Home and Community Care Digest
Methods: The labor process change of three categories of workers is examined: registered nurses (RNs), registered practical nurses (RPNs), and home support workers (HSWs). Part of a larger research study, this component included 27 interviews with home care practitioners living in Sault Ste. Marie ( a northern under serviced region, n=18) and Guelph ( a southern well serviced region, n=9). In depth, semistructured, audio taped face to face interviews were conducted with each of the three practitioner groups at both sites in the summer of 1995 and spring of 1996.
Results: Three major changes negatively impacted workers in both communities: work transfer, time constraints, and increased job stress. Work transfer refers to the transfer of responsibilities from one category of worker to others. Secondly, time constraints were implemented on all patient visits. Together, these two changes contributed to the third major change, increased job stress. The geographical analysis revealed that "size of place" impacted "work motivation and support", suggesting that characteristics of communities of various sizes affect practitioners' evaluations of work. In the two case studies, causal forces which appeared to be differentially impacting the labor process were (1) local service cultures, such as the timing and uptake of the new restructuring model between the cities; (2) local institutional practices such as the introduction of RPNs and amalgamation, and; (3) local practitioner advocacy, including union organization and job actions.
Conclusions: The process of long-term care sector reform in Ontario has had different impacts on homecare workers in the two communities. Size of place appears to be an important variable in this change. The degree to which other factors play a role varies based on local cultures, institutions and union organization. More broadly, these factors may result in continuing high rates of practitioner turnover and an overall decline in quality of care.
Reference: Williams, Allison W. "Restructuring Home Care in the 1990s: Geographical Differentiation in Ontario, Canada." Health and Place, 12 (2006) 222-238
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