Since the start of the Covid-19 pandemic, the situation in French public hospitals has only been worsening. From a lack of recognition for their labour, to understaffed teams, to difficult working conditions, caregivers have found the pandemic to be the last straw to an unbearable situation. In two years, the number of nurse vacancies has been rising from 10,000 to over 60,000.
Ever since she was a child, Kimberley Paris, a 25-year-old nurse, has dreamed of working in public healthcare. It represents something important to her, compared to private clinics. “For me, care has to be for everyone,” explained the nurse. “You shouldn’t be paying for your health,” she added.
After completing her diploma in nursing studies, she started working at the emergency department of Saint-Louis public hospital, in Paris, in May 2020. She knew it would be challenging, but nothing had prepared her for the gravity of how ill-equipped the emergency department was. During the two years she spent there, she never once worked with a full team; instead, every shift was spent trying to compensate for the nurses lacking, despite having to help the same number of patients in the A&E (accident and emergency room).
“We didn’t have the proper equipment. We didn’t have enough staff. We did the best we could, but it was horrible, impossible, unmanageable.” Last summer, seven out of twenty of her colleagues left Saint Louis hospital’s emergency department. Fed up with equipment shortages, tight schedules, and deteriorating working conditions, all of them left for private clinics and hospitals.
Last December, one of the two electrocardiogram machines of Saint-Louis’ A&E broke down. The hospital’s administration promised the team it would be repaired in less than a week. Three months later, Kimberley’s team was still working with only one machine for the entire emergency department. That’s when Kimberley decided to quit her job, in early 2022.
“In public hospitals, we would like to offer care and equipment for all patients, but we can’t because we have nothing and we’re struggling. It’s never enough,” she explained.
Degraded working conditions in French hospitals are not new to healthcare workers. When Covid-19 broke out in France, President Emmanuel Macron waged war against the deadly virus using lockdown, sanitary, and economic measures. Every night at 8pm, people took to their windows and balconies to applaud front-line workers who took immeasurable risks. But the first wave of the virus did not lead to the change in the healthcare system caregivers had long hoped for.
Since the beginning of the pandemic, nurse vacancies have increased from 10,000 to over 60,000, according to SPNI, the nurses’ trade union. “Among those who are left, 10% are on medical leave, have professional burnout or depression,” noted Thierry Amouroux, SPNI spokesperson, recalling the wave of departures of exhausted healthcare workers since June 2020.
Over the past two years, the desertion of hospitals by healthcare workers has only increased, and become a huge phenomenon. Not only have more healthcare workers quit, but one-fifth of these jobs remained vacant in 2020, according to a survey by the French Hospital Federation. The trend has only escalated since then. Last October, the Scientific Council reported that 20% of beds in French public hospitals would close due to staffing shortages.
“The situation is complicated [in hospitals],” Olivier Véran, minister of Health, acknowledged in an interview with Libération last October. “A certain number of units in hospitals are obligated to close temporarily, or to reduce their size, for lack of caregivers, and especially because of the difficulties in recruiting them,” he explained.
In the months following the first wave of Covid-19 in France, Kimberley grew increasingly despondent. “We were promised so many things,” she said. “We thought it was finally time for things to change. And nothing happened. In fact, I think it became worse.”
Healthcare workers were hoping for concrete actions: an increase in services and staff and the end of equipment shortages. In Saint-Louis’ emergency department, the administration decided to increase the service’s size after the first wave of the pandemic, hoping to increase their patient capacity. But when Kimberley’s team asked for a second nursing stretcher-bearer or a supplementary intake nurse, the administration never acted.
“We are told ‘yes, it’ll happen,’ but it never happens,” Kimberley said.
When the hospital digitised its paper filing system in 2021, nurses were glad to see their workload diminish and devote more time to patients. But doctors disagreed and the administration returned to the paper system. Kimberley and her colleagues made several attempts to meet with their hierarchy but felt unheard. “We were taking one step forward and two steps back. It was adding to our workload, and no one took that into consideration.”
In 2020, the government launched the Ségur de la santé (Health Ségur) to register health workers’ complaints, highlighted by the first wave of Covid-19, and offer solutions. An €8 billion euro plan was employed in hospitals. But caregivers were not satisfied with simple salary raises. Their departures are often caused by difficult working conditions and staff shortages, problems that were not solved by the Ségur.
Like Kimberley, many caregivers struggled during the pandemic to create a dialogue with their higher-ups regarding working conditions. Marie, 35, is a care assistant specialised in medical and psychological help, an “AMP” in French. Working in the psychiatric department of a public hospital in southern France, she repeatedly requested a 20% reduction in hours to spend more time with her children. But her request was never accepted as the team was understaffed.
Laura’s working rhythm was tough to maintain while raising her two children, 11 and nine, on her own. She was regularly scheduled on night and day shifts, as well as weekends and bank holidays, and could finish at 10pm, or start at 6am. It was impossible to negotiate another schedule or adapt the rhythm to her children’s needs.
Laura also found the quality of care concerning. A patient in the addiction department of the hospital spent three months waiting for a bed in a drug rehabilitation centre due to administrative complications. When she tried to suggest new initiatives, such as the idea of a “therapeutic meal shared between caregivers and patients”, her higher-ups refused, citing financial limitations.
Last summer, Laura was on medical leave for a work injury due to exhaustion when her phone rang. It was an employer offering her a job in a private institute with a Monday to Friday schedule from 9am to 6:30pm. “I understood that it was the moment to quit,” said Laura.
Like many, she was heartbroken to leave the public hospital. Public service aligned with her values and made her happy. “I told myself I have a real role; I have a real function. It was my mission, to ensure that people have unlimited access to care,” she explained. “I wish I never would’ve had to leave public hospitals.”
She now works with elderly people in a private clinic. While her salary dropped significantly, she doesn’t regret the change. “I reached the end of what I could do in the public service. This job [offer] fell from the sky, it was a gift from heaven,” Laura explained.
Less than two years after the beginning of the Covid pandemic, Nathalie Delorme, a 44-year-old doctor who lives in Orléans, found herself barely sleeping and unable to focus on daily tasks. She felt life had become unmanageable. “I’m a shadow of myself compared to before Covid,” sighed Nathalie. After 16 years working as an emergency room doctor at the Orléans public hospital centre, she took a medical leave last January.
Like in Nathalie’s case, difficult working conditions not only fractured careers but also worsened people’s mental health. According to the National Order of Nurses, exhaustion is widespread among caregivers, with “54% of employees in public institutions believing they are going through burnout,” according to a December 2020 study, a situation that has “detrimental effects on the quality of care.”
“I really had to force myself to go to work. I couldn’t stand it anymore, and everything went downhill. I felt like the ground was taken from under my feet,” explained Nathalie. With 150 out of 400 beds closed in the hospital because of a lack of medical staff, the emergency department was constantly full. Patients would stay for upwards of five days on a stretcher because of a lack of beds. “It became really unbearable on a daily basis not to treat people well. I couldn’t back it anymore, I thought about it all the time, I couldn’t get rid of it,” she explained.
One morning, Nathalie was still in her everyday clothes when she arrived for her shift at the A&E (accident and emergency room) . A few metres away, she saw an elderly man hitting a nurse; when she tried to step in, the man punched her in the shoulder. “It was not his fault,” Nathalie said. The man, suffering from Alzheimer’s, spent the night in a lit corridor, on a stretcher, because of a lack of beds; he was disoriented and lost.
But the A&E was so full Nathalie could not debrief the incident with her colleagues or decompress. She was left in shock, in an overcrowded emergency department, anguished by all the patients in poor condition who might not be treated that day.
Last January, Nathalie began to have dark thoughts, was unable to care for her kids, and drank more than usual, having to take medication to calm herself down. She went on medical leave and never returned to the public hospital.
Yet, nursing jobs are still attractive to the French public. On Parcoursup, the French career orientation platform for high schoolers, nursing is one of the top requested training courses, with nearly 10% of students choosing this course every year since 2020. But once students finish their training, nurses do not last long in public service: one out of three graduates abandon their job in the first five years after graduation, according to Thierry Amourroux.
Last February, Kimberly started a new job as a postoperative nurse in a private hospital in the suburbs of Paris, where her working conditions improved drastically. Still, Kimberly is thinking about leaving hospitals for good. “I’m very happy here, but I know that in a few years, I will leave the hospital altogether,” explained Kimberley. Like many of her young friends and colleagues who have recently graduated, she’s thinking about a career outside of the healthcare system. “It’s horrible, very sad. I think we all feel a little guilty about it. But when there are so many other accessible jobs, with much better conditions, we ask ourselves ‘Why are we doing this?’”
For Kimberley, Laura, and others, the issue is also the lack of career prospects. As nurses or care assistants, they do not have many opportunities to change jobs. And the situation is the same across public and private hospitals. That situation always concerned Alexandre Breil, in his 25 years of career at the head of bigger and smaller structures.
« This is a profession that has very few career prospects. Apart from arbitrating according to their lifestyle, their family constraints, nurses have no prospect,” said the former director of the Private Hospital of Antony, now deputy chief operating officer at Ramsay Health group. Career development opportunities include going back to school to become an executive, or upgrading to a manager position, but it is not always possible. Moving to another department involves accepting other constraints, such as working until 11 pm, or working a night shift.
Competing between gratifications, bonuses, housing accommodation, and subsidies, public and private hospitals face the same problems during recruitment. Medical and paramedical staff are quitting, looking for a better quality of work and of life, for other conditions, for another rhythm. As of now, the Assistance Publique-Hôpitaux de Paris, known as AP-HP, which is the network regrouping the 39 public hospitals in Paris’ region, is in need of 1,400 nurses. This is equivalent to the entirety of the graduates of all the nursing schools in the region over one year.
However, if the private healthcare system will keep running in the years to come, many caregivers worry about public hospitals, which were long seen by French people as a well-functioning, accessible, and high-quality healthcare system. But for many, the privatisation of the public healthcare system is coming, sooner or later.
Julie is 28 years old and worked as a nurse in a public hospital in Lorraine. Now on maternity leave, she will not return to the hospital. She accepted a job in a private centre for disabled people with a better schedule and work conditions. She’s pessimistic about the future. “At a certain point, we are going straight into a wall,” she declared angrily. “The state wants to put an end to the public hospital system, in favour of the private one, and no more social security. We are heading towards an American-style system and we are heading there fast,” she said.
Veering toward a U.S.-style healthcare system is a worry shared by many and symbolises the end of the French public system, free care for all, regardless of income, job, or immigration status. According to Kimberley, the system will first run out of nurses, then care assistants, and finally doctors, before privatising everything.
“I’m sincerely worried. The public system is deteriorating more and more. In any case, nurses will not make a career in a [public] hospital because the hospital is being completely destroyed,” explained Kimberley. According to her, to survive as a nurse, it is either a private hospital or private and associative structures.
“It’s not like before. Before, it was the elite! The AP-HP, it was incredible to have a permanent contract there. Now, people just go there, train for a year or two, and then leave. As soon as they have an opportunity.”
When indicated, first names have been changed and last names not mentioned to respect the sources’ will to remain anonymous, for fear of being identified by their former or current recruiter.
Article by Julia GALAN
Header image : © Jeanne Menjoulet / Creative Commons