Who will listen to these testimonies of doctors and breathless staff of the University Hospital of Clermont-Ferrand?

What happens in this maternity hospital – the only one in Auvergne to have a neonatal resuscitation service – enough to close six beds in a month.

On Monday, March 14, in the wards of pediatric resuscitation, neonatal resuscitation, pediatric intensive care and neonatology and in the kangaroo unit of the University Hospital of Clermont-Ferrand, health workers, nurses and childcare workers went on strike indefinitely.

“The time of applause and grass concerts is no longer enough! We are in trouble. And in the face of the difficulties we had anticipated! It is urgent for the government to consider the legitimacy of caregivers for project management. “

Dr. Benoit Boeuf (Head of the neonatal and pediatric intensive care unit, CHU de Clermont-Fd.)

1. Beds condemned for lack of staff

In these services, a banner is enough to signal the anger and leaflets that explain. The staff continues to work. On strike, but assigned to their posts for continuity of care: we expect no less premature or risky births in these state-of-the-art services. They will still provide.

The woman-child sector must also coordinate the support of Montluçon which is temporarily not autonomous in paediatrics. However, on 19 April 2022, due to the lack of personnel despite the hiring of precarious workers, it was necessary to close four out of 16 neonatological beds and two out of ten neonatal and pediatric sheaves.

“For the first time we have not opened the four general pediatric beds that we open during epidemics, between December and March. “

Professor Etienne Merlin (Head of the general and multidisciplinary pediatrics unit, University Hospital of Clermont-Ferrand)

“There is also what has not been done,” slips Professor Etienne Merlin, head of the general and multidisciplinary pole of Pediatrics.

2. Absences not replaced

We want to understand what’s wrong. We immediately understand that it will be complicated.

What Professor Merlin has in his heart goes beyond the Auvergne university hospital. The empty promises of the Ségur de la Santé, the means of the public hospital that follow a trajectory contrary to the needs of care and the quality of life of caregivers, an accounting logic that evaluates in minutes the needs for the time of care, policies that make vocations are schizophrenic… And two years of health crisis that have exhausted human resources.

But a department head also sees the public order needs to which the hospital must hide; steering constraints …

In total, today, must we ensure continuity and quality of care with 30 people arrested out of a workforce of 170 ?!

Then it focuses again on quantifiable shortcomings. On April 19, 11 out of 40 people were missing in pediatric intensive care (including nine pregnancy-related arrests) ?; 11 out of 60 in neonatal intensive care (including three pregnancies); six out of 24 people in the pediatric ward ?; three out of eight in the pediatric counseling sector …

3. Absenteeism, exhaustion … Explanations

“As of April 14, 26 out of 80 nurses were missing. We are reaching a dropout rate of 18% to 26%,” explains Laure Cuvillier, staff representative (CGT).

On that date, the overtime count from January was 696 hours, only for the neonatal, neonatal resuscitation, neonatal intensive care and Kangaroo wards.

“Currently no one replaces us, so we replace ourselves when there are pregnancies or illnesses. But there are too many. We have absorbed more than 100 days or nights in this way since January 1st! “

Giulia and her colleagues (Department of Perinatology)

“Even fully staffed and with closed beds, we are just in time. Can’t we fill in the gaps in the program where are we scheduled ?! Well yes, we always get there, but we can’t take it anymore. Should we take over ?! “, Explain Julie and her” perinatal colleagues.

At the end of a meeting with the hospital management, on April 20, the delegates were pleased to have “at least obtained the promise to reconstitute a minimum pool of substitutes and the replacement of every person arrested”. But as soon as possible. That is to say, provided you can hire

.

4. The crisis of substitution“Objectively we are reaching a quality of care never seen before in history… But until then there was no real replacement basin in our services, this margin of oxygen that would allow us to absorb the jolts. We have no margin ?! We are permanently underwater. We call people back at the last minute. There is a wear effect, ”observes the pole head.

Professor Etienne Merlin.

By the domino effect, unsubstituted stops feed the cycle of exhaustion. To this is added an experience of guilt: because care can no longer be offered as in the school of good practices, because colleagues will have to absorb the work if you don’t come, or because if you go, you still have to leave your family for hours. overtime on short notice.

“Hi, I’m really sorry, I know you’re on vacation but I don’t have anyone for tonight, do you want to work overtime?” “Difficult to refuse. “I’ve been awake for 24 hours …” Exchanges on the WhatsApp group

(Extract from the letter to the families)

Julie and her “perinat colleagues” have written an open letter to the families. They explain how it happens whenever the team’s SOS in place fails on the WhatsApp group. “- Hi, I’m really sorry, I know you’re on vacation but I don’t have anyone for tonight, do you want to work overtime?

Difficult to refuse. There is this guilt of not coming if others need it. “- Ok I’ll be there.
I explain to my wife; to my children that their mother will take care of the sick children… It is 7 pm, I do not sleep all day and I have been attacking for 12 hours … At 7 am tomorrow morning, I will be up for 24 hours.

5. It was not possible to cure the patients

“Yes, we are in trouble. We’ve been overwhelmed with work for six months. We plug the holes. We are in constant tension, ”explains Dr Mathieu Lang in NICU.

Lack of staff and closed beds: mathematically the teams end up admitting that they are stuck.

“We don’t know how we will spend the summer… How we will manage to meet the demand for care. ” Dr. Mathieu Lang

(Neonatal resuscitation service, CHU de Clermont)

The quality of care is preserved in these pediatric wards that are dedicated to extraordinary things. In neonatology even numbers are regulated.

But, since January 2022, the children who should have been cared for at CHU Estaing have already been transferred to hospitals outside Auvergne due to lack of staff or space: a newborn from Montluçon to Limoges, a case of bronchiolitis in Montpellier …

“Closing the beds is clearly a failure. The teams take these transfers very badly. But when there are no people to post, you can’t invent them, ”says Dr. Lang.

6. Transfers to forceps and postponements of operations

Here, too, non-urgent interventions had to be postponed.

Pr. Merlin also raises the question of medical transport which involves the risk of loss of opportunities.

“With the magnitude of the bronchiolitis episode this winter, about fifty children could not be admitted to the wards of the CHU equipped with the necessary staff and equipment. Some had to stay in peripheral hospitals and then sometimes be redirected out of Auvergne. “ Doctor Manzo

(Head of pediatric and neonatal resuscitation, CHU de Clermont.)

Finally, nurses and childcare workers explain that they are under constant pressure to “make room” as soon as possible, so that they can welcome new arrivals. There is talk of a rush to transfers to less intensive services as soon as the young patients are a little better. They talk about their patients’ trips to outlying hospitals or returning home without taking the time they would have liked to have. Doctors confirm.

7. What is the next step?“We are in balance because the teams are made up of extremely worried people. People who managed to stand up. But they can’t take it anymore! We call them once, twice, a hundred times. The administration has got used to this happens with overtime … Only after Covid it doesn’t happen anymore. Everyone is exhausted, ”warns Dr. Lang.
Inflow of bronchiolitis to pediatric emergencies in October 2021

“We don’t know how the summer will go. We don’t know how we will be able to meet the demand for treatment.”

“What keeps us staying is the quality level of the care offered. What could set us off is the deterioration of the care supply … And it starts today. “ Doctor Souad Bentaoui

(ICU pediatrician, head of the pediatric palliative care team, Clermont-Fd. University Hospital)

However, Professor Merlin is keen to remember that there is not much to reverse the dynamics. “The lack of personnel must not alienate young people from these extraordinary professions. ”


The management of the CHU de Clermont did not want to respond to our request for an interview. After the strike by the staff of the Louise-Michel hospital (23 March in Cébazat), the management explained to “organize to support the teams”. With the allocation of additional human resources: 3 permanent nursing assistant positions and 4.6 hospital service agent positions and increased replacement monthly salaries for nursing positions. For neonatology, the unions evoke the promise of a replacement pool.


Rejecting the impossible: state-of-the-art pediatrics in the heart of Auvergne
Anne Bourges

anne.bourges@centrefrance.com

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