A long-standing staffing crisis at Hôpital Maisonneuve-Rosemont Hospital (HRM), the main hospital serving Montreal’s predominantly working class east end, has intensified in recent months. On Monday, January 16, nurses on the evening shift in HRM’s emergency department refused to work to protest against the onerous working conditions, chronic understaffing and mandatory overtime that is ruining their personal lives.

The previous Friday, about 90 percent of the 110 workers in their emergency department team signed a petition demanding the departure of their unit manager. They accused the manager of causing a “dramatic deterioration” in their working conditions, of “having done nothing” to retain staff and of using intimidation to impose mandatory overtime. Just on the first weekend in January, over 400 hours of mandatory overtime had been worked. The nurses threatened to resign en bloc the following Wednesday if their demands were not met.

On Monday, the management of hospital facilities for Montreal’s east end added fuel to the fire by proposing a contingency plan that would have simply increased the workload of those nurses on duty. The nurses rejected the plan, fearing for patient safety. In response, they launched the sit-in protest, forcing management to partially close the emergency unit until Tuesday morning and redirect ambulances to other facilities.

The nurses’ militant actions forced the provincial health minister, the wealthy accountant Christian Dubé, to intervene. The unit manager was reassigned to other duties and Dubé appointed an outside consultant to help implement a “micromanagement” plan to address the manpower shortage. This cynical manoeuvre, which Quebec Premier François Legault has supported, does not address the workers' demands. The goal is to maintain the overtime plan but to allow nurses to choose when they “want” to do it!

Quebec Premier Francois Legault, a multimillionaire former CEO and longstanding advocate of the privatization of public services, initially presented the dispute as an isolated problem resulting from mismanagement—although Quebec’s nurses have been complaining bitterly about forced overtime and inhumane working conditions for years. The premier then tried to excuse his government by saying that there is a “lack of nurses everywhere” and that the need is simply greater at HMR than elsewhere in Quebec.

In reality, HMR is the canary in the mine for a health care system on the verge of collapse after decades of cuts by previous Liberal and PQ (Parti Québécois) governments and now Legault's hard-right CAQ (Coalition Avenir Québec). From 1996 to 1998 in particular, the PQ under Lucien Bouchard eliminated thousands of nursing positions with the full support of the unions—including the nurses' union—by goading workers into taking early retirement in the name of realizing its 'zero-deficit' policy.

The deplorable state of the health care system has been made catastrophic by the ruling class’ criminal “profits before lives” COVID-19 pandemic policy. In addition to doing nothing to stop the spread of the many respiratory viruses that continue to overwhelm hospitals and emergency rooms, Legault and his CAQ are pursuing a “live with the virus” policy. This has resulted in more deaths and sick people, further exacerbating the labour shortages in the health care system.

As a result, emergency rooms have been overflowing for months across Quebec and patients are struggling to get care. The average occupancy rate in the province's emergency rooms is approximately 130 percent, a peak not seen since January 2020. At the Suroît Hospital in Salaberry-de-Valleyfield, the emergency room occupancy rate reached 270 percent last week.

In response to deteriorating working conditions and mandatory overtime, sit-ins like the one organized by the HRM nurses last Monday have increased dramatically in recent years, especially since the eruption of the pandemic. While the crisis at HRM was making headlines, nurses in the emergency room of the Jonquière hospital in the Saguenay region also organized a sit-in to denounce their working conditions, with emergency unit occupation at 144 percent.

The Legault government has turned a blind eye to the simmering crisis at HRM. Last December, Minister Dubé rejected a joint union and management “pilot project” to reduce mandatory overtime by offering bonuses to attract and retain staff. Across the health network, the CAQ has adopted a deliberate policy of maintaining mandatory overtime, enshrining the right of managers to use it in collective agreements and postponing until 2025 any measures to reduce it.

The unions, in keeping with the role they have played for decades in suppressing rank-and-file struggles for better working conditions, will do everything they can to quell the nurses’ anger and avoid a direct confrontation with the Legault government.

Denis Cloutier, president of the union of health care professionals for the east end of Montreal, admitted that the recent nurses’ actions were initiated independently by rank-and-file members, not by the union. Admitting his fear at not being able to contain rank-and-file opposition, Cloutier said that the intervention of a mediator “solves the problem of the threat of mass resignation. ... But I am very concerned that there will be more sit-ins in the future.”

While the union bureaucrats were gripped by fear due to the workers’ initiative, rank-and-file workers in other hospitals responded enthusiastically to the HMR nurses’ protest. In a letter obtained by La Presse, nurses from Hôpital Cité-de-la-Santé in Laval wrote in support of their HMR colleagues: “We want to show you our respect and support in the ordeal you have been going through for several months now. It is essential that we stand together in the face of adversity and this is why our hearts go out to you.”

This expression of class solidarity points to the possibility of workers mobilizing to repel the right-wing CAQ government’s concerted attack on public services and the working conditions of the workers who administer them. Quebec nurses must stand together with the half-million other provincial public sector workers whose collective agreements expire, like their own, at the end of March. The nurses must also appeal for the working class as a whole, not just in Quebec but across Canada, to join them in a counteroffensive to capitalist austerity.

The anger of nurses in Quebec is part of a growing rebellion among health care workers and the working class internationally. In the UK and the US, thousands of nurses have gone on strike to protest below-inflation pay increases, intolerable working conditions and staff shortages. In France, 2 million people took to the streets or went on strike last week in opposition to Emmanuel Macron, popularly dubbed the “president of the rich,” who is seeking to raise the minimum retirement age and otherwise slash pensions while hiking military spending by 40 percent in the 2024-2030 military budget .

Nurses and public sector workers must take control of their struggle out of the hands of the union apparatuses, which have become integrated with the capitalist state and systematically suppress rank-and-file resistance in the name of maintaining “social peace.”

The defence of public services and worker rights requires an independent working class political struggle. A crucial first step is to form new organizations of struggle, rank-and-file committees completely independent of the pro-capitalist unions. Their task will be to mobilize the full social strength of the working class to ensure decent working conditions and quality public services for all.