National Survey of the Work and Health of Nurses

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Many nurses regularly work overtime and many have more than one job. A ground-breaking new study indicates that psychosocial and interpersonal factors (including work stress, low autonomy and lack of respect) are more strongly associated with health problems among Canada's 314,900 nurses.

The first-ever National Survey of the Work and Health of Nurses examined links between their work environment and health. It found that nurses face a broad range of physical and emotional challenges in a demanding, often hectic, workplace.

The proportion of nurses who reported a high level of work stress (as determined by the level of job strain, physical demands, and support from co-workers and supervisors) was higher than that for employed people overall. Job strain results when the psychological demands of a job exceed the worker's discretion in deciding how to do it.

Nearly one-third (31%) of female nurses were classified as having high job strain. The figure for all employed women was 26%.

Job strain was strongly related to fair or poor physical and mental health, and to lengthy or frequent absences from work for health-related reasons. For example, 17% of nurses who perceived high job strain reported 20 or more sick days in the past year, compared with 12% of nurses who perceived less job strain.

The survey found that many nurses worked overtime, and only about 6 in 10 had full-time jobs in 2005.

Nearly half (46%) of nurses reported that their employer expected them to work overtime, and 3 in 10 regularly worked paid overtime, for an average of five hours per week. One-half regularly work unpaid overtime, averaging four hours per week.

Among female nurses, a substantial share (19%) had more than one job. This was more than double the proportion of 9% among employed females in the general population.

A key finding concerned the support nurses feel they receive from co-workers. A disproportionately high share (45% of female nurses and 51% of male nurses) reported low support from co-workers compared with employed Canadians in general (33% of females and 32% of males).

On the positive side, the vast majority of nurses reported that they had the support of their supervisors and immediate managers, and that they felt free to use their own judgment in making important decisions.

Overall, 9 out of 10 nurses reported that they had good working relations and collaborated well with doctors. And over one-half of nurses said that they were able to spend time with their patients, thanks to adequate support services.

Although relatively few nurses reported low respect from superiors or poor working relations with physicians, these factors were linked to health problems. For example, 12% of nurses who felt that they received low respect from superiors said their mental health was only fair or poor, compared with 4% of nurses who reported higher levels of respect.

In the year before the survey, over half of nurses had taken time off work due to physical illness, and more than 1 in 10 had been away because of their mental health.

Canada's nurses: A profile

An estimated 314,900 nurses were employed in Canada in 2005. The vast majority, 95% or 297,600, were women.

Nurses accounted for 2% of all employed individuals aged 21 or older, and female nurses made up 4% of all employed women in this age group.

Most of Canada's nurses (79%) were registered nurses (RNs), and 20% were licensed (or registered) practical nurses. Registered psychiatric nurses accounted for less than 2% of employed nurses.

Almost 9 out of every 10 nurses were employed in positions involving direct patient care. The remaining 12% were in administrative, management, education or research positions. About 59% of nurses worked in hospitals, the rest in long-term facilities, community health settings, or other areas such as doctors' offices.

Nurses were significantly older than the employed population aged 21 and over. The average age of female nurses was 44.4 years, 3.4 years older than employed women in general. The average age of male nurses was 42.9 years, about a year older than all employed men.

Stress, collaboration and respect

The survey data showed that the level of work stress encountered by nurses, their level of job dissatisfaction, and the physical demands of their job were all higher than in the general population of employed people.

About 45% of female nurses, and 51% of male nurses, felt they had low support from their co-workers. 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 were physically demanding. This was well above the proportions of 38% of women and 46% of men in the employed population as a whole.

Job dissatisfaction was also more prevalent among nurses. About 12% of both female and male nurses were dissatisfied with their job, 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.

Nurses' perceptions of their working relations with physicians were overwhelmingly positive: 87% reported good relations; 81%, a lot of teamwork; and 89%, collaboration.

Quality of care

Nurses also shared their impressions of changes in the quality of care during the year before they were surveyed. Over one-quarter (27%) reported a deterioration in care, and only 16% reported an improvement. But a majority of nurses (57%) said there had been no change in the quality of care.

The nurses who reported deterioration cited two main factors: fewer staff and too many patients. Those reporting improved care attributed it to better management and training, as well as more staff.

Nurses were also asked about "adverse events," such as how often in the previous year a patient had received the wrong medication or dose. Nearly one in five (18%) reported that such incidents had occurred occasionally or frequently.

Just over one-third reported that patients occasionally or frequently experienced "nosocomial infections", infections that originate in a hospital or similar setting. And close to one-third said that on an occasional or frequent basis, a patient in their care had been injured in a fall during the previous year.

As for nurses themselves, 1 in 10 reported occasional or frequent injury on the job in the year before the survey.

Nearly half (48%) of nurses who were caring directly for patients reported that, at some point in their career, they had been injured by a needlestick or other sharp object that had been contaminated by use on a patient. About 11% reported having had such an injury in the past year.

Almost 3 in 10 nurses (29%) who provide direct care said they had been physically assaulted by a patient in the previous year. Over 4 in 10 reported emotional abuse from a patient.

Physical and mental health

About 37% of nurses reported they had experienced pain serious enough to prevent them from carrying out their normal daily activities in the 12 months covered by the survey. Three-quarters of the nurses with activity-limiting pain in the previous year blamed work-related factors.

About one nurse in three said that their physical health (and one in five their mental health) had made it difficult to handle their workload in the last month.

Nurses were more likely to have experienced depression in the previous year. About 9% of both female and male nurses had experienced depression, compared with 7% of all employed women and 4% of men.

Definitions, data sources and methods: survey number 5080.

Provincial/territorial profiles appear in the article "National Survey of the Work and Health of Nurses, 2005: Provincial profiles", as part of the Analysis in Brief (11-621-MWE2006052, free) series from the Publications module of our website.

The publication Findings from the 2005 National Survey of the Work and Health of Nurses (83-003-XIE, free) is now available online from the Publications module of our website. A paper version of the publication (83-003-XPE, free) is also available.

Data from the 2005 National Survey of the Work and Health of Nurses are also now available.

For more information, or to enquire about the concepts, methods or data quality of this release, contact Statistics Canada's Media Hotline (613-951-4636; fax: 613-951-4527; ssd@statcan.gc.ca), Special Surveys Division.