ARCHIVED - Findings from the 2005 National Survey of the Work and Health of Nurses

Margot Shields and Kathryn Wilkins
Statistics Canada
Co-published by Health Canada and Canadian Institute for Health Information
December 2006
ISBN 0-662-44484-1 (print publication)
Cat. No. 83-003-XPE (print publication)

Executive summary

The 2005 National Survey of the Work and Health of Nurses (NSWHN) represents a collaborative effort involving the Canadian Institute for Health Information, Health Canada and Statistics Canada. The NSWHN was designed to examine links between the work environment and the health of regulated nurses in Canada, and is the first nationally representative survey of its kind. The survey's high response rate - 80% - reflects the enthusiasm with which nurses involved themselves in the survey.

Nearly 19,000 regulated nurses - registered nurses (RNs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs) - across the country were interviewed on a variety of topics, including the conditions in which they practice, the challenges they face in doing their jobs, and their physical and mental wellbeing. They shared their perceptions of work organization, including staffing, shift work, overtime and employee support. Nurses were also asked about work stress, role overload, respect, and quality of patient care. Information about their health status, such as chronic conditions, pain, self-perceived general and mental health, medication use, and the impact of health on the performance of nursing duties, was also collected.

Key findings from the 2005 NSWHN are presented below. Where possible, comparisons of nurses with the general population of employed people (aged 21 or older) are provided, based on data from other Statistics Canada surveys: the Canadian Community Health Survey, the Canadian Labour Force Survey and the Workplace and Employee Survey.

Key findings

[Note: All findings - for example, differences between sub-categories of nurses, or between nurses and employed people in general - mentioned in this report are statistically significant. However, not all statistically significant differences that emerged in the analysis are noted in the text. Significance was defined as a p-value of less than 0.05; all differences were tested for significance using the bootstrap technique.]

Canada's nurses

• In 2005, an estimated 314,900 Canadians were employed as regulated nurses, most of whom were women (94.5%). Although nurses represented only 2% of the total Canadian workforce, female nurses accounted for 4% of all employed women.
• Eight in 10 of Canada's employed, regulated nurses (79%) were registered nurses (RNs), and 20% were licensed practical nurses (LPNs). Registered psychiatric nurses (RPNs) accounted for less than 2% of employed nurses.
• About 6 in 10 nurses worked in hospitals. Another 16% worked in long-term care facilities, 12% in community health settings, and 13% in other settings such as physicians' offices, private nursing agencies, educational institutions, governments or associations.
• The average age of nurses in 2005 was 44.3 years, and the average number of years they had spent in nursing was 18.3. Both female and male nurses were significantly older, on average, than their counterparts in the overall employed population aged 21 or older. On average, female nurses were 3.4 years older than employed women overall, and male nurses were 1 year older than employed men.
• Although the household income of nurses placed them at an overall advantage relative to the general population of employed people, pronounced income discrepancies emerged between types of nurses. A much larger proportion of LPNs (16%) than RNs (4%) or RPNs (3%) were in households classified in the lowest income quintile within their province/territory. Likewise, only 12% of LPNs were living in households in the top quintile in their province/territory, compared with 39% of RPNs and 34% of RNs.

Employment, job and workplace characteristics

• The vast majority of nurses, 84% of both females and males, had permanent jobs in 2005. The comparable figures for the employed population aged 21 or older are 77% for women, and 71% for men.
• About 6 in 10 nurses were employed full time at their main job, and the rest worked part time. LPNs were less likely than RNs and RPNs to have full-time jobs. LPNs working part time were also far more likely to be unhappy with their job arrangement. Of LPNs who worked part time, 42% would have preferred full-time employment, compared with 18% of RNs and 11% of RPNs.
• About 8 in 10 nurses were covered by a union contract or collective agreement. By contrast, only a third of the total employed population had such coverage. Hospital nurses were more likely than nurses employed elsewhere to be unionized: 90% of them were covered, followed by 79% in long-term care facilities, 73% in community health settings, and 51% in other settings.
• Three in 10 nurses reported that they usually worked paid overtime at their main job - an average of 5.4 extra hours per week. Compared with Canadian workers overall, much higher proportions of nurses worked paid overtime.
• Unpaid overtime was even more common among nurses than paid overtime. Nearly half reported usually working unpaid overtime at their main job, for an average of 4 such hours per week. Unpaid overtime was more common among nurses in Alberta, Manitoba and Ontario, where over half of nurses reported usually working unpaid overtime at their main job.
• Just under one in five (19%) female nurses had more than one job, double the figure for employed women overall (9%). The likelihood of multiple jobs was even higher among male nurses, at 23% versus 9% of all employed men.
• Quebec nurses were far more likely than those in the rest of the country to have access to employer-supported childcare. One-quarter of nurses in Quebec (26%) had such help available; elsewhere the proportions ranged from less than 2% in Newfoundland and Labrador to 14% in Manitoba.

Nursing care - quality, risks and workload pressures

• When asked if the quality of care delivered in their workplace had changed over the past year, more than half (57%) of nurses felt it had remained the same, 27% reported deterioration, and 16%, improvement.
• Over one-quarter (27%) of Quebec nurses reported occasional or frequent medication errors among patients in their care, a higher proportion than reported elsewhere. Outside Quebec, percentages ranged from 7% in Newfoundland and Labrador to 18% in British Columbia.
• Nurses in British Columbia were more likely than those elsewhere to report fair or poor team care. BC nurses, along with those in Saskatchewan, were also more likely to report that they as individuals had given poor or fair care.
• Nurses in British Columbia and in Saskatchewan were more likely than those in the rest of the country to have been injured on the job: 1 in 8 BC nurses (12%) and nearly this share of Saskatchewan nurses (11%) reported being injured - about twice the proportion in Prince Edward Island (1 in 20). The likelihood of on-the-job injury was also relatively low for Quebec nurses (7%).
• Nearly half (48%) of nurses who provided direct care reported having ever had a needlestick or other sharps (for example, scissors, scalpels, razors) injury from an object that had been contaminated by use on a patient, and 11% reported having had such an injury in the past year.
• Over one-quarter (29%) of nurses who provide direct care reported that they had been physically assaulted by a patient in the previous year; 4 in 10 male nurses (44%) reported physical assault, compared with just under 3 in 10 female nurses (28%). Emotional abuse from a patient was reported by 44% of nurses.
• Over half (54%) of nurses said that they often arrived at work early or stayed late in order to get their work done; 62% reported working through breaks. Two-thirds (67%) often felt that they had too much work for one person, and 45% said that they were not given enough time to do what was expected in their job.

Work environment - stress, collaboration and respect

• Substantial shares of Canadian nurses - 45% of female and 51% of male nurses - felt they had low co-worker support, while in the employed population overall, the estimate for each sex was around 33%.
• More than 60% of both female and male nurses said their jobs presented high physical demands; the corresponding proportions for the employed population as a whole were 38% and 46%. The proportion of LPNs reporting high physical demands (75%) exceeded the proportions for RNs (60%) and RPNs (45%).
• Nurses' perceptions of their working relations with physicians were overwhelmingly positive: 87% reported good working relations; 81%, a lot of teamwork; and 89%, collaboration.
• Job dissatisfaction was more prevalent among nurses than among employed individuals overall. About 12% of both female and male nurses were dissatisfied, compared with 8% of all employed women and men. However, only 4% of nurses said they actually planned to leave nursing in the next year, and most of these nurses were retiring.

Physical and mental health

• Back problems and arthritis were more prevalent among female nurses than among employed women overall, but no significant differences emerged for men. A quarter (25%) of female nurses had back problems, compared with 19% of females in the employed population overall.
• In the previous 12 months, more than 1 in 3 nurses (37%) had experienced pain serious enough to prevent them from carrying out their normal daily activities. More than 1 nurse in 10 reported "severe" or "unbearable" pain, and nearly one-quarter of all nurses said that pain had affected their ability to carry out their nursing duties. Three-quarters of the nurses who had had activity-limiting pain in the previous year said that it had resulted from workrelated factors.
• Compared with employed people overall, nurses were more likely to have experienced depression in the previous year. Of all employed women, 7% had experienced depression, and of employed men, 4%. These figures compared with 9% of both female and male nurses.
• About 1 nurse in 3 stated that at least some of the time in the previous month, their physical health had made it difficult to handle their workload.
• In the year before they were surveyed, 61% of nurses had taken time off for health reasons. Nurses who were absent missed an average of 23.9 days over the year. The average number of days absent for all nurses - even those who had not been off - was 14.5 days per nurse. An estimated 14% of all nurses had been absent for 20 or more days during the previous year. In Quebec, nurses who had taken time off averaged a total of 44 days absence, well over twice as long as anywhere else (13 to 20.6 days).

Bringing it all together - associations between nurses' conditions of work and their health

• Multivariate analysis was used to examine associations between work conditions and health, while taking into account the potentially confounding effects of sex, age, type of nurse, province/territory, household income, smoking and obesity.
• Fair or poor general health among nurses was related to components of work stress, including high job strain, low support from their supervisor or coworkers, high job insecurity and high physical demands. Other factors - low autonomy, poor nurse-physician working relations, low respect from superiors and high role overload - were also associated with poor or fair general health.
• Nurses who usually worked evenings had higher odds of fair or poor general health, compared with nurses who usually worked days. Nurses employed in long-term care facilities were also more likely to report their health as fair or poor, compared with those who worked in hospitals.
• Poor or fair mental health was associated with usually working evening shifts and with working in long-term care facilities. Psychosocial factors were also important to mental health; these included high job strain, low supervisor and low co-worker support, low autonomy, low control over practice, poor nurse-physician working relations, lack of respect from superiors or co-workers, and high role overload.
• Work absences for health-related reasons totalling 20 or more days over the previous year were more common among nurses with union or collective agreement coverage.
• The odds of being absent 20 or more days for health-related reasons were high for nurses reporting high job strain, low supervisor support, high physical demands on the job, low control over practice, lack of respect from superiors, or high role overload. For nurses reporting low respect from their superiors, the odds of missing 20 or more days were 50% higher, compared with nurses reporting more respect from this source.