Abstract

Since the mid-1990s, Canada and other countries have been engaged in healthcare restructuring, each having different foci, time frames and stakeholder involvement. While the contexts may differ, the resulting changes do share certain similarities: reduced hospital-bed capacity, reduced nursestaffing levels and a flattening of organizational structures. The results have led to a loss of nursing leadership and management, a reduction in clinical support and an overwhelming sense among nurses that their contributions to quality healthcare were neither valued nor recognized. However, little evidence exists to know whether or not these changes result in more cost-effective healthcare and improved health of the public. An international study was launched in 1998 to help explain the impact of hospital restructuring and to better understand the effect of the organizational environment on both nurse and patient outcomes and the relationship between the two. The organizational environment includes corporate characteristics, such as governance and nurse leadership, and professional characteristics, such as nurse autonomy, nurse control over practice, including resources, and nurse-physician relationships. Nurse outcomes include emotional exhaustion or burnout, dissatisfaction with current jobs and intent to leave them; patient outcomes include nurse-assessed quality of care, ability to provide essential aspects of care and frequency of adverse events, such as falls with injury, medication errors and complaints. In the study, registered nurses (RNs) were the informants both for organizational characteristics and for patient and nurse outcomes. This article reports on hospital-level results of the RN survey data collected from the three Canadian sites (Alberta, British Columbia and Ontario) with respect to the impact of workplace environment on nurse and patient outcomes. Implications of these findings are discussed with suggestions for improving workplace environments to retain and recruit nurses - environments that have also been shown to be associated with better patient outcomes.