse-Bonenfant (Capitale-Nationale): 1 for 50

Worst day nurse ratios

  • MB Couture (Estrie): 1 for 85 *
  • Asbestos (Estrie) : 1 in 84 *
  • Farnham (Estrie) : 1 for 83 *
  • Sainte-Croix (Montérégie): 1 for 61

Source: MSSS, data in effect during the summer.

* According to a contingency plan, more employees will be added soon

The workload of a 27-year-old night nurse is so heavy that he admits to being continuously stressed by the task, and does not even have time to take a break to eat.

“I always have to be available. I don’t have a break, I have to eat at the station, ”says Kanhkana Tum, a young nurse who works at CHSLD Youville in Sherbrooke.

During the summer, the man was alone at night for 155 residents. A responsibility that generates a lot of pressure and a lot of stress.

“I got used to being on alert, not having colleagues to help me,” he says. I run all the time, I got used to it. It’s a beat. »

Moreover, medical emergencies are numerous, and the latter must intervene each time.

One observation: not all residents sleep at night in CHSLDs.

“We have fallers, so if something happens elsewhere, we have to stop to see if the other is correct. It’s more complicated when it’s on two different floors, ”he told the Journal, at the end of a shift of 12 consecutive hours of work.

Having recently returned from vacation, he admits that he is already exhausted by the task.

“When it rolls, it rolls! Patients see me with a haze in my head and know I’m in a hurry, he says. I like it, running, but I won’t be able to do this all the time. ”

Moreover, he does not know if he will be able to continue this work for a long time under these conditions. For the past week, a second night nurse has come to help her.

“Sometimes I’m tired. But I am lucky because I am an optimistic person, and I have a good team, ”he encourages himself.

Massive investments in human resources are necessary to improve living conditions in CHSLDs, claims a specialist professor, who also believes that technological tools should be used more.

“We must not burn all the money in concrete, we must invest a lot in human resources, insists Philippe Voyer, professor at the faculty of nursing at Laval University. The operating conditions, the attractiveness of the accommodation sector, it’s a disaster. ”

A specialist in the issue of ratios in residential centers for 20 years, Mr. Voyer has observed for several years to what extent the CHSLD network is underfunded.

“The political world does not realize the scale of the task, the long-term needs. When the Prime Minister says: “I don’t sleep at night because of the lack of nurses”, we’ve been saying that for 20 years! It’s not in two or three sleepless nights that he’s going to fix it. ”

In addition, this specialist is convinced that the addition of surveillance cameras and acoustic detectors in the rooms could improve the quality of care. He said, however, that technology should not be used to replace employees.

“It helps preserve sleep at night. We don’t wake people up for nothing because we tour, says Voyer. It also makes it possible to detect wandering, awakenings, and it prevents falls. ”

At the Ministry of Health and Social Services, we replied that a surveillance camera can be installed in the room of a resident who requests it when his condition warrants it (including to check the quality of care).

The invoice is paid by the resident or the CHSLD, depending on his condition. However, senior homes and CHSLDs will not automatically be equipped with such systems.

Also, Mr. Voyer notes that more efficient incontinence diapers can be used at night, to avoid waking residents unnecessarily.

According to him, the technological tools make it possible to make up to 16 tours in one night, rather than two or three “in person”.


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