The public hospital is under a new threat. This evening and for three nights, the emergency service of the hospital center of Sainte-Foy-La-Grande, in Gironde, will close. In Amboise (Indre-et-Loire), next weekend, emergencies will remain closed from 6:30 p.m. to 9:30 a.m. In Draguignan (Var), for the past month, vital emergencies can be taken care of on Friday and Saturday evenings. Not the other nights.
Even in Paris, a specialized service at the Saint-Louis hospital (AP-HP) risks closing at night from June 1. A new illustration of a public hospital struggling everywhere in France, for lack of arms. And it is at night that the difficulties materialize first, with a crying lack of paramedics.
In Saint-Louis we “maintain the patch”
On Twitter, the National Union of Nursing Professionals (SNPI) summarizes the alarming current situation: there are 60,000 vacant nursing positions.
From local hospitals to large university hospitals (CHU), services are threatened. The possible night closure of the clinical immunopathology department at Saint-Louis Hospital (AP-HP) has been causing a stir for a month. Caregivers take care of patients from all over the region, suffering from cancers and rare diseases. However, the permanent night nurses have gone from twelve… to one. For fourteen months, the day nurses compensate, voluntarily, so that the service does not close. But the cup is full. The caregivers launched an SOS, a manifesto (to be found here), sent a letter to the two presidential finalists…
“We received a response from Olivier Véran who undertook not to close the service, explains Jehane Fadlallah, doctor in this service. But that doesn’t bring 11 nurses… At the same time, the management offered our day nurses compensation of 450 euros per month for working nights. But that only maintains the patch. The nurses asked for the retroactivity of this bonus. What management seems to have granted, but with an amount of 220 euros. » Oral promises for the time being. But the beginnings of a solution seem to be emerging. “Five day nurses, including one only on weekends, have however agreed to do more nights, explains this doctor. But they are exhausted and it is transient. And the root of the problem remains intact: there is no attractiveness, therefore no candidates for night shifts. »
Tip of the iceberg testifying to a hospital at the end of its tether
Beyond this circumscribed and perhaps soluble problem, emergencies, maternity wards, specialized services, are closing more and more in France at night. The paramedics do not hide it: they are fed up with chronic understaffing, non-stop replacements, the D system, which leads to burn-out. And have been warning for months: if the hospital starts to close at night, where will the patients go?
“We are at a critical point, warns Remi Solomon, president of the conference of the Establishment Medical Commissions (CME) of CHU. My colleagues all say so. The longer we wait, the more complicated it gets. Some think that the private hospital would take over. She does it for what is profitable. But for the permanence of care, for a heart attack in the middle of the night, you will go to the public. “Same concern on the side of the doctor at Saint-Louis Hospital. “It’s a real fundamental question: what do we want for France? President Macron has decided to be a new man, to talk to us about ecology… We talk about the collapse for ecology, but it’s the same for the public hospital! »
How to save what can be? Working at night is sometimes a choice for these paramedics. But it is often followed by important consequences. First, because the numbers are even smaller than during the day. “It’s harder physically, studies show that life expectancy is shorter for those who work at night,” notes Rémi Salomon. And sometimes also morally, when it is necessary to face the night terrors of the patients…
Three ways to improve night work in hospitals
To maintain and attract new paramedics, volunteers to work at night, no doubt it will take an additional effort, the Ségur de la Santé showing its limits. A paramedic who works at night sees his salary increase by 1.07 euros per hour, only between 9 p.m. and 6 a.m. and within the limit of 9 hours. “While our nurses are on call for 12 hours and we know that night work has an impact on health”, criticizes Jehane Fadlallah. For her, upgrading is essential. “It’s a shame that there is a gross increase of 100 euros per month for night work, whereas in the private sector it’s 30% more” “There should be a significant increase in remuneration for the night and the weekend, adds Rémi Salomon. Young people seem less ready to work staggered hours. A dynamic which has accelerated with the pandemic and which affects other professions with strong constraints and low wages such as catering. »
Second track: improve working conditions. With a sufficient number of modern, suitable equipment… Well-being depends on a better balance between professional and personal life. “The nurses, often women sometimes alone, have no night duty mode, argues Jehane Fadlallah. We have a day nurse who would be willing to spend the night except that she is raising her daughter alone. He needs 150 euros per night to pay the babysitter. We answered no, of course. It’s a sum, but we are talking about a trained, competent nurse, while temporary workers are paid more than our regular nurses. “We should offer accommodation near the hospital,” adds Rémi Salomon. Moreover, the AP-HP was not mistaken: it currently allocates 500 housing units per year and will increase this number by 50% in the years to come and offers 4,600 crèche places. No doubt more needs to be done…
Stabilize the teams
Because if the current situation looks like a vicious circle, with non-replaced departures further amplifying the work of the remaining forces which are running out, a new dynamic could change everything. If the night services were able to attract, find a stable team, it will improve the quality of care, in collective spirit… “When you start, it’s complicated not to have a referent team, underlines Jehane Fadlallah. In our service, the new ones leave running! “We must impose ratios, with the objective of having 1 nurse for 6 to 8 patients when today they run between 12 or 15”, continues Rémi Salomon. A long-standing request from the Collectif Inter Hôpitaux… which was included in the program of the Future in Common.
“I think a lot of nurses left the hospital with regret, we could get some back if the working conditions are better,” he says. The number of trained nurses should also be increased. Third possibility to provide a more comfortable setting: involve doctors. “With the absence of medical care at night, the nurses are very lonely, admits Jehane Fadlallah. For some, it’s an advantage, for others it terrifies them. Ensuring a safe working environment would help recruiting. » Should we increase the number of doctors on night duty? Pay them better? There is no doubt that this would cause other tensions.