Monitoring the Health of Nurses in Canada

Key Implications for Decision Makers

This study examined the information available to decision makers and policy makers on the health of nurses in Canada.

  • The health of nurses is affected by many different factors. To develop effective strategies to promote their well-being, decision makers need data at various levels. This includes individual factors like age, job-related factors like workload, workplace factors like staffing levels, and system characteristics like hospital mergers.
  • The best way to monitor the health of nurses is with a new tool that combines a survey of healthcare workers and work environment indicators. Much of the data on indicators (such as age, workload, etc.) are already collected and need to be synthesized into a comprehensive, easy-to-use format.
  • There is a large gap in assessing factors associated with the nursing work environment and its connection to nurses' health. To bridge this gap, national and/or provincial data sources are needed.
  • Organizations looking at nurses' health need to co-ordinate their efforts to avoid duplication.

Executive Summary

It is becoming increasingly apparent that evidence-based policies and strategies are urgently needed to help optimize the physical and mental health of nurses, thereby helping reduce costly work-related injury and illness absenteeism. Such policies and strategies may also have the added benefit of improving patient outcomes, especially in relation to improved nurse-specific outcomes and patient safety. Our study and others found that nurse workload and nurse health indicators are key factors that must be addressed in developing effective workplace health promotion and recruitment and retention strategies. The importance of ensuring a healthy and productive nursing work environment is highlighted by the results of studies like ours, but also by public opinion polls that overwhelmingly identify the quality of nursing care as the pivotal contributor to quality of patient care. Despite such public recognition for the importance of their role, nurses find themselves working in rapidly changing work environments at the same time that their membership is undergoing significant changes.

The combination of increased workloads, increased patient acuity, uncertain work environments, and an aging nursing workforce could have a major effect on nurse health and ultimately on workers' compensation and health insurance disability benefit claims. To date, there has been no overall synthesis of this multi-dimensional phenomenon, so there was a need to further investigate the health of nurses in Canada. Our study was designed to link the theoretical frameworks currently used by nursing and occupational health researchers in order to 1) explore the determinants of nurse health; 2) highlight a list of data elements that will inform policy makers and healthcare administrators about the health of nurses; 3) help identify the factors that contribute to health; and 4) thereby ultimately contribute to the development of evidence-based strategies to preserve and improve the health of nurses. The creation of organizational and work environments that support the health of nurses will not only reduce the anticipated shortage by preserving these resources for the future, it will also reduce the cost of nursing services by ensuring that the current supply of nurses is used efficiently and effectively, and in a manner that respects their right to a safe and healthy workplace.

The ultimate goal of this project was to help policy and decision makers maintain and enhance the health of the nursing workforce, while our more immediate objective was to provide the same audience with an overview of the information related to nurse health in Canada. As a prerequisite to meeting the project's long-term goal, the study conducted a synthesis of existing health information sources about nurses in Canada and highlighted significant gaps that existed. Using interviews with selected nursing stakeholders across the country, the data synthesis also profiled the major health problems of nurses in Canada and described the factors that contributed to these conditions, particularly those relating to the nursing work environment, and factors possibly related to hospital restructuring and organizational change.

The knowledge gained in the early phase of the study, in conjunction with stakeholder input, was used to generate ideas about possible mechanisms for monitoring the health of Canadian nurses on an ongoing basis. Our findings are based on a combination of reviews of current available data sources and extensive expert opinion drawn from a broad spectrum of the national nursing stakeholder community and, as such, provide policy makers with an evidence-based footing for future resource allocation decisions.

Our suggestions for ways to further enhance the sources of data on nurse health and work environment indicators (Figure 1) should be of use for policy makers considering ways of collecting such data as part of the overall strategy to help ensure the future supply of human resources in Canada's healthcare system.

Figure 1 - Three Surveillance Options

  • Use a rotating random set of hospitals/sites with a core set of questions on the health of nurses (i.e. a short survey) "piggy-backed' onto their annual workplace initiatives on the quality of work life.
  • Web-based survey linked to the provincial colleges and CIHI tool possibly similar to the online tool Employee Survey of the Working Environment (ESWE) developed at the Institute for Work & Health.
  • A dedicated national survey on the health of nurses (or all healthcare workers) with direct involvement of an agency such as Statistics Canada.

Our proposal highlights three key concerns driving the significant amount of recent interest in nurse health. The first relates to the extent of change experienced by the organizations and work environments of nurses in the past decade. Workloads are reported to be at unsustainable levels, particularly in light of the fact that the average age of nurses is increasing at the same time that the industry is anticipating a significant overall staffing shortage. The second deals with the fact that there are currently no adequate databases or other resources currently available to monitor the health of nurses across Canada.

Finally, we observed a great deal of cynicism about the possible usefulness of our study findings, as the nursing community appears to have become resigned to the fact that much gets said about the conditions they are coping with, but little seems to get done about them. There are now several recent reports on very similar aspects of the issues of nurse health and nurse work environments. We undoubtedly risk further alienation of this critical workforce if we fail to seize the important and very timely opportunity to act that this information presents to us.