The Canadian healthcare system is facinga nursing shortage that threatens patientcare. Many nurses, physically and mentallyexhausted, quit; employers can t fill thosevacancies, while paradoxically other nursescan t find secure jobs with hours that suitthem. Meanwhile, nursing schools can't keepup with the demand for new recruits.While caring for the sick and dying hasalways been demanding, many of the problemsfacing nurses today seem to arise fromwork environments that have grown increasinglydifficult through the cutbacks andupheavals of the 1990s.

This paper was commissionedto answer two questions:

What is the impact of the working environmenton the health of the nursing workforce(and hence, potentially, on patient outcomes)?What effective solutions could be implementedto improve the quality of the nursingwork environment (and hence, potentially,patient outcomes)?Research has made it clear that problemswith nurses work and work environments,including stress, heavy workloads, long hours,injury and poor relations with other professionscan affect their physical and psychologicalhealth. Research across occupations hasshown long periods of job strain affect personalrelationships and increase sick time,turnover and inefficiency.To prepare this report, we did a wide-rangingsurvey of peer-reviewed research on nursingand work in general; read a vast array ofother writing on the state of nursing; andinterviewed or held focus groups with healthsystemmanagers, nurses, governmentemployees, educators, representatives of nursesassociations and unions.From these sources, we outlined the problemsfacing nurses and defined them as issuesof work pressure, job security, workplace safety,support from managers and colleagues,control over practice, scheduling andthrough stronger leadership roles for nursesand rewards. There is no denying the seriousnessof the challenges facing nursing, but wefound many solid ideas for improving the situation.There are clear reasons why those runningthe healthcare system from the largest hospitalto a small community clinic as well asthe ministries who set their budgets and shapepolicy at the federal and provincial level, needto act. Organizations that do not create qualityenvironments to attract new recruits and retainexperienced nurses risk shortages that mayendanger patients.What can be done? Nurses, like most people,need some basic predictability in theirlives. That means they need to get back asense of job security and feel that the risk ofinjury and workplace violence has beenreduced. Longer budget cycles would helpemployers ensure that jobs won t disappear.Better equipment and more staff can helpreduce the risk of injuries, which increaseswhen there is no one to help turn a patient orwhen a nurse gets so busy and overextendedthat she pricks herself with a used needle.Studies show good relations among caregiversbenefit patients, even to the point ofreducing mortality. We believe that meansnurses need more support on the job, frommanagers who understand their work, respecttheir expertise and can offer a sense of securityand community. It means rebuilding a teamapproach to nursing where the focus can be onthe patient and not on inter-professional conflict.It means ensuring a manageable workload;it means offering educational and careeropportunities and the time to pursue them.One study found that nurses job satisfactionis the strongest determinant of clientsoverall satisfaction. Like most people, nurseswork best when they have a sense of controlover their jobs and their lives. That sense ofcontrol can be created by giving nurses morevoice in patient-care planning, more voice inpolicy-making and more say over the waythey work (such as being able to set their ownhours or not making them work mandatoryovertime).A demoralized worker is not a productiveworker, and nurses have a sense they are notvalued by the healthcare system for whichthey work so hard. Despite the increasing shiftof care into the home and other non-hospitalsettings, community nurses are often paid lessthan their hospital counterparts. Some casualnurses have more say in their hours than fulltimeemployees. Money isn t everything, but itis an important measure of worth. Incrementalpay increases recognizing expertise and experience,combined with more opportunities inmanagement and a clearer voice in runningthe system, would improve the status of nursesin their own eyes and throughout the system.This summary outlines some ideas forimproving working conditions in healthcare.There are many more in the report itself, rangingfrom finding more positions for nursepractitioners to including standards for healthyworkplaces in hospital accreditation. Some are simple to act on locally; others will requireco-operation. If better patient outcomes are tobe attained, governments, employers, educatorsand nurses must work together to create ahealthy nursing work environment.