Published at 1:12 am. Updated at 5:00 am.
(Quebec) One of the Legault government’s crisis team’s most important solutions to relieve the burden on emergency rooms is failing in the east of Montreal. Two nurses slammed the door on the new IPS clinic because of issues with “quality and safety of care.”
In November 2022, emergency rooms in the greater Montreal area are bursting at the seams with the resurgence of a wave of respiratory viruses. The situation is such that Minister Christian Dubé orders the creation of a crisis team to find quick solutions.
Among the three main measures announced is the creation of specialized nursing clinics (IPS), which will be able to treat less urgent cases.
The CIUSSS de l’Est-de-l’Île-de-Montréal quickly spoke up, so that three weeks later the very first IPS clinic in Montreal was inaugurated in record time at the CLSC Olivier-Guimond.
PHOTO EDOUARD PLANTE-FRÉCHETTE, LA PRESSE ARCHIVE
The Minister of Health Christian Dubé
Minister Christian Dubé visits it and speaks of “a small success”.
A year later, however, the picture has darkened. La Presse has learned that the only two full-time IPSs left the CIUSSS de l’Est-de-l’Île-de-Montréal last week.
“We faced issues that impacted the quality and safety of care. “Unfortunately, these problems, which were not taken seriously, are the reasons that led us to the decision to leave the company,” write the exit owners.
The letter, aimed specifically at management, was sent to La Presse by the Union of Health Professionals of the East Island of Montreal, affiliated with the Interprofessional Health Federation of Quebec (FIQ). We contacted the two ex-employees who did not want to grant us an interview.
“We learned the news with great sadness […] Because somewhere it is a project that we believe in very much,” explained the president of the union, Denis Cloutier.
The CIUSSS also says it welcomed the resignations of the two nurses “with regret.” “The two positions left vacant by these resignations are currently being advertised and will be filled as quickly as possible,” writes Christian Merciari, deputy CEO of the establishment.
“While the positions are filled, there is a slowdown in clinic activity,” he added. However, services continue to be offered to the population and the CIUSSS-IPS team “has mobilized to ensure availability and cover the transition period”.
These resignations come as emergencies come under renewed pressure due to the return of respiratory viruses and days of strikes that have crippled the network.
In the east, emergency room occupancy at Maisonneuve-Rosemont and Santa Cabrini hospitals was at 135% on Wednesday.
Harsh criticism
The nurses’ letter strongly criticizes the facility where they worked for several years: “In the past, IPS was proud to work for the CIUSSS.” [de l’Est-de-l’Île-de-Montréal]“We have lost the feeling of belonging and trust in the organization,” they write, adding that they “always believed in the project” despite the “obstacles” of the last few months.
At the heart of their complaints: the lack of equipment for patient assessment, the “almost non-existent” clinical support, the “difficult” management of the staff team and “the lack of stability of the staff”.
They particularly regret that managers, auxiliary nurses, administrative staff and several IPSs were on hand “sporadically” and that “all auxiliary nurses who worked in the clinic” came from private employment agencies.
There is no stability of the management team and nursing team and there is a lack of equipment, which hinders the provision of high-quality and comprehensive care to users.
Excerpt from the letter from the two retired nurses
The two IPS also note a “gap between management/ministry requirements and the reality on the ground.”
For example, they emphasize “the lack of representativeness of IPS in meetings about decisions related to practice in the IPS clinic” and “the need to cover inconvenient opening hours” given their small number.
The nurses write in detail that they “presented oral and written solutions to their supervisors on numerous occasions.” With their letter they want to enable “an improvement in the situation in the IPS clinic” and make the “environment attractive” and “safe”.
A “new creation”
For its part, the CIUSSS emphasizes that IPS clinics “remain new creations”. The facility explains that its teams will work to “improve this young model and ensure access to services.”
Since opening, our managers and consultants have been involved daily in solving problems and improving operations.
Christian Merciari, Assistant to the CEO of the CIUSSS de l’Est-de-l’Île-de-Montréal
He also remembers that “this clinic was founded in connection with the overload of emergency rooms.” This was done in the “context of a staff shortage” and the situation “always requires adjustments”.
PHOTO PATRICK SANFAÇON, LA PRESS ARCHIVE
The president of the Quebec Interprofessional Health Federation, Denis Cloutier
For Denis Cloutier, “the priorities were not set correctly” to ensure the long-term success of the IPS clinic, which was “a little left to its own devices” because too few positions were created at the start of the project. The union called for the creation of four to six full-time IPS positions.
Mr Cloutier criticizes the Legault government’s decisions, which he says appear to have been taken in response to crises, such as last year with the unity created by Minister Christian Dubé. “What is actually happening to this crisis team? “, he asks.
“What was the goal? Respond to media pressure or really improve access to the front? It seems that it is actually a reaction to what happened and that a few months later there is no follow-up,” complains Mr. Cloutier.
According to the latest budget presented by Minister Eric Girard, Quebec plans to create 23 new IPS clinics within five years, including six in 2023, to improve first-line access. The establishment of these clinics requires a total investment of 395 million by 2027-2028. Six IPS clinics were built in 2022.
Learn more
1314 Number of specialized nurse practitioners (IPS) in Quebec as of March 31, 2023. NPs hold a master’s degree and a diploma in a specialty of their choice.
SOURCE: Order of Nurses of Quebec