In the interest of simplicity, the feminine form is used in this text to denote either gender.

1. What is the hiring process?

Among other things, we place ads in the periodical, Perspective infirmière, and participate in the annual congress of the Ordre des infirmières et infirmiers du Québec [Québec order of nurses]. Candidates enter into contact with the northern nursing advisor of the Nunavik Regional Board of Health and Social Services. Those selected for an interview will then meet our standing selection committee, which is composed of representatives of both institutions and the regional board. A successful interview, followed by a check on references according to our hiring criteria, will place you in our resource pool. We have two health centres that serve as hospital centre and CLSC (dispensary).

According to needs, you may be hired by the Inuulitsivik Health Centre at either the hospital centre or one of the points of service in the Hudson subregion, or by the Tulattavik Health Centre at either the hospital centre or one of the points of service in the Ungava subregion.

2. Does this work require special training or studies other than nursing?

For the moment, nurse training, whether at the collegial or university level, constitutes the first prerequisite, besides pertinent work experience. See question #5.

3. Is membership in a specific order (e.g., OIIQ) required?

You must be a member in good standing of the Ordre des infirmières et infirmiers du Québec. Upon hiring, you will be required to provide a copy of your license to practise.

4. What is the profile (qualities, skills) of an efficient nurse in a remote region?

Bilingualism is essential. Also, besides a structured nursing technique, you will need an open mind, respect for other cultures, a taste for adventure, resourcefulness, a desire to learn constantly, good organizational skills, a good sense of teamwork, interpersonal skills, a positive outlook and knowledge of your own limits. The list could go on, but basically you need to be constructive and willing to share your knowledge with your colleagues and contribute to community development by teaching health matters.

5. What work experience is necessary for practising in a remote region?

Solid and diversified experience in pediatrics, obstetrics, traumatology, infectious diseases, community health, etc. is useful. I often recommend that candidates join a floating team for at least one year to become familiar with all of the departments. The daily reality of work in Nunavik can include a major emergency involving multiple traumas, a child of five months in isolation for an invasive meningococcus infection, a parturient patient with dilation of four centimetres in active labour and requiring ante-partum follow-up and preparation for delivery, and so forth. You will always work with a colleague in 12-hour shifts, and there is always a nurse on duty for the delivery room.

6. What are the delegated medical acts performed in remote regions (e.g., sutures)?

It would take too long to list all the delegated medical acts. They are established according to the complete physical examination, which in itself is a delegated act, as well as the diagnostic methods. However, upon your arrival in the territory, you will undergo a training period on the delegated acts listed in the therapeutic guide. The delegated acts are unique to each health centre, with minor variations between them. Sutures are among those acts, as is the prescription of antibiotics and other medication.

7. What are the nursing acts performed (independent, interdependent and dependent)?

Our nursing acts are classified according to the three categories mentioned above. Independent signifies that the nurse performs the first assessment of the case. Interdependent applies to the appropriate treatment according to the therapeutic guide set forth by the members of the medical establishment.Dependent applies to cases that have already been seen by a physician for any act not covered in the therapeutic guide (list of delegated acts).

8. What types of contract are signed? What is their term and when are they renewed (if possible)?

We do not function by contract. We first meet you in an interview, then we confirm your candidature within the organization and, depending on your preferences, we propose either fulltime work or a replacement with a predefined period. Once you have successfully completed your probation period in the territory, it is up to you to decide on how long you wish to stay. We always need personnel. Sometimes, a person who occupies a position decides to share that position with a colleague, with the employer's authorization. A shared position is thus established, with details as agreed on by the parties. Such a situation may involve two months of work in the territory followed by two months of vacation or other activity. Some candidates strictly prefer replacement contracts on an as-needed basis. They are then systematically registered in our recall list and are contacted when needed. However, the first replacement period must last at least two months, as it includes a training period and a probation period. Subsequently, due to the high transportation costs, we ask for a minimum period of availability of four weeks at a time.

For those who wish to work in a northern region, it is important to specify that Section 37.10 of the collective agreement presently in effect in the province of Québec entitles them to leave without pay to work in a northern institution. Such leave can initially last for a maximum period of 12 months, but it can be extended for up to 48 months. The employee can therefore be absent from her institution of origin for a maximum period of five years.

9. Which union represents nurses in remote regions?

In Nunavik, there are two independent unions affiliated with the Fédération des infirmières et infirmiers du Québec (FIIQ) [Québec federation of nurses], one for the Inuulitsivik Health Centre on the Hudson coast, the other for the Tulattavik Health Centre on the Ungava coast. You will have exactly the same rights you currently enjoy in your region of origin.

10. What expenses are my responsibility in a remote region (rent, food, etc.)?

You make no monthly rent payments for housing. However, at the end of the year, for income tax purposes, an amount representing the cost of your housing ($17.02 per day) will be added to your annual income as a taxable benefit. On the other hand, as a person working in a remote region, you are entitled to a tax deduction of $15.00 per day. There may be slight variations in the amounts between the two subregions. Nevertheless, you have no direct payment to make for housing rent.

For food, you will receive a cost-of-living allowance, paid on a pro rata basis relative to hours worked. That allowance exists to minimize the difference in food costs between the urban regions and the communities of the Far North. Today, most of the communities are quite well provisioned in terms of foodstuffs. You can therefore purchase your groceries at the local stores, and you also have the possibility of sending your grocery order by fax or e-mail to a store in the South. You then pick up your order at the airport.

11. Is the cost of living truly higher in remote regions?

Everything is relative, and it is true the cost of living is higher in a remote region. That is why your employer compensates by providing housing as well as the cost-of-living allowance.

12. What is a nurse's salary in a remote region? And the premiums?

The collective agreement applies to remote regions like any other region in Québec. Your salary class is therefore determined by your employment attestations, and your base salary is established as a consequence. An isolation premium is added, which varies depending on whether you are alone or accompanied by your dependants and according to your place of assignment (Section 34.05, Division II). Without dependants, this premium can vary between $4 658 and $9 018 annually. With dependants, it can vary between $6 659 and $15 898 annually. Further, you are entitled to an installation/retention premium, which varies between $14 000 and $17 000, again according to your place of assignment. That premium is not in the collective agreement and has been in application since April 1, 1999. This incentive was created to deal with the nurse shortage. Moreover, you will be required to put in overtime hours and provide onduty services. You will receive all the premiums established in the collective agreement: evening premium, weekend premium and so forth.

13. Do I continue to accumulate seniority if I decide to return to work in an institution, for example, in Sherbrooke? (If I have five years' seniority in a remote region and I decide to work in Sherbrooke, will I be able to take over the position of a nurse who has four years' seniority?)

The seniority you accumulate in a remote region will be recognized only in your institution of origin, that is, the one that granted you leave without pay to work in a northern institution. Thus, if your locality of origin is Sherbrooke and you left on northern leave that was renewed for a total duration of five years, your seniority accumulated in the remote region will be recognized and you shall be entitled to the various clauses of the collective agreement concerning bumping.

14. If I leave after having occupied a position for a certain time in a remote region, may I reapply for the same position in the future?

No, you may not reapply for a position you previously occupied, unless it is still vacant, which is quite unlikely. We provide essential services; therefore, vacant positions must be filled immediately. However, you may reapply to come back and work with our organization. In our experience, those who have worked in remote regions are a valuable asset.

15. What type of approach do you use with the clientele?

We apply a multidisciplinary approach, involving all of the team members: the nurses, social workers, physicians, community workers, interpreters, etc. We favour the McGill conceptual model, as it takes into account the responsibilities unique to the various interveners in supporting the client, the extended family and the community while respecting Inuit culture.

16. What type of follow-up do you perform with your patients?

There is pre-established follow-up according to the various programs and protocols, such as prenatal follow-up, vaccination follow-up and so forth. There is also follow-up performed according to the nurses' judgment for cases seen in the clinic, such as, for example, follow-up for an infected ingrown nail.

17. Do the points of service function similarly to a CLSC? Are there patients hospitalized on site?

Each dispensary is a CLSC point of service and therefore functions similarly. Although patients are not hospitalized at those points of service, they are regularly kept for observation purposes to monitor developments in their health problems. However, when a medical evacuation is necessary, the patient remains under observation until the aircraft arrives. Other types of intervention may also require observation, such as antibiotic therapy.

18. Are there more men than women in the nursing personnel in remote regions?

The profession of nursing is recognized as one where the majority of practitioners are women; however, more and more men are joining their ranks. Finally, we have noted that for the past several years, the nursing personnel in Nunavik tends to be composed of 50% men and 50% women.

19. How are the tasks and care duties distributed in the points of service?

The tasks in the points of service as well as duty shifts in the evenings, nights and weekends are equitably distributed between the members of the nursing team. Below are some examples of the various tasks or duties of the nurses working in the points of service:

  • regular clinical services;
  • patient follow-up;
  • application of community health programs;
  • administrative tasks.

In the interest of simplicity, the feminine form is used in this text to denote either gender.

Mélanie Lepage, inf. Staffing Advisor