As a Quebec Nurse: The Need for Flexibility and Stability in the Healthcare System
I remember the start of my nursing career – starry-eyed and full of anticipation for what was to come. I imagined the difference each encounter with patients would make, and a team of nurses working together, spreading joy like pixie-dust. The reality was a little different. Time was crunched due to staffing shortage. Patient loads grew. Encounters with patients became shorter and more systematic. The pressure to work overtime became greater. Tension grew. Nurses would leave. The cycle continued.
For Quebec nurses, it isn’t surprising that the number of provincial nurses registered is at a 10-year low at the start of January 2024 (1). While nurses have been facing shortages, burnout, and difficult work conditions for decades, measures taken during the pandemic and in the last couple of years have caused a greater exodus to other work venues that provide more flexibility and financial stability. (2). According to a study published by MEI, evaluating the years 2016-2021, for every 100 nurses trained, 44 nurses exit the profession before their 35th birthday. (3). In 2021, Quebec’s Health Minister stated that the province was short 4,000 nurses. That same year, 6,524 of 105,692 nurses left the profession. (4).
Forced Increase in Work Hours
Between 2013 and 2015, I relished my 0.4 position while working at the Montreal General Hospital. A 0.4 meant a mandatory four shifts every pay-period, which was the most part-time position allowed in Quebec. For myself, this meant greater flexibility in time with family, space to engage in occasional mission work overseas, and the ability to pursue a master’s degree in Nursing, all while being able to work.
Fast-forward nearly a decade, and I found myself unable to secure any position with two kids at home and one on the way. Despite needing nursing hours (500 every four years to retain my nursing license) and Quebec lacking an extraordinary number of nurses, I couldn’t secure a position. The work requirements had changed. Instead of a minimum 0.4 position, the bar was raised to 0.7 -seven shifts every pay period. (5). The intent was to force nurses to work more during the pandemic shortage, but rather than do this, it forced nurses out – nurses seeking a better work-life balance and nurses who had families, especially those with younger children, like myself.
The Abolishment of Agencies
With limited choices regarding employment, I turned to independent nursing agencies and was able to bank close to 400 hours. The agencies gave me the one thing I needed most – flexibility, and in return, wanting to prioritize quality time with my toddlers, I chose the unwanted shifts of weekends and nights. It was a win-win.
I caught the tail end of the nursing agencies’ prominent existence in Quebec, as the new bill 15 was passed to ban most agency work. Their critique was that they drove up public health costs, costing 1.5B in 2023-2023, while only acting as a band-aid for the chronic issue of nursing shortages. (6). However, the agencies had provided two things many nurses were looking for – flexibility and increased stability.
Santé Quebec – A solution?
While independent nursing agencies were banned in hopes of driving nurses back to the public health system, Quebec knew they had to have another strategy to improve staffing retention and the healthcare system itself. Enter, Santé Quebec.
Santé Quebec was designed as a state-owned enterprise, like Hydro-Quebec or the SAQ, where all of Quebec’s healthcare system, with more than two dozen organizations falling under its leadership, as of December 2024 (7). Some of its primary goals are efficiency, accessibility and performance of the province's health and social services network – aiming to find 1 Billion of savings in the health system, reduce emergency room wait times and improve the recruitment and retention of nurses. (7, 8). In 2024-25, Quebec’s health and social services spending nearly doubled to $60 billion from around $35 billion in 2019, and Santé Quebec is confident that its oversight of day-to-day operations will ensure a reduction in spending. (9)
Only in full operation for three months, there are mounting critiques of Santé Quebec simply being another bureaucracy with top salaries. (9). Furthermore, the major health and social services union, APTS, has filed a court complaint against Santé Québec for a payment delay of bonuses to thousands of its members. (10).
From a nursing standpoint, there are a lot of promises made with no given pathway on how these results will be produced. Only time will tell if Santé Quebec is truly a solution to nursing shortage and retention and overall healthcare improvement.
How to Keep Nurses in Quebec
In 2023, 42% of nurses polled were considering leaving the profession - 71% mentioned overwork as the main cause, and 58% said the pay was insufficient. (2). The need for flexibility and financial stability has remained a crucial point in retaining Quebec nurses. While independent agencies did cost public health a substantial amount, an MEI report stated that “Nurses need more freedom of practice, and those [nursing] agencies that help provide it should not be handicapped by regulatory obstacles, or prohibited by law” (2). Now that they’ve been almost completely banned, unless Santé Quebec can somehow save and partly funnel capital back into nurses’ salaries and provide more flexibility in scheduling, nurses are bound to leave the profession or move outside the province to continue their careers.
Nurses are the spine of better healthcare in the province, and it seems that mandating higher hours and forcing out agencies are not currently effective in keeping a solid workforce. For healthcare to improve, solutions around flexibility, workload management, addressing compensation and staff shortages, and revisiting government policy that listens to the concern of nurses will be key.
I’m a mother and a Quebec nurse. I know there are many more who wish to contribute to healthcare, and rather than looking for an exit, are looking for any possible way to stay. For the better health of Quebec and the better health of all Canadians.
References
1. Macdonald, Thomas (12 January 2023). Number of newly licensed Quebec nurses reaches 10-year low. The Canadian Press. ://globalnews.ca/news/10222407/quebec-nurses-licenses-10-year-low/
2. Faubert, B. E, (12 October 2023). The Nurse Shortage in Quebec: Improving Flexibility and Working Conditions. MEI ://www.iedm.org/the-nurse-shortage-in-quebec-improving-flexibility-and-working-conditions/
3. Le Journal de Montreal (12 October 2023). La moitié des infirmières quittent la profession avant l’âge de 35 ans. ://www.journaldemontreal.com/2023/10/12/avant-lage-de-35-ans-la-moitie-des-jeunes-infirmieres-quittent-la-profession
4. Morasse, Marie-Eve (9 September 2021). Une question de formation ou de rétention? La Presse. https://www.lapresse.ca/actualites/sante/2021-09-09/penurie-d-infirmieres-dans-le-reseau/une-question-de-formation-ou-de-retention.php
5. Rukavina, Steve. (16 March 2022). Part-time nurses in Quebec feel betrayed by new contract forcing them to double workload. CBC News. ://www.cbc.ca/news/canada/montreal/part-time-nurses-fiq-contract-1.6385360
6. King, Adam (24 October 2024). For-Profit Nursing Agencies Are Siphoning Public Health Funds. The Maple. https://nursesunions.ca/wp-content/uploads/2024/09/Agency-Full-Report-Final-English-20Sept2024.pdf?ref=readthemaple.com
7. Serebrin, Jacob (17 November, 2024). Explainer: How will Quebec’s new health-care agency change the system? The Gazette ://www.montrealgazette.com/news/article567452.html
8. Santé Quebec. (2025). https://sante.quebec/
9. Shwartz, Susan (1 December 2024). ‘We are ready to get down to work:’ Santé Québec is officially in operation. The Gazette. ://www.montrealgazette.com/news/provincial-news/article567163.html
10. The Canadian Press. (5 February 2025). Health union files complaint against Sante-Quebec over unpaid bonuses. https://www.ctvnews.ca/montreal/article/health-union-files-complaint-against-sante-quebec-over-unpaid-bonuses/
