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FIQ (Fédération Interprofessionnelle de la santé du Québec)

Message from Isabelle Groulx, FIQ Vice-President and Political Officer for the Occupational Health and Safety Sector

Healthcare professionals are in the best position to identify the risks and dangers in their workplace. However, far too often problems encountered in the field are not seen as occupational health and safety risks. Just think of long work hours, understaffing, and workplace violence. These problems are often addressed by a union process – work is done on the organization of work, grievances are filed and mobilization planned – however, they are rarely approached from an OHS risk prevention perspective.

For the 2023 OHS Week, we would like to highlight the OHS aspect of problems that healthcare professionals face in the field.

In 2023, the organization’s top priority is provincial negotiations. Our demands essentially depend on the resolution of these major problems, which are encountered on a daily basis in care settings. For healthcare professionals, it’s clear that the government and employers must do something about them now. Throughout negotiations, healthcare professionals are mobilized and ready to fight for gains. 

We want to take advantage of healthcare professionals’ interest in these issues and approach them from an OHS perspective. That’s why the theme of the 2023 OHS Week is inspired by the negotiation slogan, “There’s a limit!” From an OHS point of view, the key to prevention is “Knowing how to set limits.” Setting limits is a collective process. It is by being united that healthcare professionals can participate in identifying OHS risks and seeking solutions that the employer should use.

We have identified a number of issues that are experienced on an almost daily basis, such as long work hours, understaffing and violence. The aim is to inform healthcare professionals and raise their awareness, so that they can better manage these risks and work with employers to find ways of preventing them. When well-informed about the OHS nature of these problems, healthcare professionals will be able to denounce these situations.

We hope that the content of the 2023 OHS Week will inform, raise awareness among and equip healthcare professionals to better manage OHS problems encountered in the field. Let’s set limits and denounce situations that put our health and safety at risk.

Happy 2023 OHS Week!

À lire également

What are the advantages of dealing with problems from an
OHS prevention perspective?

In the field, the problems that healthcare professionals experience are often related to OHS. We have chosen to mainly focus on:

  • Long work hours
  • Understaffing
  • Workplace violence

The Act respecting occupational health and safety (AOHS) provides a framework for risk prevention work.

The objective of the Act is “to eliminate, at the source, dangers to the health, safety and physical or mental well-being of workers.” Prevention cannot therefore be limited to risk mitigation or compensation measures. In practice, this hierarchy of preventive measures must be followed:

Source
https://www.cnesst.gouv.qc.ca/sites/default/files/documents/outil-didentification-des-risques.pdf

OHS is not just about physical risks! Protecting psychological integrity is also part of the prevention process. These are the types of risks that are often overlooked from an OHS perspective.

The AOHS specifies the employer’s general obligations. In particular, the employer must:

3° ensure that the organization of the work and the working procedures and techniques do not adversely affect the safety or health of the worker;
(…)
5° use methods and techniques intended for the identification, control and elimination of risks to the safety or health of the worker;
(…)
9° give the worker adequate information as to the risks connected with his work and provide him with the appropriate training, assistance or supervision to ensure that he possesses the skill and knowledge required to safely perform the work assigned to him;
(…)
16° take the measures to ensure the protection of a worker exposed to physical or psychological violence, including spousal, family or sexual violence, in the workplace. (…)

The AOHS also stipulates that workers have an obligation to “participate in the identification and elimination of risks of work accidents or occupational diseases at his workplace;”. Therefore, healthcare professionals must speak up about OHS!

Dealing with problems within an OHS prevention approach requires us to be proactive, collaborative, and diligent. In other words: we can’t drag our feet!

Long work hours

Unsurprisingly, many OHS risks are associated with long work hours. What’s more, accumulating several hours of overtime, even voluntarily, also entails its share of risks.

Fatigue

Long work hours cause significant fatigue among healthcare professionals. This fatigue is a health and safety risk. In 2019, the FIQ produced a document on fatigue prevention.

We understand that long work hours are more than just an inconvenience, they constitute a significant OHS risk!

Fatigue also:

  • Reduces our physical and mental functioning
  • Impairs our judgement and concentration, increasing risk taking
  • Lowers our motivation
  • Slows our reaction time

Significant fatigue increases the probability of having a work accident. Therefore, managing fatigue means reducing all other OHS risks.

For healthcare professionals, knowing how to recognize certain signs of fatigue is essential for setting limits. The most obvious signs are:

  • Reduced efficiency and performance
  • Lapses in attention
  • Increase in errors of omission
  • Yawning and sleepiness
  • Feeling of exhaustion and irritability
Work-personal life balance

Work-personal life balance is another major OHS issue, accentuated by long work hours.  It is an important dimension of the organization’s psychosocial safety climate. An inability to reconcile these two spheres of life can translate into health risks for workers.

A study conducted among healthcare workers during the second wave of COVID-19 revealed that nearly a quarter of respondents found it difficult to reconcile personal and professional obligations. Moreover, the risk of experiencing psychological distress is higher among workers who struggle to maintain a balance between their personal and professional life. The negative health impacts of a difficult work-life balance can be explained in particular by the fact that these people face high demands in this dual role, and have an insufficient number of hours of leisure and rest. This can lead to psychological distress, depressive symptoms and presenteeism.

Understaffing

Work overload

Work overload is another element that can carry OHS risks. According to the INSPQ, workload refers to the amount of work to do, the intellectual effort required, and the time constraints that must be met. It goes without saying that the workload will intensify when there is an understaffed team.

There is constant pressure to work harder. In our healthcare environments, the process of intensification is partly caused by the lack of resources the government invests in public services. This resource shortage leads to the intensification of work, and to employers adopting more restrictive and demanding modes of work organization for healthcare professionals.

The aim is always to do more with less. The Lean method is a case in point. Through work intensification, the increased pressure to meet unrealistic targets can lead to work-related malaise and distress among healthcare professionals. Work overload has an impact on health. Links have been demonstrated between work overload and mental, musculoskeletal, and cardiovascular diseases.

When it comes to workload, we must also consider the notion of work “complexity.” In addition to having to work fast and understaffed, healthcare professionals must simultaneously perform extremely complex functions (preparing medication, responding to requests from patients and their families, revising and writing notes, carrying out examinations and assessments, etc.).

The following factors can increase work overload (intensity and complexity) in healthcare settings:

  • Pace/objective constraint: the employer demands that healthcare professionals take charge of a certain number of patients and complete a certain number of care tasks within a given timeframe, all without allocating sufficient resources to complete all tasks safely.
  • Heavy responsibilities: the responsibility of providing care is a heavy one, and mistakes can have major consequences on the health of patients.
  • Contradictory instructions: employer directives, the code of ethics, patient requests and collaboration with physicians are all factors that can lead to contradictory requests and instructions. For example: healthcare professionals are asked to provide quality care without being given the resources to do so; they are asked to prioritize care in a context of overload, while elsewhere, employers impose disciplinary and administrative measures for care not provided. Healthcare professionals often find themselves caught between a rock and a hard place.
Conflicting values

Working understaffed can also generate value conflicts among healthcare professionals. Value conflicts can be exacerbated not only by understaffing, but also by long work hours. These conflicts are triggered when the desire to offer quality care comes up against a lack of resources to provide it. Healthcare professionals then have to act in contradiction to their values. In 2016, the FIQ produced a document on preventing moral distress that covers several aspects of the notion of conflicting values.

These conflicts pose a risk to psychological health. For healthcare professionals, whose professional identity and expertise lie in their ability to provide care, conflicts of values can be particularly difficult to live with. Healthcare professionals have been dealing with the risk of conflicting values for a long time.  For example, conflict of values was one of the factors accentuating the psychological distress of healthcare workers during the second wave of COVID-19.

Healthcare professionals who are exposed to value conflicts over a long period of time may come to adopt behaviours that are harmful to themselves, their health, and their safety:

  • Hyperactivity to compensate for a lack of time and resources can lead to exhaustion
  • Cynicism to detach emotionally from the value conflict affecting them can lead to distress and negative behaviour within the care team
Musculoskeletal disorders (MSD)

Finally, understaffed work, like long hours, can contribute to the development of musculoskeletal disorders. Workload and stress cause behavioural reactions in healthcare professionals in order to cope with the stress. These behavioural reactions can lead to the onset of MSD:

  • A lack of time forces healthcare professionals to perform certain tasks without taking the necessary precautions (e.g., applying the PDSP), which can lead to the risk of developing MSDs
  • Psychosocial risk factors can lead workers to adopt a more sedentary and less healthy lifestyle, making them more vulnerable to MSDs
  • The workload forces healthcare professionals to skip their breaks, preventing rest and recuperation, which in turn leads to the development of MSDs
  • Stress leads to involuntary muscle contraction, which can contribute to the development of MSDs

Working on an understaffed shift is a common reality for a large number of healthcare professionals. It is a phenomenon caused by the lack of harmonious working conditions, which in turn generates a shortage of healthcare professionals.

Workplace violence

In the healthcare environment in which healthcare professionals work, violence is often trivialized. For some, violence is even “part of the job.” While it’s true that providing care to vulnerable people can expose healthcare professionals to the risk of aggression, this doesn’t mean that violence should be normalized. On the contrary, violence is an OHS risk in its own right and, as with other risks, it is essential to work to eliminate or reduce the risk at the source. Moreover, healthcare professionals’ clinical judgement is fundamental to identifying the risk of violence from patients.

A few figures from the CNESST

  • In Quebec, the number of work-related injuries associated with violence rose from 2,868 in 2018 to 3,605 in 2021.
  • In 2021, in Quebec, 21.1% of accepted occupational injuries associated with psychological violence were attributable to patients or residents. They were also responsible for 57.5% of injuries associated with physical violence.
  • 1% of accepted occupational injuries associated with physical violence were caused in the health and social services network.

According to the Association paritaire pour la santé et la sécurité du travail du secteur affaires sociales (ASSTSAS), the possible consequences of incivility on health are as follows:

Immediate effects/reactions Short-term effects Long-term effects

Uncivil behaviour (reacting with the same behaviour)

Increased self-doubt and passivity

Increased negative emotions

Diminution de la capacité à récupérer après une journée de travail

Diminution de la satisfaction
au travail

Augmentation de la détresse et
diminution du bien-être

Augmentation de
l’intention de quitter

Diminution de l’engagement et
de la prestation au travail

Augmentation du risque
d’épuisement professionnel

 

Patient violence

Several factors can increase the risk of suffering patient violence, including:

  • Working directly with patients with violent behaviour or a history of violence
  • Individual work with patients
  • Faulty organization of space that can impede the vision and movement of healthcare professionals
  • Inadequate workplace lighting
  • Faulty, inaccessible, or little-used means of emergency communication
  • Gaps in the company’s violence prevention policy
  • Working understaffed
  • High staff turnover
  • Lack of security-trained personnel (security guards, trained Code White response teams)
  • Long wait times for patients, which creates frustration
  • Perception that violence is tolerated by the institution

Training courses are available to help healthcare professionals deal with and preventively defuse situations of patient violence. The best known is the OMEGA training. It is an essential four-part training course. Find out more about the new version here.

To help prevent the risk of violence, healthcare professionals must systematically report violent incidents and accidents. However, there is still ongoing significant under-reporting.

A recent study shows that only 19% of violent events are officially reported. Healthcare professionals can rely on their clinical judgement to assess the potential danger of a patient and identify the measures to be taken. That, too, is about setting limits!

Colleague violence

The presence of psychosocial risk factors (such as work overload, for example) can accentuate the risk of incivility and violence between colleagues. Indeed, in a stressful work environment, where all healthcare professionals are overworked, where every minute counts, and where there is frequent mandatory overtime, the environment can become a real incubator for violence.

Healthcare professionals can play an important role in promoting civility and preventing violence between colleagues. According to ASSTSAS, they can:

  • Respect the means of preventing incivility (and violence) established by the employer (policy, code of civility)
  • Become aware of how they interact with others
  • Refuse incivility
  • Denounce incivility that is experienced or observed
  • Act with civility

Without justifying horizontal violence or incivility, it must be recognized that an excessive workload, by accentuating tensions within the care team, is undoubtedly a major risk factor. The fight for working conditions that make it possible to provide quality care is therefore just as important in preventing internal violence.

Preventing domestic violence

Preventing domestic and family violence in the workplace is one of the employer’s OHS obligations. This obligation is set out in section 51.16 of the AOHS. You will find more information on this subject on this CNESST page.

Domestic and family violence can manifest itself in the workplace in a number of ways:

  • Harassment by phone, text or email
  • Frequent intrusion of the violent person into the victim’s workplace
  • Violent person’s communication with the victim’s colleagues or employer
  • Secret observation of the victim by the abuser

Healthcare professionals and employers alike need to be on the lookout for signs that a colleague may be experiencing domestic or family violence:

  • Physical signs (e.g., bruising)
  • Significant change in behaviour (fatigue, anxiety, irritability, etc.)
  • Impression that a colleague is taking refuge in her work (e.g., willingness to work a lot of overtime)
  • Attendance problems
  • Abnormal work interruptions for family reasons
  • Colleagues concerned about the safety of the potential victim

The Milieux de travail alliés contre la violence conjugale initiative produces and gives comprehensive training on the prevention of domestic violence in the workplace. Please talk to your local union team.

The goal is not to turn all healthcare professionals into domestic violence specialists. Above all, it’s a question of being aware of and welcoming potential victims, and of notifying the employer or specialized resources if we have reason to believe that a colleague is a victim of violence.

Conclusion

The goal of the 2023 OHS Week is to make healthcare professionals aware of the OHS aspect of various issues that are often not perceived as such. Addressing long work hours, understaffing and violence as OHS issues offers healthcare professionals a new perspective.

Healthcare professionals know their work and the associated risks the best. Let’s learn to set our limits!

To learn more

General Resources and References

About Fatigue

Work-Life Balance

Work Overload

Values Conflicts

Musculoskeletal Disorders

Violence