Health Nurses Survey

1. Health Nurses Survey Dr. Judith Shamian, President & CEO April 19, 2007

2. The Journey:…1999…2007….

3. 1999-We had a problem….Nurses had/have the highest absenteeism rate among 40+ occupations.

4. Fast Forward “The way to better healthcare is through healthier healthcare workplaces and it is unacceptable to work in, receive care in, govern, manage and fund unhealthy healthcare workplaces” QW-QHC 2006 (Quality worklife-quality healthcare collaborative)

5. QWQHC= QUALITY WORKLIFE-QUALITY HEALTH CARE COLLABORATIVE • Partnership among 11 National Organizations: CCHSA, CCHSE, CNA, CMA, CHA, CFNU, CHSRF, ACAHO,ACEN, NQI, ONP-HC and 40 health care leaders who working together to develop an integrated action strategy to transform the quality of work life for Canada’s healthcare providers

6. Background • First nationally representative survey of nurses in Canada • Data collection: October 2005 - January 2006 • Frame: 26 nursing organizations and regulating bodies 2

7. 2005 National Survey of the Work and Health Survey • Responding sample: 18,676 • Response rate: 80% • Survey - partnership between Canadian Institute for Health Information, Health Canada and Statistics Canada • Advisory Committee 3

8. Why a national survey? • Nurses represent largest group in the health care sector • Concern that “health care reform” has led to: • Fewer jobs • Increased workload • Higher patient - staff ratios • Other concerns: • Absenteeism (illness, stress, disability) • Injuries • Job satisfaction 4

9. Survey objectives • Provide information on the health and working conditions of the 3 regulated nursing professions (RNs, LPNs and RPNs). • Establish baseline data for future monitoring. • Make comparisons among provinces and combined northern territories. • Compare nurses with the total employed population. 5

10. Canada’s nurses • 315,000 nurses; most are women (94.5%) • Nova Scotia has 11,900 (3.8% of total) • Types of nurses: • 79% Registered Nurses (RNs), 75% in NS • 20% Licensed Practical Nurses (LPNs) • 2% Registered Psychiatric Nurses (RPNs) 6

11. Surveys used for comparisons of nurses with total employed population • Canadian Community Health Survey, 2005 • Workplace and Employee Survey, 2003 • Canadian Labour Force Survey, October 2005

12. Canada’s nurses • Average age: 44.3 – significantly older than employed population (females 3.4 years older; males 1 year older) • Work settings: • 59% hospitals • 16% long-term care facilities • 12% community health • 13% other 7

13. Household composition • About 70% of nurses live in households as part of a couple, similar to the total employed population (21+). • However, nurses are more likely than all employed women and men to be single parents, or to be living alone: • 9% of female nurses vs. 7% of employed women (21+) are single parents; • 14% of female nurses vs. 11% of employed women (21+) live alone. Single parent Lives alone

14. Employment characteristics • Higher proportion of nurses are unionized: 82% of nurses vs. 34% of all employed • Nurses worked more paid overtime: • Women: 30% of nurses vs. 13% of all employed • Men: 37% of nurses vs. 28% of all employed • Among nurses, unpaid overtime more common than paid overtime; 50% reported unpaid overtime, averaging 4 extra hours per week. 8

15. Employment Characteristics • Nearly 66% of Nurses in Nova Scotia have full-time jobs • 61% in Canada overall • 42% of Nurses in Nova Scotia put in more than 40 hours a week, this was much greater than the rest of Canada – 37%

16. Employment characteristics • Nurses more likely to have more than 1 job: • Women: 19% vs. 9% • Men: 23% vs. 9% • Female nurses more likely than employed women to work long hours (40+ hours / week): • 37% vs. 25% 9

17. Quality of care • Only 8% of Nurses in Nova Scotia said that their Nursing team had delivered poor or fair care, this was significantly lower than the rest of the country, 12% • Perceived changes in quality of care in past year: • 27%: deteriorated (25% in NS) • 16%: improved (same in NS) • 57%: no change • Main reasons given for deterioration: • fewer staff (67%) • too many patients (38%) • Main reasons given for improvement: • Improved management / Reorganization (30%) • More staff (29%) 10

18. Nurses’ reports of adverse events (occasional or frequent) in past year 11

19. Nurses reporting physical assault by a patient in past year 12

20. Physical assault by a patient in past year, by area of nursing %

21. Role overload 13

22. Work stress • High job strain: psychological demands of the job exceed worker’s discretion in deciding how to do it • 31% female nurses • 26% all employed females • Low co-worker support • 45% female nurses • 33% all employed females • High physical demands • 62% female nurses • 38% all employed females 14

23. Job dissatisfaction • Job dissatisfaction more common in nurses than in total employed • Women: 12% vs. 9% • Men: 12% vs. 8% • Nova Scotian Nurses: 8% vs. 12% rest of Canadian Nurses • Only 4% of nurses planned to leave nursing in the next year―mostly for retirement 15

24. Job dissatisfaction, by nursing job category %

25. Working relations • Working relations between nurses and physicians • 87%: good working relations • 81%: a lot of team work • 89%: high levels of collaboration 16

26. Physical and mental health • Nurses’ physical health similar to that of all employed persons. • Mental health of nurses worse. • Women: 5.5% of nurses vs. 4.0% of all employed women (21+) • Men: 5.6% of nurses vs. 3.5% of all employed men (21+) % Physical health Mental health

27. Rate of depression in past year among nurses 17

28. Absence from work • 61%: 1+ absence in the past year due to a health problem (66% in NS) • 14.5 sick-days, on average • 14%: took 20+ sick-days in past year 18

29. Nurses’ health in relation to their working conditions

30. Fair or poor general health, by work stress 19

31. Fair or poor mental health, by psychosocial work factors 20

32. Summary of multivariate modelling relating fair/poor physical or mental health to working conditions • Few associations emerged between ill health and factors such as shift work or long hours. The factors most consistently related to the variables reflecting nurses’ health were: • Low autonomy • Low control over practice • Poor nurse-physician working relations • Low respect from superiors • Role overload

33. What does the Data Show? Work life • The proportion of the nursing workforce with multiple employers increased from 12.8% in 2004 to 14.1% in 2005 (CIHI 2006) • The majority of nurses in management positions range in age from 46-55: (Heather Laschinger et al)

34. BC AB SK MB ON QC NS NB PE NL YK NT NU Planned Activities to Address Workplace Issues X X X X X  X X X Succession Planning  X X Relocation Assistance X Bursaries and Tuition Support X X X  X X Incentive eg. Education Programs Enrollment X Full-time jobs for nurse graduates X Continuing Education X X X X Career Laddering X Mentorship X X X Professional Development and Training X X X X X Salary adjustments X Conversion of Casual Work to Permanent X Leadership Training X  X X X Occupational health and safety and programs to reduce injuries X X X Phased Retirement Programs X Employee Recognition Program X X FPT Health Human Resources (HHR)Action Plans & Targets (reported ones only) Initiatives & Targets*

35. What is next??

36. What are some of the “new/old ideas” • Succession Planning • Generation Gap • Practice Issues

37. 1. Succession Planning • Recognize emerging leaders • Support and guide emerging leaders • Provide opportunities • Leadership Pipeline • Mentorship

38. 2. Understanding the Generation Gap How are values different for the next generation filling health care positions?

39. Generation Gap (Stephen Sheperd)

40. Generation Gap

41. 3. Practice Issues • Span of Control • Workload • Autonomy (moral distress) • Violence in the Workplace • Interprofessional relationships

42. THANKYOU Dr. Judith Shamian Judith.shamian@von.ca www.von.ca

43. www.nursingleadershipstudy.ca • www.von.ca • www.vifamily.ca • http://www.longwoods.com/home.php?cat=456.