Interview with Régine Laurent: In defence of a public system serving patients

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      Mehrzad Nicholas GhadiriNicholas Ghadiri

      Interview with Régine Laurent: In defence of a public system serving patients
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      Régine Laurent

      On December 1, Régine Laurent will turn the page on eight years as president of one of the largest unions in the Quebec health system, the Interprofessional Federation of Quebec Health (FIQ) and its 75,000 healthcare professionals, including nurses, licensed practical nurses, respiratory therapists and clinical perfusionists.
      A nurse since 1980 at the Santa Cabrini Hospital in Montreal, Laurent quickly took on activist roles, including secretary on the executive committee of the FIQ from 1991 to 2001, and leader of the Interprofessional Alliance of Montreal, a union affiliated with the FIQ, from 2005 to 2009. She became president of the FIQ in June 2009 during the H1N1 pandemic, a time when the government was questioning whether it should force health professionals to be vaccinated.
      Later that year the FIQ began tough negotiations to renew its collective agreement, seeking working conditions that would, among other things, stem the flow of nurses from the public system to private placement agencies.
      Has Quebec’s healthcare system improved since 2009?
      I can not say it is healthier. I do not see anything for the patients or the healthcare professionals in the reforms of (Quebec Health Minister) Dr. Gaetan Barrette. Take the example of grouping services: It’s one thing to do it on the Île-de-Montréal, where everything is relatively close. It’s another to bring it to a region like Abitibi-Témiscamingue (in western Quebec, along the Ontario border). The government will tell us there are no cuts in services, except that it is not the same for an 80-year-old to travel from Amos to Rouyn-Noranda (more than 100 km) to get a service she used to receive at home.
      One of the objectives of health reform in Quebec was to reduce the bureaucracy …
      That’s what the government sold to the people. On the management side, the situation has only got worse. … Are patients seen more quickly? No. Is the wait in the emergency less than an hour? No. The state of the CHSLD (long-term care centres) is a shame. The only thing that has progressed is the remuneration of the doctors. …
      The public health system is emptied for the benefit of things like family medicine groups and superclinics, which we pay as taxpayers, but over which we have no control.
      What should be done by the government?
      Rather than embarking on reforms that only benefit the private sector, the healthcare system should have been stabilized. For example, by planning the workforce (care professionals). It is not normal for 50% of the workforce in a 24-hour healthcare network to work part-time. There is no shortage, only bad management.
      In addition, we proposed different ways of overcoming one of the major problems of the network, namely accessibility, by setting up proximity clinics where nurses could work independently but in partnership with physicians. However, the medical federations do not want it.
      We must also move from a system that manages the disease to a real health system. This requires an investment in prevention, which is not just about a few TV campaigns. To do this, it would take politicians who are able to see (10 or 15 years ahead).
      There has been recent media talk of abuse of power by some people in positions of authority. Do you see this in healthcare?
      I can not speak of sexual harassment or other such abuse, although I am sure there is.
      What I see, however, is organizational violence against the healthcare professionals. This form of intimidation places the obligations of employees, of these professionals, and their ethical obligations in contradiction, whereas the latter should always prevail. The effects are devastating and they have increased with the Dr. Barrette’s reforms, because the managers themselves are afraid of the minister.
      And how do we get out of this cycle of organizational violence that you describe?
      By resuming our clinical leadership, which is crushed by the system with the pressure to always “do more with less.” I remind the professionals that they have knowledge that allows them to exercise clinical judgment to treat patients.
      New professional responsibilities granted to some nurses seem to have difficulty getting off the ground. Why?
      There are many reasons for this, and they are hard to understand, even for me. I know that the College of Nurses of Quebec is working hard on this issue. Here is an example of an anomaly: If a nurse changes care units within the same institution, she loses her right to prescribe and she must redo the process to get it again. It’s ridiculous. Does she have the right to prescribe autonomously or not?
      What is your opinion on the place of specialized nurse practitioners?
      This is unfortunate because they are underpaid for the training that is required of them and what they do in the health system. The presence of a specialized nurse practitioner in a clinical setting is pure happiness—both for patients and also for other nurses, who benefit from clinical support that speaks the exact same language as they do.
      With the increase in duties that nurses can now perform, should a Bachelor of Nursing degree be the entry standard for the profession?
      There would be a lot to say on this topic! I am still angry at the government and the Nursing Emerging Education Task Force that it set up in 2012, whose conclusions were in favour of raising the standard of entry to the profession.
      In Ontario, nurses with some experience were reclassified. Forget this type of investment in Quebec! If the government wants one day to move forward with this project, let it set the conditions and answer our questions: How can you make the transition? How can you guarantee access to training for nurses in every region? How can you ensure a place for university students?
      After you leave the presidency of the FIQ, what do you plan to do?
      I will not go into politics! My mother has always said that a “no” with a point is a complete sentence. I am officially going to retire from the Santa Cabrini Hospital. I intend to continue my contribution to the House of Haiti, a community organization for asylum seekers. I would also like to get involved with the Maison Bleue, which helps pregnant women and their families living in a vulnerable situations. I love newborns. I’m always told that I spoil them too much but babies can never be spoiled! I will also remain an activist.
      This interview was originally conducted in French.

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