Linda McGillis Hall, RN, PhD Diane Doran, RN, PhD Linda O’Brien Pallas, PhD Joan Tranmer, RN, PhD Deborah Tregunno, RN, PhD Ellen Rukholm, RN, PhD Donna Thomson, RN, MBA Leah Pink, RN, MN Jessica Peterson, RN, PhD Student Erin Johnston, RN, MN Student Amy Palma, RN, BScN Funded by The Ontario Ministry of Health & Long-Term Care MARCH 2006 Quality Worklife Indicators for Nursing Practice Environments in Ontario Determining the Feasibility of Collecting Indicator Data
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Linda McGillis Hall, RN, PhDDiane Doran, RN, PhD Linda O’Brien Pallas, PhD Joan Tranmer, RN, PhD Deborah Tregunno, RN, PhD Ellen Rukholm, RN, PhD Donna Thomson, RN, MBA Leah Pink, RN, MNJessica Peterson, RN, PhD StudentErin Johnston, RN, MN StudentAmy Palma, RN, BScN
Funded by The Ontario Ministry of Health & Long-Term Care
MARCH 2006
Quality Worklife Indicators for NursingPractice Environments in OntarioDetermining the Feasibility of Collecting Indicator Data
Linda McGillis Hall, RN, PhD
Associate Professor, Faculty of Nursing & CIHR New
Investigator & Co-investigator, Nursing Health Services
Research Unit, University of Toronto
Diane Doran, RN, PhD, Faculty of Nursing,
University of Toronto
Linda O’Brien Pallas, PhD, Faculty of Nursing,
University of Toronto
Joan Tranmer, RN, PhD, Queen’s University/
Kingston General Hospital
Deborah Tregunno, RN, PhD, Faculty of Nursing,
York University
Ellen Rukholm, RN, PhD, School of Nursing,
Laurentian University
Donna Thomson, RN, MBA, St. Peter’s Hospital
Leah Pink, RN, MN, Faculty of Nursing,
University of Toronto
Jessica Peterson, RN, PhD Candidate, Faculty
of Nursing, University of Toronto
Erin Johnston, RN, MN Student, Faculty of Nursing,
University of Toronto
Amy Palma, RN, BScN, Faculty of Nursing,
University of Toronto
Funded by The Ontario Ministryof Health & Long-Term Care
MARCH 2006
Quality Worklife Indicators for NursingPractice Environments in OntarioDetermining the Feasibility of Collecting Indicator Data
Acknowledgements
We gratefully acknowledge the Ontario Ministry of Health and Long-term Care, Dr. Dorothy Pringle – Executive Lead, and Peggy White of the Health Outcomes for Better Information and Care initiative for
their support of this research. The findings reported herein are those of the authors. No endorsement by the Ontario Ministry of Health
and Long-term Care is intended or should be inferred.
We would also like to acknowledge the contribution of DavidMontgomery for his assistance with the statistical analysis.
Finally, we would like to thank the hospital nursing personnel, unitmanagers, nurse executives, and chief executive officers, of the
participating sites who gave their time and energy to support this study.
Toronto Ontario Region:University Health Network – Toronto General Hospital site
Shalom Village (Hamilton)Chelsey Park Mississauga
Toronto Salvation Army GraceSpectrum Health Care (Toronto)
Southwestern Ontario Region:Huron Perth Healthcare Alliance – Stratford General Hospital
St. Joseph’s Health Centre (London)St. Peter’s Health System (Hamilton)
ParaMed Home Health Care (London)
Eastern Ontario Region:Kingston General Hospital
Peter D. Clark Long-Term Care Centre (Nepean)Perley & Rideau Veteran’s Health Centre (Ottawa)
St. Mary’s of the Lake Hospital (Kingston)All-Care Health Services (Kingston)
Northern Ontario Region:Manitoulin Health Centre-Little Current and Mindemoya sites
Bethammi Nursing Home (Thunder Bay)Pioneer Manor (Sudbury)
St. Joseph’s Care Group (Thunder Bay)Bayshore Home Health (Thunder Bay)
Cover photograph provided by University of Toronto, Public Affairs
Quality Worklife Indicators for Nursing Practice Environments in Ontario: Determining
24 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Employment Status of Nurse Participants
Table 8 indicates that the majority of nurses participating in this study (n=275, 61%) wereemployed full-time, while less than one-third (n=133, 30%) were employed part-time, and 6%(n=28) held casual positions. Some nurses indicated that they worked a combination of thesealternatives (3%), (n=12). These patterns of employment remained consistent across all sectors.
In comparison, the employment status of the sample is reflective of the averages found inOntario, in which 50.4% of regulated nursing workers in 2004 were employed full-time, 28.9%were employed part-time, and 7.6% were employed casually (CIHI, 2005a). This is slightlydifferent than the national averages, which showed that 48.8% of all regulated nursing personnelworked full-time, 32.2% part-time, and 10.8% casual (CIHI, 2005a).
Table 8. Employment Status of Nursing Personnel by Sector
ComplexAcute care Long-term care continuing care Homecare Overall care
The majority of respondents (n=383, 85%) indicated that their employment status had beenchosen by them (see Table 9). These response patterns remained consistent across all sectors.
Table 9. Choice of Employment Status of Nursing Personnel by Sector
ComplexAcute care Long-term care continuing care Homecare Overall care
Participants were asked what types of changes they would like to have made to their employmentstatus. Over half (n=248, 55%) identified that they wanted their work hours to remain unchanged,while one-quarter (n=107, 24%) indicated that they wanted to work more, and 87 (19%) indicatedthat they wanted to work less (see Table 10).
Table 10. Preferred Change in Employment Status of Nursing Personnel by Sector
ComplexWork status Acute care Long-term care continuing care Homecare Overall care
Average rates of absenteeism were highest in long-term care and complex continuing care in thisstudy (see Table 14). Unregulated workers had the highest absenteeism with their average numberof days absent in long-term care (x̄=61), followed by acute care (x̄=20), and complex continuingcare (x̄=5). For RNs, the highest average number of days absent occurred in long-term care(x̄=22), followed by complex continuing care (x̄=9), acute care (x̄=8), and homecare (x̄=4). Thesepatterns were similar for RPNs with the highest average number of days absent being in long-termcare (x̄=27), followed by complex continuing care (x̄=11), acute care (x̄=7), and homecare (x̄=4).
Table 14. Average Number of Days Absent AnnuallyComplex
Acute care Long-term care continuing care Homecare Overall care
Overall, unit managers in this study indicated that 43% of RNs were employed full-time, while33% were employed part-time, and 25% in casual positions (see Table 15). In contrast, 38% ofRPNs were employed full-time, with close to 35% part-time, and 27% in casual positions. Finally,39% of URWs worked full-time, 27% part-time, and 34% casually.
Table 15. Percentage of Employment by Occupational Status Complex
Acute care Long-term care continuing care Homecare Overall care
These results imply that overall, there were no substantial differences between the WQI and
NWI-R scale reliabilities. However, the NWI-R instrument tended to have lower alpha scores than
the WQI instrument for the majority of the subscales, within all health care sectors. As well,
within the NWI-R subscales, the homecare sector appears to have lower alpha values than the
other sectors, for three out of four NWI-R subscales.
The completion rate for the scales showed some differences with the WQI subscales achieving
a better completion rate by respondents in this study. While there does not seem to be over-
whelming evidence to suggest that one instrument is superior to the other, this study suggests
that the WQI may be a more stable measure of nursing work environments. Both appear to be
fairly reliable and consistent, although some specific sectors (i.e., long-term care) and nursing
personnel groups (i.e., URWs) experienced difficulties relating to some of the questions. Thus,
consideration should be given to adapting the language of these measures to specific health care
sectors (i.e., long-term care, homecare) to accurately capture their unique work environments.
40 Quality Worklife Indicators for Nursing Practice Environments in Ontario
FIv
e Chapter Five: Feasibility and Utility of Collecting Nursing Worklife Indicator Data
Introduction
Assessing the Feasibility
and Utility of Nursing Worklife
Indicator Data Collection
Summary
41
INTRODUCTION
The second study objective was to examine the feasibility of collecting nursing worklife indicator
data in everyday practice settings in acute care, complex continuing care, long-term care, and
homecare settings in Ontario, Canada. The specific research questions were: (1) What is the
receptivity to nursing worklife indicator data collection by nurses and managers? and
(2) What is the burden of collecting nursing worklife indicator data for nurses and managers?
The third study objective examines the utility of nursing worklife indicator data for nurses and
managers in acute care, complex continuing care, long-term care and homecare settings in
Ontario, Canada. The specific research questions were: (1) To what extent are the nursing
worklife indicator data comprehensive, as perceived by nurses and managers? and (2) How
relevant and useful are the nursing worklife indicator data in assisting nurses and managers in
decision-making for the organization?
ASSESSING THE FEASIBILITY AND UTILITY
OF NURSING WORKLIFE INDICATOR DATA COLLECTION
Focus groups were held with nursing personnel and unit managers to explore the feasibility and
utility issues related to nursing worklife data collection. Nursing staff participants worked in
either a surgical or a medical unit in an acute care, long-term care, complex continuing care, or
homecare setting. Most of the participants were registered nurses, although there were RPNs and
URWs as well. All participants were actively involved in the discussion and validated the points
raised. Focus group interviews were conducted with 14 nursing staff (i.e., RN, RPN and URW) and
10 manager representatives from each of the four regions in Ontario where the study was being
conducted. Nursing staff participants consisted of one person from Region 1 (Central Ontario),
six from Region 2 (Southwestern Ontario), three from Region 3 (Eastern Ontario), and four from
Region 4 (Northern Ontario). Managers included two from Region 1 (Central Ontario), one from
Region 2 (Southwestern Ontario), five from Region 3 (Eastern Ontario), and two from Region 4
(Northern Ontario).
In order to assess the feasibility of collecting nursing data in practice settings, information was
obtained in focus groups on the amount of time it takes for a nurse and manager to complete the
worklife indicator survey. Participants in focus groups were asked to identify the time involved
in survey completion, and to identify any barriers and facilitators to nursing worklife indicator
data collection. In addition, data was collected from nurses on their perceived ease of collecting
the nursing worklife indicator data, ease of interpreting the nursing worklife indicator data, and
perceptions of the frequency that it should be collected. Nurses were consulted on their
receptivity to incorporating a standardized approach to nursing worklife indicators assessment.
Another aspect of feasibility is whether it is possible to collect the nursing worklife indicator
data in a timely manner. Information was gathered about the time required for data collection
to be completed, completeness of data collection, and reasons for failure to complete the survey.
Data was collected from nurses and managers on their perceptions of the factors in the work
environment that influence nurses’ receptivity to completing the survey.
42 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Receptivity and Burden of Nursing Worklife Data Collection
for Nursing Personnel
The nurse surveys contained two instruments that measure aspects of the nursing work
environment, the Nursing Work Index – Revised and the Work Quality Index, as well as a number
of demographic questions. Nursing personnel in this study identified that it took between 15 to
30 minutes to complete the nursing worklife indicators survey, and identified that it was
relatively straightforward. Nurses’ receptivity towards nursing worklife data collection and
assessments of the burden associated with it can be characterized by exploring their perceptions
of the barriers and facilitators to the process of this data collection. Most of these relate to the
organization of nursing work and the work environment. While a few nurses denied any barriers
to this data collection existed, a number of impediments were identified by others that related to
time available to complete the worklife indicators survey. Getting away from the unit and then
returning later to “a mess of things that went wrong” was a problem for one nurse. In addition to
returning to the unit to face a number of problems, nurses also had to cope with colleagues who
were frustrated that they had to cover for them when they were gone. “Trying to make do with
fewer nurses” was identified as a challenge. Another nurse felt that the timing of the survey was
an obstacle to participation. In this case, the data collection took place at a point in the day
when the workload was heavy. Some nurses ended up staying late to complete the survey while
others completed the survey on their own personal time. While some expressed aggravation at
taking their own time to complete the survey, others talked about the importance of
participating despite the additional time required.
“…I did it at the end of shift and I was very, very frustrated.”
“...it causes resentment when it’s imposed upon my time to say you’re to do this but you’ll do
it on your own time.”
“I specifically had to arrange my day so that I could take time to come and do it. And I just believe
that it’s important so it was something that I wanted to do.”
“You really do have to create time if you want to do these things.”
“I guess I looked at it from the standpoint that yes, I did it on my coffee break but I wanted
to get my opinion in so I didn’t mind,”
There was some concern among nurses that management would “catch wind” of the data they
reported in the survey.
“I was kind of rallying my colleagues to fill it in. They were a little bit intimidated to think
that this might be something that might reflect on them badly should they sit down and
take the time to do it.”
“I found people when they filled it out they were asking each other back and forth, you know,
is it okay to put this type deal because they didn’t want to be reprimanded for it.”
Determining the Feasibility of Collecting Indicator Data 43
“I specifically had to arrange my day so that I could take time to come and do it. And I just believe that it’s important so it was something that I wanted to do.”
Participants identified a number of factors that facilitated their participation. Several people
talked about being given a room where they could sit, along with a treat to have while they filled
out the surveys (i.e., cookies).
“…cookies helped because we were able to sit down, have a snack.”
“If I’m not mistaken, it was the only break I had that day which was nice.”
Support from managers to participate was also identified as a facilitator.
“We were very well prepared and our manager actually pulled us … pulled us from the
floor and said don’t worry.”
“Our manager was very supportive because a group of us were isolated up in a room and
said here’s a half an hour to fill out this survey. She was very supportive and encouraged
us to do that.”
“We had a nice experience. Our nurse manager mentioned it at a staff meeting and then supplied
a nice quiet room for us to go to and had cookies so it was a good experience.”
A couple of nurses talked about how having the data collector explain confidentiality facilitated
their willingness to participate.
“[The data collector] who did come to our facility did stress that this was completely anonymous.”
“They were very good at reassuring us that this was anonymous and was research and not
punitive based.”
Despite the need to use personal time, one nurse suggested it helped that the survey was
dropped off in the morning and picked up later, giving her time to “ponder” her responses over
coffee and lunch breaks. The opportunity to “debrief” facilitated participation for some of the
nurses.
“I really found I actually enjoyed doing the survey because I think as nurses we don’t often
have the opportunity to sit down and meet with each other and talk.”
“It was really nice just to sit down for even half an hour with my peers and just say, you
know, maybe this place isn’t such a bad place to work and I really enjoyed it.”
Comprehensiveness and Relevance of Nursing Worklife Indicator Data Collection
for Nursing Personnel
Most nursing staff participants reported that the survey was comprehensive, “detailed”, and
“really did get to the heart of the matter”. However, there were some difficulties identified by
homecare nurses who were completing the survey, compared to nurses working in long-term
care, complex continuing care, and acute care sectors. One nurse explained,
“There were a lot of questions that didn’t apply to them [homecare nurses] and they weren’t sure
what to answer.”
44 Quality Worklife Indicators for Nursing Practice Environments in Ontario
“We had a nice experience. Our nurse manager mentioned it at a staff meeting and then supplied a nice quiet room for us to go to and had cookies so it was a good experience.”
Participants further highlighted the unique environment in which homecare nurses work.
They discussed a variety of services they provide to patients that normally fall outside of
nursing (e.g., social work, occupational therapy, and physiotherapy).
“There are definitely things that the homecare nurses face that you wouldn’t necessarily face
in a facility.”
One nurse pointed out that the survey refers to interactions and relationships with other
staff on the ‘unit’, such as physicians. These questions do not capture the quality of the work
of homecare nurses (e.g., isolation) because they are tailored to the acute care rather than the
community setting. In response to these problems, one nurse suggested that a future survey
elicit feedback specifically from homecare nurses.
One participant referred to “trick questions”, where items on the surveys were unclear or
difficult to understand. Participants were asked about a number of specific areas of the survey
that had been identified in preliminary data analysis as not being consistently answered.
Some nurses had difficulty with questions that referred to a Chief Nursing Officer, Clinical Nurse
Specialist, or support staff because there were no such positions in their organizations. While
there may have been at one point in time, the question was not applicable to the organization’s
current status at the time of data collection.
“…when I put ‘not applicable’ it’s because really they don’t exist and you should have an
explanation as to why it’s not applicable.”
There was also some confusion over the question on the survey pertaining to nursing care
delivery models. Focus group participants indicated that the model used in practice can often be
ambiguous.
“…years ago they converted us from team nursing to total patient care and yet in fact the ways
things went … it started out that way but we’ve gone back to team nursing because you cannot do
total patient care anymore because things are so hectic and stressed and rushed so you absolutely
depend on the team.”
One nurse referred to the model of care as a “method of survival”. Another nurse denied that
there was any official model of care delivery, rather “it’s just what we need to do to get the
work done.”
When nurse participants in the focus group talked about preceptorship there was a sense that
additional clarity for survey questions around preceptorship would be helpful.
“…preceptor program, does that mean an orientation program for new staff?”
“…what is the definition of that preceptorship?”
Determining the Feasibility of Collecting Indicator Data 45
“There were a lot of questions that didn’t apply to them [homecare nurses] and they weren’t sure what to answer.”
Another question on the survey asked about opportunities to participate in hospital committees.
One participant said that there were no formal committees in their organizations, therefore the
question did not apply to them. Others had a problem answering this question because, while
committees exist within their organizations, there were either no openings for new members or
the nurses had no time to spare.
Nurses also talked about the beneficial aspects of the survey in terms of how they view this
process as giving them a voice.
“…I think we want a voice and what I’m hearing is that we don’t have one.”
However, the motive and outcome of the research was questioned by a nurse who contemplated
whether their opinions were really valued or if interest in their feedback was just, “lip service.”
Another nurse wondered,
“…who’s really doing anything about this because over the years you receive so many of these
surveys and you fill them out with good intentions but we still go to work and we’re still short-
staffed and nobody listens to us.”
Receptivity and Burden of Nursing Worklife Indicator Data Collection
for Unit Managers
Unit managers were asked to provide information on the unit-related information in a survey
that related to the percentage of RNs in staff mix; percentage of full-time, part-time, and casual
nursing staff; educational background of nursing staff; experience of nursing staff employed on
the study units in the study sites; span of control of the unit manager; and unit absenteeism
rates. Managers identified that it took them between 45 minutes to 2 hours to complete. Survey
completion took longer for those managers responsible for multiple nursing units.
Similar to the nursing staff, unit managers also found the institutional-focus of the survey a
barrier for those in a homecare setting. One manager commented that the survey did not seem
applicable to all health care sectors, and expected that the community sector would have filled
out a different survey.
Comprehensiveness and Relevance of Nursing Worklife Indicator Data Collection
for Unit Managers
A few participants suggested that there was a need to look at advanced practice nurses (APN) and
how they were utilized on the unit, although there was concern that it might be difficult to
capture an APNs mandate on a survey.
“…depending on whether they have a regional mandate versus just an organizational mandate
makes a difference to their availability on the patient care areas.”
With respect to the usefulness of the information, managers felt that knowledge of the
percentage of baccalaureate nurses, use of casual staff, and breakdown of full- and part-time
staff was useful. Gathering those kinds of data made the managers more aware of their numbers.
“I think knowing how many degree nurses I have was important.”
“And it also made me look at my ratio because I’ve always strived for 70% full-time and 30% part-
time so in that sense it made me re-look at my complement, my ratio.”
46 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Managers found some survey questions difficult to complete because the requested information
was not readily available. Some problematic areas included the percentage of baccalaureate
nurses, years of experience, nurse to patient ratios, use of casual staff, and the number of
voluntary resignations.
“I had to go to Human Resources and to our nursing staffing office to help with the years
of experience.”
“To determine the casual staff over a year in each category is…I don’t know I’d collect it all.
We don’t keep it. We don’t keep that kind of data in categories and by unit.”
Unit managers discussed some of the problems they faced in completing the survey. Several
participants described having to gather information from different computer programs to fill out
the survey.
“…one of the biggest challenges for myself in doing the questionnaire was having to go from one
program electronically to another to access some of the information.”
Other participants had to physically search for the needed information in different departments.
As one manager noted,
“I think some of us had to physically run from one building to the other to Human Resources and
to Finance to find some of the data that we needed.”
Overall, questions about part-time and casual employment numbers as well as voluntary
resignations, and number of beds was a source of difficulties for several participants.
“I also found that the last page, there was a lot of answers I had…I couldn’t get.”
In general, the survey was less challenging to fill out for those with smaller units and was more
problematic for larger units with more staff.
“It depends on how many staff you do have because it means HR has to look up the file on each
of those people.”
“My unit’s small with 20 registered staff so the information was right there. I didn’t have the
same challenges that the larger units had.”
There were four areas with inconsistent answers that needed clarification, which included data
pertaining to the length of orientation programs and educational programs offered, absenteeism
data, and information on the use of agency staff. When asked to clarify their responses around
orientation programs, most respondents stated that orientation was provided in their facilities,
and the length of orientation was based on need.
“…if the staff nurse comes and say that they need more we will give more orientation.”
“We really do try to individualize it to meet the needs.”
Determining the Feasibility of Collecting Indicator Data 47
“And it also made me look at my ratio because I’ve always strived for 70% full-time and 30% part-time so in that sense it made me re-look at my complement, my ratio.”
Most agreed that new graduates received more orientation than experienced nurses.
“…we give a week for an RN but if they require more we give more and for new grads we’ve
done a mentorship program for about a month.”
“Also new grads are given more orientation.”
Managers were also asked about keeping track of educational programs for nurses as well as
funding for education. Most units kept track of mandatory education classes attended, such as
WHMIS and Advanced Cardiac Life Support courses.
“It’s tracked through our staff education department and it’s tracked on-line…which courses
they’ve attended because they have mandatory…WHMIS, all that are mandatory.”
“We have a binder on the unit that the nurses sort of keep track on their own unless it’s something
that’s mandatory education and then the clinical educator keeps track of that but we haven’t
gotten to the on-line part yet.”
With respect to educational funding, there was a mix of responses with some managers
commenting that course and conference registration fees were paid for, and others stating that
registration fees were not paid for.
“Registration fees are given.”
“We pay for the course cost.”
“…we were getting reimbursement from RNAO, submitting like a group of nurses’ registration fees
for the year type thing but we’re not doing that this year, they’re not doing that.”
One manager commented that time off was given for courses, however, several participants
referred to a lack of paid education days.
“We’ll accommodate their time off.”
“…but we don’t have paid education days per se.”
“We don’t have education…paid education in the budget.”
“…but they don’t get paid for their day of work so…”
To determine who had access to educational opportunities, one unit manager stated,
“If there’s a course that let’s say, for example, 10 nurses wanted to go [to] then we might draw
names out of a hat.”
48 Quality Worklife Indicators for Nursing Practice Environments in Ontario
“If there’s a course that let’s say, for example, 10 nurses wanted to go [to] then we might draw names out of a hat.”
Many commented that educational funding is limited as the educational budget for the unit
is divided per nurse. Managers spoke of having to divide funds allotted for education
among nurses.
“Programs have a certain amount of money budgeted, however, it’s watered down significantly
per nurse.”
“The education line budget is held with the Director and the Director has more than one program
or one area so it’s hard to even know what we have available but I know it’s not a lot and it’s
probably getting less.”
Managers were also asked to clarify their responses about the absenteeism. Several participants
stated absenteeism data was easily available and many kept track of nurse absenteeism with
attendance management programs.
“We’re very aware because of our new attendance management program that’s been
implemented.”
“It’s available on the staffing program…and it’ll break down stats-leave of absence, sick
time, WSIB, whatever.”
“And we’ve also implemented an attendance management program so the managers are
very well aware of absenteeism.”
“We have an attendance management program in [facility name] as well and that’s how we’re
keeping track of, you know, the frequent offenders.”
“…it does have an attendance awareness program on-line, which is tracked to the information that
our Occupational Health Services department provides us quarterly information so we follow up.”
Unit managers participating in the focus groups also clarified their responses around use and
tracking of agency staff. Some hospitals did not use agency nurses, while others had an in-
hospital resource pool or used casual nurses for staffing.
“[Name of organization] does not use agency nurses.”
“[Name of organization] has no agencies like that.”
“…internally we have a resource pool and that’s how we manage our staffing vacancies.”
Some units did use agency staff and agency use was tracked and accessible for managers. One
manager commented that when benefits for full-time staff were considered, the cost for agency
staff was roughly the same as for regular staff.
“[Name of organization] does use agency nurses and we can track that on our financial reports.”
“When you factor in the benefits that the full-time staff get, 14%, or what part-time staff would get
the dollar figure is approximately the same as with agency replacement.”
Determining the Feasibility of Collecting Indicator Data 49
SUMMARY
The focus groups examined nursing personnel and unit managers’ perceptions of the data
collection process and provided a better understanding of the feasibility of gathering these data.
Specifically, focus groups provided information about the experience of completing the surveys,
comprehensiveness, feasibility, utility, and barriers and facilitators to participation. As well,
areas identified as problematic during preliminary analysis were explored in more detail.
Nurses and managers reported that while the surveys were mostly comprehensive, they were
institutionally-focused and therefore, at times, not applicable to the homecare setting. In
addition, one manager suggested that the manager survey look more specifically at the presence
and utilization of APNs. Several barriers and facilitators for completing the nurse surveys were
identified, a number of which were related to problems with physically leaving the unit. A heavy
workload, leaving colleagues to cover their patients, fewer nurses left on the unit, and having
to stay late were among the challenges discussed. The institutional focus of both the nurse and
unit manager surveys was identified as a barrier. There was also intimidation around
management having access to nurses’ responses.
Conversely, one of the facilitators identified by nurses was having a data collector who
thoroughly explained how confidentiality would be protected. Support from managers, time and
space to complete the survey, and providing refreshments were also identified as facilitators.
A number of problematic sections of the surveys were identified and explored during the focus
groups. In the nursing surveys, questions referring to nursing administrative and support staff
were not always answered because they did not exist in some organizations at the time of data
collection. Similarly, questions around opportunity for committee involvement may not have
been answered because there were either no committees in the facility, or there were no
openings on committees. Finally, the question that referred to model of care delivery was not
always answered because the model in practice was unclear in some settings.
Problematic sections in the unit manager surveys were also explored. For the most part this
related to their lack of access to key data on their units such as percentage of baccalaureate
nurses, years of experience, nurse to patient ratios, use of casual staff, and number of voluntary
resignations. There were also some areas with inconsistencies requiring clarification, including
orientation and educational programs, absenteeism, and agency use. Concern with government
access to worklife data was raised in the manager focus group, specifically related to disparity
between two sources of the same data: reports to the government and the survey data.
50 Quality Worklife Indicators for Nursing Practice Environments in Ontario
SIx
Chapter Six: Collection and Storage of Nursing WorklifeIndicator Data
Introduction
Feasibility of Collecting and Maintaining
Nursing Worklife Indicator Data
Summary
Nurses’ Perspectives of Nursing Worklife
Indicator Data Collection (Focus Groups)
Managers’ Perspectives of Nursing Worklife
Indicator Data Collection (Focus Groups)
Summary
51
INTRODUCTION
The fourth study objective examines the potential sources for where these data can be housed in
a database in the future. The specific research questions were: (1) What is the feasibility of
collecting nursing worklife indicator data as part of the data collected by the College of Nurses
of Ontario (CNO), the Canadian Institute for Health Information (CIHI), and the Canadian Council
on Health Services Accreditation (CCHSA), and (2) What is the feasibility of housing nursing
worklife indicator data with the CNO, CIHI, and CCHSA.
These interviews were held between July 19, 2005 and July 26, 2005. Representatives from the
CNO, CCHSA, and CIHI were interviewed separately to determine their positions on the feasibility
of their involvement in collecting, maintaining, and storing nursing worklife data. These
interviews were led by the Principal Investigator and were taped and transcribed to allow for
analysis and integration of responses. As well, information obtained from nurses and managers
during the focus groups that relates to these study objectives are also presented.
FEASIBILITY OF COLLECTING AND
MAINTAINING NURSING WORKLIFE INDICATOR DATA
(1) College of Nurses of Ontario (CNO) Perspective
The CNO is the governing body for the 140,000 RNs and RPNs in Ontario, Canada. The CNO
regulates nursing to protect the public interest and sets requirements to enter the profession,
establishes and enforces standards of nursing practice, and assures the quality of practice of the
profession and the continuing competence of nurses (CNO, 2005).
The CNO is in the process of reviewing all of the data currently collected on their annual
membership renewal form, and at the moment CNO is not considering collecting data on nursing
worklife in Ontario. There are a number of reasons for the current review of their data. First, it is
reviewed regularly, with the impetus of enhancing the accuracy of the data that is collected as
there is heavy reliance externally on CNO data. It is self-report data and thus the CNO encounters
obvious problems with individual nurses not completing the form, which leads to gaps in the
data, particularly around employment status. Second, the review is examining why and how CNO
can make the tool more user-friendly, while retaining the compulsory elements needed from a
regulatory perspective.
Challenges for Collecting Nursing Worklife Indicator Data
A number of challenges for the CNO to collect nursing worklife data were identified. When
considering the CNO strategic plan, which in part discusses bridging the practice realities for
nurses, you could make an argument for how it “fits” with the idea of collecting data on nursing
worklife in Ontario. On the other hand, the CNO’s current requirement for data and the approach
taken is to try to enhance the trust that individual nurses have in the regulator’s role. The CNO
has been actively working at meeting health human resource data planning needs in Ontario.
Moving into collecting data on nursing worklife would be an entirely new agenda for them to
consider. The CNO would have to strategically think about how or if they could meet another
data collection need. One of the challenges to be considered would be how CNO could merge
these two perspectives – nursing health human resources and worklife data collection. CNO
52 Quality Worklife Indicators for Nursing Practice Environments in Ontario
would need to give serious consideration to whether or not it is appropriate for them to collect
data on nursing worklife. Of particular importance is the mandate of the college, as well as
nurses’ perception of the role of the college.
A determination of whether the data being collected related to nursing worklife were mandatory
would be required. The focus of current CNO data collection as part of the renewal form is
mandatory data, not voluntary reporting of select items. If these new data elements were not
compulsory, it could lead to confusion for nurses completing the form. The rationale for
collecting these data needs to be clearly articulated. Nurses want to know what is going
to happen as a result of these data being collected and how quickly they are going to see the
difference. Otherwise, they will question the point of collecting these data. As well, this is
a very costly exercise, not just financially, but in the goodwill and the general interest that
nurses have in ensuring quality care. If the effort, time, and resources of nurses are being put
towards mandatory collection of these data, we need to ensure that it really has an impact on
quality of care.
On the contrary, if these data were compulsory, a number of new challenges would emerge.
First, a by-law change would be required. The CNO would have to look at their legislation and
determine whether regulatory bodies have the authority to make this information mandatory. It
is likely that both a regulation change as well as a by-law change would be required, as the
information currently collected by CNO is specified in the by-law. It will be important to consider
the length of time and the process that is required for legislative and by-law changes. If the
MOHLTC is convinced that there is a role within regulatory colleges to collect worklife data, it
should be explored sooner rather than later, because the Health Professions’ Regulatory Advisory
Council’s (HPRAC) consultation regarding potential changes to the Regulated Health Profession’s
Act is going on at this time. The report to the Minister is due by the end of March, 2006. It is
timely to be looking at expanding it while the legislation is opened. The minister’s current plan
is to bring legislation forward in the fall of 2006. If a legislative change is to happen after that
time, it will take substantially longer, perhaps 2009 at the earliest.
The terminology used on the CNO renewal form can also pose challenges. The CNO would have
to create definitions to ensure that everyone completing the forms understands what is meant
when they use a term. That will require substantial education for nurses prior to beginning to
collect the data, as well as re-formatting of the existing renewal form.
It is also important to consider the implicit assumptions that underpin data collection by the
CNO. It is possible that a skewed response would occur if the regulator is collecting information
about nurses’ worklife. Nurses may underrate the quality of their work environment when
reporting to the regulatory body. For example, a nurse may know that their obligation as a member
of a self-regulated profession is to meet the standards of practice. For whatever reason, they may
find themselves having difficulty meeting the standards of practice. The environment might be a
factor, but the individual nurse is then deciding how much of a factor the environment is.
From a more philosophical perspective, it is quite likely that people would challenge nursing
worklife data being collected by the CNO, even if a legislated change were made for it to become
the regulator’s role, particularly if there is any intention of linking these data to the individual
Determining the Feasibility of Collecting Indicator Data 53
nurse and patient outcomes. A substantial barrier is the link to a unique identifier – the link to
individual nurses. This raises questions about what the data are going to be used for. For the
CNO, this concern could compromise their quality assurance program. The CNO would need to
look at the impact this would have on the College’s mandate in relation to ongoing competence.
If it were to move forward, it would be a huge initiative that would require a great deal of
planning, consultation, and external stakeholder support. The CNO could envision it as a
possibility down the road far more easily if it were aggregate data for settings, rather than data
linked to individual nurses.
Facilitators for Collecting Nursing Worklife Indicator Data
The most obvious reason for the CNO to collect data on nursing worklife is that a mechanism
already exists for them to obtain information from Ontario’s nurses on an annual basis.
Advantages can be seen in linking this data collection with registration and annual renewal.
The primary advantage is that registration is mandatory annually, and if the regulator collects
these data, it reinforces the importance of completing the data forms for nurses. If the intent
is not to have mandatory data collection for the nursing worklife data, then it probably does
not make sense to have the CNO collect these data. This does not mean that the college might
not have a role in collecting the data, but maybe it would be at a different time of the year.
As well, the CNO strategic plan serves as a facilitator with strategies aimed at bridging nurses’
practice realities and supports for nurses and employers in providing quality care in practice
settings. This linkage would be evident to the CNO College Council. This leads to some reasons
why CNO may be interested in having access to these data, even if the data were available at an
aggregate level. Whether the nursing worklife data are collected by CNO or another body, CNO
might have an interest in looking at the relationships between nursing worklife data and data it
collects through its regulatory processes, such as kinds of calls they get to their practice line in
relation to care in a particular sector, the incidence and type of complaints from the public, and
reports of termination of nurses.
If the nursing worklife data were collected and reported at a higher level of analysis than the
individual nurse, it would be easier to achieve compliance with data collection. Collecting non-
aggregate data begs the question of what is the real purpose of linking the data to the individual
nurse. The obvious conclusion for a CNO member would be that it will be used to challenge
nurses’ individual competencies. It therefore seems like the logical place to start would be at the
organization- or unit-level, to get nurses to accurately report in a manner that they feel that they
will not be incriminating themselves.
If collection of worklife data were mandatory for all regulated health professions, that would be
a facilitator. As well, support and buy-in by unions would also be a facilitator.
Frequency of Collection of Nursing Worklife Data
The CNO representatives felt that the collection of data on nurses’ worklife should definitely not
be conducted any more frequently than annually. Based on their expertise, the CNO suggested
that it would be hard to go to nurses and ask them to report on this more frequently than once a
year. While decision-makers may wish to have data on nurses’ worklife more frequently, it is not
practical. It takes considerable time to collect these data, review what is being collected, ensure
54 Quality Worklife Indicators for Nursing Practice Environments in Ontario
that the data being collected are the right data, and ensuring that good quality data are being
collected in an accurate manner.
Data Collection Process for Nursing Worklife Indicator Data
One of the concerns that have been identified by the advisory committee to the Hospital Report
Research Collaborative (HRRC) is the number of different data collection activities that are going
on within the province related to worklife. Institutions are saturated with these activities, and
that means that individuals are saturated too. The more data collection that we can link, the
better. Also, people would be able to see a logical connection among the data that they are
providing. The HRRC collect their data annually, so it would make sense to have some of these
new initiatives linked. Perhaps the nursing worklife indicator data could be collected through
that process.
Data Storage and Accessibility
A number of locations for data storage and access were identified by the CNO respondents.
Possible locations included the Canadian Institute for Health Information (CIHI), the Ontario
Ministry of Health and Long-term Care (MOHLTC), the HRRC, and the CNO if legislated. CIHI was
identified as an option, particularly if the data being collected involved more than just nursing
and were national, rather than just provincial data. Another option is the information
management infrastructure within the MOHLTC – the Health Results Team for Information
Management. The HRRC collaborative was previously identified as they collect annual hospital-
level data from hospitals across Ontario. Finally, the CNO could be contemplated given all of the
considerations outlined in this interview. The CNO stressed the importance of standardization of
the data collection process for these data.
The CNO suggested that there should be means and ways of having the data accessible to
researchers and decision-makers. Such systems are currently in place at the CNO and they are
exploring new ones to enhance accessibility. There are safeguards that need to be in place to
ensure privacy, a clear understanding of why the information is being obtained, what it is going
to be used for, and who it is released to. Currently the college publishes annual membership
statistics reports that are posted on the website. The CNO also handles complex research
requests regarding information not available through the report. This involves a separate request
that is submitted and processed. When data are released, it is aggregate data that cannot link
back to the individual nurse.
Costs Associated with Data Collection and Storage
A number of costs are associated with the collection of data of this nature. Many of these are
difficult to estimate. If these data were to be collected by CNO, it may be layered on to the
existing renewal forms, or it may need to be done separately. The current renewal process is a
smooth, but complicated process. There would be an additional cost involved in collecting and
processing the data because it is quite a lengthy process of reviewing and cleaning the annual
renewal form. Costs associated with collecting nursing worklife data could be based somewhat
on the annual renewal process costs, as well as this parallel process required to collect the new
worklife data. It would be that cost plus the extra burden in the first few years for data cleaning,
set up of the database, and testing. As well, it may be necessary to house the data offsite
because of space challenges, thus leading to additional costs.
Determining the Feasibility of Collecting Indicator Data 55
(2) Canadian Council on Health Services Accreditation (CCHSA) Perspective
The mission of the CCHSA is to drive quality in health services through accreditation. To achieve
its mission, CCHSA provides health services organizations with an accreditation program based
on national standards and knowledge exchange. CCHSA has a demonstrated interest and proven
experience in data collection related to work life indicators. In March 2004, CCHSA convened a
national meeting to share information and knowledge regarding recent work in the area of work
life indicators in Canada. A significant number of meeting participants represented professional
nursing bodies from across Canada. In 2004, CCHSA and the Ontario Hospital Association (OHA)
formed a partnership to collaborate on a worklife indicators research project. The objective was
to develop and test a pulse-type survey tool that would enable health service organizations to
monitor key work life indicators.
Challenges for Collecting Nursing Worklife Indicator Data
CCHSA representatives have noted that a number of different data collection initiatives targeting
the health care workplace and worklife issues are currently underway, both nationally and
provincially. If a review of the data/information that is being collected from each of the tools
was conducted, collaboration on data collection may be possible. For example, CCHSA could
identify the information that it requires for their accreditation process. Then, once the tools
required to measure nursing worklife were identified, they may complement the accreditation
process, and CCHSA could explore whether there is a way to either synchronize or tie together
the data collection tools. As a national organization, it is important to CCHSA that any tool
developed and resulting data collected are applied nationally so that all health care
organizations benefit. Consequently if work in this area is Ontario-based, it is important for
CCHSA to be able to apply it on a broader scale so that all can benefit. While data collection on
nursing work life is profession-specific and provides vital information, worklife quality is a
concern of leaders in health care organizations across all employment and professional groups.
CCHSA has noted that it is important to pursue a measurement tool that provides a worklife
pulse relevant to multiple professions and employees.
Facilitators for Collecting Nursing Worklife Indicator Data
CCHSA would be interested in nursing worklife data, regardless of which organization collects
the data. As the accreditation program evolves, CCHSA will be collecting and monitoring
organizational data on a continual basis, to provide surveyors with information about the
environment in which they will survey. This will identify specific areas upon which the surveyors
might focus. CCHSA is therefore looking at a number of priority areas and associated data
elements that would help to scope out and identify these survey target areas.
The identification of elements that need to be measured in the nursing work environment would
be important information that CCHSA would benefit from. Based on CCHSA’s leadership position
in accreditation, the Council may be well-positioned to collect nursing work environment-related
data. CCHSA’s involvement would facilitate recognition of the importance that the nursing work
environment must be attended to, and that it is an essential component of measuring quality
within health care organizations.
CCHSA recently completed a pilot test of the worklife Pulse survey, in conjunction with the
Ontario Hospital Association. The Pulse survey includes measures related to the work
56 Quality Worklife Indicators for Nursing Practice Environments in Ontario
absenteeism, presenteeism, organizational satisfaction). CCHSA is currently investigating
whether to incorporate this tool into the accreditation program. The Pulse survey would then be
available to any of its client organizations. In addition to providing the organizations’ leadership
with important information, as mentioned above, these data elements would also help CCHSA
identify target areas within organizations upon which the surveyors might focus.
Frequency of Collection of Nursing Worklife Indicator Data
From CCHSA’s perspective, it is important to collect data in a timely manner to support the
accreditation process. As a result, the timing of data collection as well as data utilization are
important issues for CCHSA to consider. Ideally, the timing for data collection should correspond
to and support the accreditation timeline and the critical issues (priority focus areas) that face
the organization. In addition, ultimately, the data must be accessible in a timely way and meet
the accreditation process requirements.
By way of example, CCHSA discussed the worklife Pulse tool and the frequency of data
collection. The Pulse survey is a simple tool that can be administered by an organization at
almost any time. At the direction of the organization’s leadership, staff could complete the
online survey from a computer within the organization or externally. To optimize its value, the
Pulse survey should be completed relatively frequently – a minimum of twice a year. This
minimum takes into consideration the rapid changes in the health care environment, and the
related issues and stressors faced by care and service providers. As improvement initiatives are
implemented, the online survey can provide “a pulse” as to the results or impact. Are initiatives
and strategies which have been implemented, having the desired impact on worklife? The tool
can therefore provide relatively rapid insight into key worklife indicators being monitored and
inform decision-making.
The simplicity of data collection may also be an important factor to consider when attempting
to identify an appropriate measurement instrument related to nursing worklife. The CCHSA-OHA
Pulse tool includes 20 measures that would inform planning and action within health care
organizations. The Pulse survey should be considered as complementary to a more comprehen-
sive employee survey. At indicated, the Pulse survey would be administered at regular intervals,
complementing a more intensive employee survey currently used annually or biannually by
health care organizations. The complementary model approach may also enable organizations to
add a limited number of specific measures (questions) to the Pulse tool in order to gather data
on a particular issue or concern that the organization is facing at that time.
Data Collection Process for Nursing Worklife Indicator Data
As discussed above, CCHSA is supportive of an online data collection process for a worklife
survey. Nurses would be able to complete the survey from their homes or work. While access to
computers and computer knowledge can both be challenging issues, strategies can be
implemented to manage them successfully. CCHSA’s experience is that a Pulse survey
team/champion within each organization is required to facilitate and coordinate the online
survey process. It is important to communicate the objectives of the survey clearly and
consistently, and to take action based on survey results.
Determining the Feasibility of Collecting Indicator Data 57
Data Storage and Accessibility
Collecting the nursing worklife data and maintaining it in a database is something that CCHSA
would consider. Factors such as the size of the survey, and the scope of the data collection
anticipated for the future would be important considerations. The current survey data that CCHSA
collects, not including the worklife Pulse data, is accessible to members in aggregate form. CCHSA
also produces a national health accreditation report which is released on an annual basis. This
aggregate report is widely distributed across the country, and available on the CCHSA website.
Individual client organizations can also access their own organization-specific confidential data.
Given the significant database built on survey data, CCHSA has the potential to compare sectors
across the country and produce provincial roll-up reports, as long as individual organization data
confidentiality is maintained. Similarly, CCHSA has processes and systems in place to share data
with researchers and decision-makers while protecting client confidentiality.
CCHSA suggests that a national organization is best suited to manage the worklife data collection
and storage. This would ensure consistency in data collection and storage, and would support
integrity of the overall objective. CCHSA has no concern if these data were to be collected and
housed by another national organization, provided that CCHSA has timely access to the data for
accreditation-related purposes. Data collection and storage by provincial regulatory colleges
would likely lead to data inconsistencies between the provinces, as well as challenges when
trying to aggregate the data nationally.
Costs Associated with Data Collection and Storage
If CCHSA were to lead the data collection and storage processes, the associated costs would have
to be identified and long-term funding obtained. Sustainable funding would be required to
support long-term data collection and analysis so that worklife trends and patterns can be
identified and addressed across the country. The costs of collecting, analyzing, maintaining, and
storing data are important questions for any national organization considering this challenging
and exciting endeavor.
(3) Canadian Institute for Health Information (CIHI) Perspective
CIHI is an independent, pan-Canadian, not-for-profit organization working to improve the health
of Canadians and the health care system by providing quality, reliable and timely health
information (CIHI, 2005d). CIHI develops and maintains a number of health databases and
registries related to health care, including health care services, health human resources, and
health spending. This includes identifying national health indicators and conducting special
studies and analyses on key areas of interest.
CIHI has led the development of a standardized database on nursing health human resources in
Canada, and publishes nursing workforce reports annually based on these data. Most recently,
CIHI has partnered with Statistics Canada and Health Canada in undertaking a National Survey of
the Work and Health of Nurses. The survey is being administered by Statistics Canada to a
sample of registered nurses (RNs), licensed practical nurses (LPNs), and registered psychiatric
nurses from across Canada and will help to identify relationships between selected health
outcomes, the work environment, and worklife experiences. Specific topic areas include: work
history, job satisfaction, hours of work, absences from work, perception of the quality of care,
respect and support, general health, chronic conditions and work limitations, and work stress.
58 Quality Worklife Indicators for Nursing Practice Environments in Ontario
The one-time survey will produce a comprehensive national data set that will provide
information on the health and working conditions of nurses across Canada (CIHI, 2005d).
Challenges for Collecting Nursing Worklife Indicator Data
CIHI typically does not do primary data collection, although because of their level of existing
involvement in nursing data collection in Canada, CIHI may consider the possibility of collecting
this nursing worklife data. CIHI’s role would likely be that of the data warehouse, therefore
somebody else would need to collect the data and file it in an electronic format that is consistent
with CIHI standards.
At CIHI there is a transfer of ownership or partnership that needs to be established for the
maintenance of data. Typically, there would be an agreement between the owner and CIHI to
create a partnership that would establish the frequency of data collection, that privacy is being
respected, and how the data can be used and accessed. The time involved with this process may
be considered a challenge for data collection.
Data being collected also have to fit within the CIHI mandate, and the use and relevancy for
CIHI to house and maintain this type of database must be considered. Currently the mandate of
CIHI may be broad enough to reflect data collection on nursing worklife indicators, but this
request would need to be considered by the Board of Directors and the Chief Executive Officer
to determine if CIHI can play a role with these data. It is important to consider how these
data can be considered an important component of health information in Canada to fit with
CIHI’s mandate.
CIHI is a nationally based institute, but they do not reject data collection because it takes place
in a single province. CIHI would normally be interested in promoting it if other provinces wanted
to use the tool and provide the data back to CIHI for the development of larger reports.
Facilitators for Collecting Nursing Worklife Indicator Data
The key facilitator for CIHI is that it has longstanding experience in collecting data related to
nursing human resources in Canada. Currently CIHI is also collaborating on data being collected
by Statistics Canada on the National Survey of the Work and Health of Nurses. The areas covered
in that survey are similar to those identified as key worklife indicators for nursing. Thus, CIHI is
uniquely positioned both experientially and as a data institute to manage these data and has the
system in place and the technology for such data collection. It would be necessary to adapt their
technology according to the fields and the number of records that would need to be maintained.
CIHI also has a data quality framework that is applied to all data. They have experience with
developing data quality processes for large datasets to ensure the accuracy of the information.
Essentially, when CIHI receives a file, it would go through some edit checks electronically as well
as an edit check visually. Often there is a need to go back to the owner or the sender with a few
questions, and then once the process is done and the data is considered clean, it goes into the
database where it could be queried for analytical output. After that, the data goes through CIHI’s
data quality framework where every piece of information is documented (e.g., number of surveys
sent out, response rates, changes to survey, number of questions removed or added, etc.). This
data framework guides CIHI’s interpretation of the data in any reports generated from it.
Determining the Feasibility of Collecting Indicator Data 59
Frequency for Collection of Nursing Worklife Indicator Data
One of the key factors to consider with data collection of this nature is who the target audience
is. For decision-makers, planners, or health care professionals, they tend to want to see the
results of the data collection and have time to develop strategies around the findings. In some
cases it can take up to three years for an institution to respond. Therefore by repeating the
survey too quickly, you would not see the results expected from the application of a new policy,
new guidelines, or new procedure as a result of the previous findings. It can take four to five
years to see a change. Decision-makers always indicate the need to generate a response to the
data and to give that change time to occur. Some policies can be applied quickly, while others
take time.
In contrast, if you are looking for trends only, data collection could be conducted yearly. Caution
should be taken with annual trends data to ensure that they are not used in a negative or punitive
manner towards the institution. Annual data collection could be used more for monitoring of
worklife. This can be particularly useful at times of changes in government funding or new policy
directions that are out of the control of the institution. In these cases the yearly data collection
could give some good information – timely information. You could get the reaction to a SARS
event, for example, things that the employer cannot control.
CIHI works with a lot of stakeholders, and one of the challenges they hear is that if the tool is
changed too frequently, you lose comparability. Comparability is a key element to be considered
in order to see trends and enable accurate comparisons.
Data Collection Process for Nursing Worklife Indicator Data
From CIHI’s perspective individual-level data collection is always better. With gathering
individual-level nursing worklife data at the place of employment there may be a sense that the
administration will have ownership of the data. If data collection were to be conducted by the
MOHLTC, responses may be reflective of government policies (i.e., cutbacks to funding), rather
than the issue being addressed in the survey. The regulatory bodies or Colleges may be most
feasible as they already have the mechanisms and processes for surveying nurses annually.
Data Storage and Accessibility
CIHI, as the premier health information data warehouse in Canada, have systems and processes
in place for data storage and access. These systems include mechanisms to ensure data
consistency and accuracy, as well as processes for accessing data by researchers and decision-
makers. This process includes preparing a statement of the project purpose or research
question, determining the data holdings from which data are needed, reviewing the relevant data
quality and privacy information, developing a list of the scope of data and data elements
required to achieve the study purpose – including a rationale for each variable requested, prior
to having initial discussion with the CIHI data contact person, and completion of a data request
and confidentiality form. CIHI provides cost estimates for these data requests.
Costs Associated with Data Collection and Storage
CIHI costs related to data management would include an initial cost for the system, and then
smaller costs associated with maintenance of the system on an ongoing basis. As well, human
resources costs for data maintenance would need to be determined.
60 Quality Worklife Indicators for Nursing Practice Environments in Ontario
SUMMARY
All three of the stakeholder groups provide some considerations for who could be a potential
source to house the nursing worklife data in the future. Each has specific challenges that bear
deliberation. It is plausible that data collection and storage will need to be considered separately.
For example, while CIHI may be seen as a repository for storage and maintenance of these data,
they are not in the habit of conducting primary data collection. In contrast, the CNO has a
mechanism in place to survey nurses annually, yet to do so would require a change in their
mandate. Finally, CCHSA has identified an existing short Pulse tool that they are currently
testing, and suggest it could serve as a marker for when a more focused nursing worklife survey
is needed. As well, CCHSA may able to accommodate this nursing worklife survey as part of their
accreditation process.
Nurses’ Perspectives of Nursing Worklife Indicator Data Collection
(Focus Groups)
When asked about preferred methods of data collection, nurses in the focus groups discussed a
variety of options, weighing the pros and cons of completing the survey along with their nursing
registration, on-line, at home, and at work. Several nurses preferred the idea of having the data
collected along with annual renewal of their College of Nursing registration.
“If you’re already in the frame of mind of having to fill out a survey and what’s another couple of
pages when you’re already sitting down and dedicating that block of time to doing something.”
It was also suggested that the response rate would be higher if the data was collected along with
CNO registration. However, there was a concern expressed regarding anonymity.
“…if you want to reach more nurses and have everybody have a chance to do it then send it with
the registration as long as they can send it back in a separate envelope and be anonymous.”
There were also nurses who disagreed with the notion of collecting the data along with the CNO
registration. One nurse suggested that it would cause problems for nurses who tended to
procrastinate with renewing registration.
An alternative to collecting data with renewal of registration was an on-line survey. Other focus
group participants resisted on-line data collection.
“I dislike the computer.”
“I don’t get on-line often enough because my kids are always on-line.”
One nurse suggested that they be given the choice between completing the survey on-line or
with registration.
Determining the Feasibility of Collecting Indicator Data 61
“If you’re already in the frame of mind of having to fill out a survey and what’s another couple of pages when you’re already sitting down and dedicating that block of time to doing something.”
Another debate centred on whether it was best to complete the survey at home or at work. While
some completed their nursing worklife study survey at home out of necessity (e.g., sick leave),
others chose to complete it at home because they found it “more relaxing.” Nurses talked about
how completing it at work made them feel rushed. Some questioned the accuracy of either
approach to data collection. One nurse was concerned that they may not have paid as much
attention to the survey at work as they might have if they had done it at home.
“I really felt that if we had the opportunity to take it home some of my answers would have been
maybe a bit different because I would have had more time to consider the right response.”
Another indicated that it was possible that by completing the survey at home, there would be a
failure to capture the emotions aroused in the work environment.
“…if you do it at work you’re getting an honest opinion at the time of the irritations, of the things
you like, things you don’t like. If you come home you sort of cool off and you think well maybe it
wasn’t this bad but then you go back the next day and it was that bad.”
Focus group participants were asked how often they thought the nursing worklife indicator data
should be collected. The vast majority thought that in order to fully capture changes in the
workplace, the data should be collected approximately every six months.
“… because in our society now everything is changing so fast. You can go into work one week, be
off three weeks, go back and they’ve decided to change something already. And I mean there’s just
so much change going on in our world and with our patients.”
“…my answers I would have sent in last fall would be totally different from how I would answer
the questionnaire today.”
“…depending on which provincial party’s in or if there’s a change of rules that comes down the
pipeline, you know, you can be stressed at one time of year and then things resolve and you’re less
stressed at another time of year and things happen frequently.”
“There’s a little bit more volatility in the workplace because of the changing government and
budgets and the downfall from, you know, top down kind of perspective but I think definitely
needing it at least twice a year because of that change and we need to reflect that.”
Managers’ Perspectives of Nursing Worklife Indicator Data Collection
(Focus Groups)
Managers were also asked about their preferred method of collecting nursing worklife data. Many
were happy to submit the data on-line and most preferred to be able to update changes instead
of re-entering data from the start.
“If this was somehow on-line and I could just go in and amend the data when something changed.”
“I get impatient with having to provide the same information, I would rather update information.”
“…then if we could do it and then send it back and just make any changes that would be
one option.”
62 Quality Worklife Indicators for Nursing Practice Environments in Ontario
“I get impatient with having to provide the same information, I would rather update information.”
Others would prefer that the survey be sent out electronically or that a central website be
created where the information would be located, only requiring periodic updates. Some
managers wanted an integrated way of collecting nursing worklife data, but there were no
specific suggestions on how to achieve this.
“…it sounds good to have an integrated way of doing it.”
Participants discussed access to the nursing worklife data, and some expressed concern over the
MOHLTC having access to the information, especially if there were inconsistencies between the
data submitted from the nursing worklife survey and information from other reports and sources.
“I guess we would have to make sure that the numbers that we were submitting to this were
consistent with what the hospital was submitting to the Ministry…numbers coming in from two
different sources don’t always match up for very, very innocent reasons…that kind of thing I found
in my experience is a bit of an alert to the Ministry where there doesn’t really need to be one.”
“We have to report that to the Ministry anyway so it’s not like they’re unaware of what our
numbers are. It might perhaps be overly emphasizing a point that some of us would rather not be
overly emphasized.”
Others were concerned about submitting data that could be misinterpreted if information was
collected at a time when the unit was in the process of reorganization or change.
“They [the Ministry] wouldn’t have any idea of the changes that were going on within an
organization that could impact our responses from one six month period or annually.”
“…in how this information was going to be used in the sense that if you were in an environment
that was evolving or changing, programs, units, or increasing the number of staff based on the
opening of beds, that would make a different flavour to answer those questions on an annual or
every six month basis for some and so it could be misleading in some way…”
SUMMARY
In terms of frequency, focus group participants recommended that nursing data should be
collected every six months to keep up with the dynamic health care environment. Nurses
discussed different methods of data collection, such as collecting data along with annual College
of Nursing registration and on-line. There was a suggestion that nurses be given a choice
between the two methods of data collection as there was some resistance to both. Managers also
expressed a preference for a system in which data could be entered one time only, and then
updated.
Determining the Feasibility of Collecting Indicator Data 63
“…it sounds good to have an integrated way of doing it.”
se
ve
n Chapter Seven: Nursing Worklife in Ontario
Introduction
Mean Scale Scores for Work Quality Index
(WQI) by Nursing Personnel Group
Summary
Mean Scale Scores for Work Quality Index
(WQI) by Health Care Sector
Mean Scale Scores for Nursing Work Index
(NWI-R) by Health Care Sector
Conclusions
65
INTRODUCTION
Further analysis of the nursing worklife survey data was conducted to obtain an assessment
of nursing worklife in Ontario. First, the mean scores for each of the scales and subscales were
assessed. Next, differences in the mean scores for each of the nursing personnel groups and
health care sectors were explored.
MEAN SCALE SCORES FOR WORK QUALITY INDEX (WQI)
BY NURSING PERSONNEL GROUP
The WQI has seven response options ranging from “not satisfied” to “satisfied”. Overall, the mean
score for all of the nursing staff grouped together was 4.314 indicating that study participants
were neither satisfied nor dissatisfied with the quality of their work environment (see Table 24).
Table 24. Mean Score for Worklife Indicators for Nursing Personnel Groups (RN, RPN, URW) and Health Care Sectors
Long-RN RPN URW All Acute term Complex Home Overallonly only only staff care care care care care
66 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Further analysis of the responses for each of the nursing personnel groups was conducted by
exploring the mean scores on the WQI overall. Table 26 demonstrates that registered nurses
had a significantly higher overall mean WQI score (x̄=4.392) than did the unregulated workers
(x̄=4.008) [t=1.989, 26 df, p <.05 one tailed] in this study. Mean scores for registered practical
nurses (x̄=4.237) were not significantly different from either the RNs or the URWs.
Some variation in the mean scores could be seen for the individual subscales (see Table 25).
The overall mean scores were highest for the “work worth to self and others” (x̄=4.996) and
“autonomy of practice” (x̄=4.967) subscales, and lowest for the “professional work environment”
(x̄=3.745) and “benefits” (x̄=3.901) subscales. RNs scored highest on all but one of the subscales
with the exception of “work worth to self and others”. In turn, RPNs scored higher than URWs on
all of the subscales with the exception of “work worth to self and others” and “benefits”. Some of
these differences in mean scores were found to be significant (see Table 26). Specifically, RNs had
a significantly higher mean score for the “professional work environment” (x̄=3.819) than URWs
(x̄=3.520) [t=2.164, 37 df, p <.05 two tailed]. In contrast, RPN mean scores were not significantly
different from either the RNs or the URWs for the “professional work environment” subscale.
RNs also had a significantly higher mean score for “autonomy of practice” (x̄=5.155) than did
the URWs in this study (x̄=4.243) [t=15.30, 44 df, p <.05 two tailed] (see Table 26). As well RNs
had a significantly higher mean score for “autonomy of practice” (x̄=5.155) than did the RPNs
(x̄=4.243) [t=9.16, 222 df, p <.05 two tailed]. Similarly, RPNs had a significantly higher mean
score for “autonomy of practice” (x̄=4.830) than did the URWs (x̄=4.243) [t=9.126, 59 df, p <.05
two tailed].
In contrast, URWs had a significantly higher mean score for “work worth to self and others”
(x̄=5.073) than did RPNs (x̄=4.922) [t=2.011, 52 df, p <.05 two tailed] (see Table 26). Also, RNs
had a significantly higher mean score for “work worth to self and others” (x̄=5.030) than did
RPNs (x̄=4.922) [t=2.396, 233 df, p-value <.05 two tailed. Mean scores for RNs and URWs were
not significantly different for the “work worth to self and others” subscale.
RNs also had a significantly higher mean score for “professional relationships” (x̄=4.735)
than did URWs (x̄=3.845) [t=4.776, 27 df, p <.05 two tailed] (see Table 26). As well, RPNs had
a significantly higher mean score for “professional relationships” (x̄=4.565) than did URWs
(x̄=3.845) [t=3.672, 33 df, p-value <.05 two tailed]. Mean scores for RNs and RPNs were not
significantly different for the “professional relationships” subscale.
RNs also had a significantly higher mean score for “professional role enactment” (x̄=4.434) than
URWs (x̄=3.933) [t=2.54, 44 df, p <.05 two tailed] (see Table 26). As well, RPNs had a significantly
higher mean score for “professional role enactment” (x̄=4.355) than URWs (x̄=3.933) [t=2.105,
47 df, p-value <.06 two tailed]. Mean scores for RNs and RPNs were not significantly different for
the “professional role enactment” subscale.
RNs had significantly higher mean scores for “benefits” (x̄=3.988) than RPNs (x̄=3.758) [t=4.29,
270 df, p <.05 two tailed] (see Table 25). Mean scores between RPNs and URWs as well as RNs and
URWs were not significantly different for the “benefits” subscale.
Determining the Feasibility of Collecting Indicator Data 67
Table 25. Work Quality Index Mean Score Differences Between Nursing Personnel Groups (RN, RPN, and URW)
WQI x̄ SD N
Professional work environment RN 3.819 .60 237
URW 3.520 .75 32
t = 2.164*, df = 1,37
Autonomy of practice RN 5.155 .29 247
URW 4.243 .34 37
t = 15.30*, df = 1,44
RN 5.155 .28 247
RPN 4.830 .34 128
t = 9.16*, df = 1,222
RPN 4.830 .34 128
URW 4.243 .34 37
t = 9.126*, df = 1,59
Work worth to self and others RN 5.030 .39 230
RPN 4.922 .34 128
t = 2.396*, df = 1,233
URW 5.073 .36 31
RPN 4.922 .34 128
t = 2.011*, df = 1,52
Professional relationships RN 4.735 .68 241
URW 3.845 .90 25
t = 4.776*, df = 1,27
RPN 4.565 .80 114
URW 3.845 .90 25
t = 3.672*, df = 1,33
Professional role enactment RN 4.434 1.18 250
URW 3.933 1.04 33
t = 2.54*, df = 1,44
RPN 4.355 .94 130
URW 3.933 1.04 33
t = 2.105*, df = 1,47
Benefits RN 3.988 .49 236
RPN 3.758 .48 128
t = 4.29*, df = 1,270
Overall RN 4.392 .79 195
URW 4.008 .86 22
t = 1.989*, df = 1,27
*P <0.05
68 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Mean Scale Scores for the Nursing Work Index (NWI-R)
by Nursing Personnel Group
The NWI-R has four response options ranging from “strongly agree” to “strongly disagree”.
Table 25 demonstrates that overall, the mean score for all of the nursing staff grouped together
was 2.298 indicating that study participants reported some presence of the key work
environment factors in their work settings (i.e., autonomy, control over practice setting, nurse-
physician relationships and organizational support). Further analysis of the responses for each
of the nursing personnel groups was conducted by exploring the mean scores on the NWI-R
overall. No significant differences were found between the overall mean scores for RNs
(x̄=2.314), RPNs (x̄=2.251) and URWs (x̄=2.304; see Table 25).
RNs had a significantly lower mean score on the “autonomy” subscale (x̄=2.192) than URWs
(x̄=2.385) [t=11.038, 55 df, p <.05 two tailed] (see Table 27). RNs also had a significantly lower
mean score on the “autonomy” subscale (x̄=2.192) than RPNs (x̄=2.270) [t=4.567, 186 df, p <.05
two tailed]. As well, RPNs had a significantly lower mean score for “autonomy” (x̄=2.270) than
did the URWs (x̄=2.385) [t=5149, 117 df, p <.05 two tailed].
There were no significant differences in mean scores for the “control over practice” subscale
between the three nursing personnel groups in this study.
RNs had a significantly higher mean score on the “nurse-physician relationship” subscale
(x̄=2.153) than RPNs (x̄=2.110) [t=4.035, 352 df, p <.05 two tailed] (see Table 27). RNs also had
a significantly higher mean score on the “nurse-physician relationship” subscale (x̄=2.153) than
did the URWs (x̄=2.021) [t=5.429, 44 df, p <.05 two tailed]. Finally, RPNs had a significantly
higher mean score on the “nurse-physician relationship” subscale (x̄=2.110) than URWs (x̄=2.021)
[t=3.893, 34 df, p <.05 two tailed].
RNs had a significantly higher mean score for “organizational support” (x̄=2.287) than RPNs
(x̄=2.240) [t=1.961, 334 df, p <.05 two tailed] (see Table 26). Mean scores between RNs and
URWs and between RPNs and URWs were not significantly different for the “organizational
support” subscale.
Determining the Feasibility of Collecting Indicator Data 69
Table 26. Nursing Work Index Mean Score Differences Between Nursing Personnel Groups (RN, RPN, and URW)
NWI-R x̄ SD N
Autonomy RN 2.192 .11 243
URW 2.385 .10 39
t = 11.038*, df = 1,55
RN 2.192 .11 243
RPN 2.270 .18 132
t = 4.567*, df = 1,186
RPN 2.270 .18 132
URW 2.385 .10 39
t = 5.149*, df = 1,117
Nurse-physician relationship RN 2.153 .15 253
RPN 2.110 .05 133
t = 4.035*, df = 1,352
RN 2.153 .15 253
URW 2.021 .13 32
t = 5.429*, df = 1,44
RPN 2.110 .05 133
URW 2.021 .13 32
t = 3.893*, df = 1,34
Organizational support RN 2.287 .26 242
RPN 2.240 .19 128
t = 1.961*, df = 1,334
*P <0.05
SUMMARY
Work Quality Index
RNs in this study had significantly higher overall perceptions of the quality of their work and
work environment than URWs. Specifically, RNs held higher perceptions of the professional work
environment, autonomy of practice, professional relationships and professional role enactment
than URWs. As well, RNs had higher perceptions of autonomy of practice, work worth to self and
others, and benefits than RPNs in this study.
RPNs in this study had higher perceptions of autonomy of practice, professional relationships,
and professional role enactment than URWs. In contrast, URWs held a higher perception of their
work worth to self and others than RPNs in this study.
70 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Nursing Work Index-Revised
No substantial differences between the nursing personnel groups were noted overall for the NWI-R.
RNs had lower scale scores for autonomy, which indicates that they have higher perceptions of
autonomy than URWs or RPNs. As well, RNs had higher perceptions of the nurse-physician role
than either RPNs or URWs, and higher perceptions of organizational support than RPNs.
RPNs had lower scale scores for autonomy than URWs, indicating that they have higher levels
of autonomy. As well, RPNs identified higher perceptions of the nurse-physician relationship
than URWs.
MEAN SCALE SCORES FOR WORK QUALITY INDEX (WQI)
BY HEALTH CARE SECTOR
Table 27 demonstrates that homecare nurses had a significantly higher overall mean WQI score
(x̄=4.809) than acute care nurses (4.163) [t=3.258, 47 df, p <.05] and complex continuing care
nurses (x̄=4.215) [t=2.925, 51 df, p <.05]. As well, long-term care nurses had a significantly
higher overall mean WQI score (x̄=4.440) than acute care nurses (x̄=4.163) [t=2.568, 194 df,
p-value <.05].
Homecare nurses had significantly higher mean scores on the “professional work environment”
subscale (x̄=4.261) than acute care nurses in this study (x̄=3.475) [t=5.557, 73 df, p <.05] as well
as complex continuing care nurses (x̄=3.511) [t=4.961, 92 df, p <.05] (see Table 28). Long-term
care nurses had significantly higher mean scores on the “professional work environment”
subscale (x̄=4.013) than complex continuing care nurses (x̄=3.511) [t=5.773, 173 df, p <.05] and
acute care nurses (x̄=3.475) [t=7.838, 229 df, p <.05].
Homecare nurses had significantly higher mean scores on the “autonomy of practice” subscale
(x̄=5.713) than acute care nurses in this study (x̄=4.921) [t=18.459, 115 df, p <.05], as well as
complex continuing care nurses (4.748) [t=17.842, 162 df, p <.05), and long-term care nursing
staff (x̄=4.758) [t=20.436, 145 df, p <.05]. In contrast, acute care nurses had significantly higher
mean scores on the “autonomy of practice” subscale (x̄=4.921) than complex continuing care
nurses (x̄=4.748) [t=3.919, 144 df, p <.05] and long-term care nursing staff (x̄=4.758) [t=5.548,
264 df, p <.05].
Long-term care nurses had significantly higher mean scores on “work worth to self and others”
(x̄=5.002) than complex continuing care nursing staff (x̄=4.92) [t=2.249, 193 df, p <.05].
Determining the Feasibility of Collecting Indicator Data 71
Table 27. Work Quality Index Mean Score Differences Between Health Care Sectors
WQI x̄ SD N
Professional work environment Home 4.261 1.02 59
Acute 3.475 .53 130
t = 5.557*, df = 1,73
Home 4.261 1.02 59
Complex 3.511 .69 94
t = 4.961*, df = 1,92
Long-term 4.013 .52 106
Complex 3.511 .69 94
t = 5.773*, df = 1,173
Long-term 4.013 .52 106
Acute 3.475 .53 130
t = 7.838*, df = 1,229
Autonomy of practice Home 5.713 .32 71
Acute 4.921 .24 132
t = 18.459*, df = 1,115
Home 5.713 .32 71
Complex 4.748 .38 93
t = 17.842*, df = 1,162
Home 5.713 .32 71
Long-term 4.758 .30 120
t = 20.436*, df = 1,145
Acute 4.921 .24 132
Complex 4.748 .38 93
t = 3.919*, df = 1,144
Acute 4.921 .24 132
Long-term 4.758 .30 120
t = 5.548*, df = 1,264
Work worth to self and others Long-term 5.002 .29 105
Complex 4.92 .22 91
t = 2.249*, df = 1,193
Professional relationships Home 5.081 .65 57
Acute 4.480 .79 135
t = 6.389*, df = 1,130
Home 5.081 .65 57
Complex 4.588 .80 91
t = 4.111*, df = 1,139
Home 5.081 .65 57
Long-term 4.599 .66 100
t = 4.449*, df = 1,120
72 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Continued
WQI x̄ SD N
Professional role enactment Home 5.499 .70 73
Acute 4.173 1.34 135
t = 9.349*, df = 1,208
Home 5.499 .70 73
Complex 4.027 1.09 95
t = 10.633*, df = 1,163
Home 5.499 .70 73
Long-term 4.158 1.09 114
t = 10.268*, df = 1,187
Benefits Complex 3.961 .53 95
Home 3.732 .65 68
t = 2.400* df = 1,127
Long-term 4.139 .68 110
Home 3.732 .65 68
t = 4.003*, df = 1,149
Long-term 4.139 .68 110
Complex 3.961 .53 95
t = 2.114*, df = 1,203
Complex 3.961 .53 95
Acute 3.756 .41 126
t = 3.147*, df = 1,173
Long-term 4.139 .68 110
Acute 3.756 .41 126
t = 5.174*, df = 1,175
Overall Home 4.809 1.00 34
Acute 4.163 .85 115
t = 3.258*, df = 1,47
Home 4.809 1.00 34
Complex 4.215 .81 79
t = 2.925*, df = 1,51
Long-term 4.440 .66 81
Acute 4.163 .85 115
t = 2.568*, df = 1,194
*P <0.05
Homecare nurses had significantly higher mean scores on the “professional relationships”
subscale (x̄=5.081) than acute care nurses in this study (x̄=4.480) [t=6.389, 130 df, p <.05] as
well as complex continuing care nurses (x̄=4.588) [t=4.111, 139 df, p <.05], and long-term care
nurses (x̄=4.599) [t=4.449, 120 df, p <.05].
Determining the Feasibility of Collecting Indicator Data 73
Homecare nurses had significantly higher mean scores on the “professional role enactment”
subscale (x̄=5.499) than acute care nurses in this study (x̄=4.173) [t=9.349, 208 df, p <.05] as
well as complex continuing care nurses (x̄=4.027) [t=10.63, 163 df, p <.05], and long-term care
nurses (x̄=4.158) [t=10.26, 187 df, p <.05].
Complex continuing care nurses had significantly higher mean scores on the “benefits” subscale
(x̄=3.961) than homecare nurses (x̄=3.732) [t=2.400, 127 df, p <.05] and acute care nurses
(x̄=3.756) [t=3.147, 173 df, p <.05]. As well, long-term care nurses had significantly higher mean
scores on the “benefits” scale (x̄=4.139) than homecare nurses (x̄=3.732) [t=4.003, 149 df,
p <.05], complex continuing care nurses (x̄=3.961) [t=2.114, 203 df, p <.05], and acute care
nursing staff (x̄=3.756) [t=5.174, 175 df, p <.05].
MEAN SCALE SCORES FOR NURSING WORK INDEX (NWI-R)
BY HEALTH CARE SECTOR
Table 28 demonstrates that homecare nurses had a significantly lower overall mean NWI-R score
(x̄=1.89) than acute care nurses (x̄=2.44) [t=10.036, 94 df, p <.05], complex continuing care
nurses (x̄=2.34) [t=7.621, 103 df, p <.05] and long-term care nurses (x̄=2.28) [t=6.869, 99 df,
p-value <.05]. As well, long-term care nurses had a significantly lower overall mean NWI-R
score(x̄=2.28) than acute care nurses (x̄=2.43) [t=3.057, 170 df, p <.05].
For the specific subscales, home care nurses also had significantly lower mean scores on the
“autonomy” subscale (x̄=1.85) than acute care nurses (x̄=2.37) [t=27.778, 202 df, p <.05], complex
continuing care nurses (x̄=2.33) [t=21.774, 151 df, p <.05], and long-term care nurses (x̄=2.257)
[t=23.889, 187 df, p <.05] (see Table 28). As well, long-term care nurses had significantly lower
mean scores on the “autonomy” subscale (x̄=2.25) than complex continuing care nurses (x̄=2.33)
[t=3.327, 174 df, p <.05] and acute care nurses (x̄=2.37) [t=6.063, 244 df, p <.05].
Home care nurses also had significantly lower mean scores on the “control over practice”
subscale (x̄=1.92) than acute care nurses (x̄=2.52) [t=12.476, 136 df, p <.05], complex continuing
care nurses (x̄=2.57) [t=14.539, 111 df, p <.05], and long-term care nurses (x̄=2.437) [t=9.971,
155 df, p <.05] (see Table 29). As well, long-term care nurses had significantly lower mean scores
on the “control over practice” subscale (x̄=2.44) than complex continuing care nurses (x̄=2.57)
[t=3.067, 196 df, p <.05].
Home care nurses also had significantly lower mean scores on the “nurse-physician relationship”
subscale (x̄=2.05) than acute care nurses (x̄=2.26) [t=14.694, 170 df, p <.05], complex continuing
care nurses (x̄=2.22) [t=10.479, 117 df, p <.05], and significantly higher than long-term care
nurses (x̄=1.96) [t=8.001, 168 df, p <.05] (see Table 29). As well, complex continuing care nurses
had significantly higher mean scores on the “nurse-physician relationship” subscale (x̄=2.04)
than long-term care nurses (x̄=1.96) [t=14.135, 161 df, p <.05]. Finally, acute care nurses had
significantly higher mean scores on the “nurse-physician relationship” subscale (x̄=2.26) than
long-term care nurses (x̄=1.96) [t=18.122, 231 df, p <.05].
74 Quality Worklife Indicators for Nursing Practice Environments in Ontario
Home care nurses also had significantly lower mean scores on the “organizational support”
subscale (x̄=1.96) than acute care nurses (x̄=2.41) [t=12.567, 151 df, p <.05], complex continuing
care nurses (x̄=2.36) [t=10.943, 145 df, p <.05], and long-term care nurses (x̄=2.24) [t=6.707,
172 df, p <.05] (see Table 29). As well, complex continuing care nurses had significantly higher
mean scores on the “organizational support” subscale (x̄=2.36) than long-term care nurses
(x̄=2.24) [t=2.985, 194 df, p <.05]. Finally, acute care nurses had significantly higher mean
scores on the “organizational support” subscale (x̄=2.41) than long-term care nurses (x̄=2.24)
[t=4.340, 204 df, p <.05].
Table 28. Nursing Work Index Mean Score Differences Between Health Care Sectors
NWI-R x̄ SD N
Autonomy Home 1.85 .09 72
Acute 2.37 .17 130
t = 27.778*, df = 1,202
Home 1.85 .09 72
Complex 2.33 .19 97
t = 21.774*, df = 1,151
Home 1.85 .09 72
Long-term 2.25 .14 118
t = 23.889*, df = 1,187
Long-term 2.25 .14 118
Complex 2.33 .19 97
t = 3.327*, df = 174
Long-term 2.25 .14 118
Acute 2.37 .17 130
t = 6.063*, df = 1,244
Control over practice Home 1.92 .29 61
Acute 2.52 .34 133
t = 12.476*, df = 1,136
Home 1.92 .29 61
Complex 2.57 .24 96
t = 14.539*, df = 1,111
Home 1.92 .29 61
Long-term 2.44 .39 115
t = 9.971*, df = 1,155
Long-term 2.44 .39 115
Complex 2.57 .24 96
t = 3.067*, df = 1,196
Determining the Feasibility of Collecting Indicator Data 75
Continued
NWI-R x̄ SD N
Nurse-physician relationship Home 2.04 .04 74
Acute 2.26 .16 136
t = 14.694*, df = 1,170
Home 2.04 .04 74
Complex 2.22 .16 98
t = 10.479*, df = 1,117
Home 2.04 .04 74
Long-term 1.96 .10 113
t = 8.001*, df = 1,168
Complex 2.22 .16 98
Long-term 1.96 .10 113
t = 14.135*, df = 1,161
Acute 2.26 .16 136
Long-term 1.96 .10 113
t = 18.122*, df = 1,231
Organizational support Home 1.96 .22 66
Acute 2.40 .26 132
t = 12.567*, df = 1,151
Home 1.96 .22 66
Complex 2.36 .23 95
t = 10.943*, df = 1,145
Home 1.96 .22 66
Long-term 2.24 .32 108
t = 6.707*, df = 1,172
Complex 2.36 .23 95
Long-term 2.24 .32 108
t = 2.985*, df = 1,194
Acute 2.40 .27 132
Long-term 2.24 .32 108
t = 4.340*, df = 1,204
Overall Home 1.89 .28 42
Acute 2.44 .34 108
t = 10.036*, df = 1.94
Home 1.89 .28 42
Complex 2.35 .34 70
t = 7.621*, df = 1,103
Home 1.89 .28 42
Long-term 2.28 .33 77
t = 6.869*, df = 1,99
Long-term 2.28 .33 77
Acute 2.44 .34 108
t = 3.057*, df = 1,170
*P <0.05
76 Quality Worklife Indicators for Nursing Practice Environments in Ontario
CONCLUSIONS
Nursing Personnel Groups
From the perspective of individual nursing personnel groups, the WQI appears to tap moredimensions of the nursing work environment that are relevant to different care provider groupsthan the NWI-R in this study. Overall, the NWI-R appeared to discriminate less between theprovider groups in this study.
Health Care Sectors
From the perspective of the different health care sectors, both instruments appear todiscriminate between the sector groups well. Home care nurses had higher perceptions of thework environment overall and on most of the subscales for both instruments.
Determining the Feasibility of Collecting Indicator Data 77
eIG
HT
Chapter Eight: Abstracting and Linking Nursing WorklifeIndicator DataIntroduction
Unit-Manager Data
Summary
79
INTRODUCTION
The fifth study objective examines the feasibility of abstracting and linking nursing worklife
indicator data to other datasets (e.g., outcomes). The specific research questions were: (1) What
is the feasibility of abstracting nursing worklife indicator data? and (2) What are the issues
associated with abstracting and linking nursing worklife indicator data to data from different
databases, such as Management Information Systems (MIS), Canadian Institute for Health
Information (CIHI), and across settings?
Data were collected using two mechanisms to test these linkages. First, unit managers for each of
the study units were asked to provide unit-level data on the nurse structural variables –
percentage of registered nurses in staff mix; percentage of full-time, part-time, and casual nursing
staff; educational background of nursing staff; experience of nursing staff employed on the study
units in the study sites; span of control of the unit manager; unit absenteeism rates; nursing
overtime hours; and agency staff hours. These data elements were used in a unit-level analysis of
the data. As well, secondary data on the secondary data structural variables – nursing hours per