Nurse to patient ratios and staffing issues : a qualitative investigation of nurses' perceivedwork environments in Quebec's integrated healthcare centers

Nurse to patient ratios (N/P) are designed to ensure acceptable levels of patient load as well as enough nurses to properly care for patients. Representatives of the nursing profession and unions have been urging government to implement regulation to ensure the respect of minimum established N/P ratios at all times in Quebec healthcare organizations. This paper aims to examine N/P ratios, in the context of demands of many organizations for a law enforcing mandatory staffing ratios in Quebec healthcare organizations. A qualitative exploration was conducted using 42 semi directive interviews with unionized nurses throughout the province of Quebec. A thematic analysis was carried out using NVivo. Using the Nursing job demands resource model, which gives importance to the broader organizational climate, we assessed nurses' perceptions of their working environment.

Four main themes emerged: 1) intensifying workload, 2) inadequate skill mix, 3) cost effective management, 4) adverse outcomes. Our findings suggest that reducing the number of patients per nurse will not necessarily result in better working conditions if other lean strategies are adopted to compensate for the higher staffing costs, nor will it make the work environment fundamentally more attractive. While higher staffing levels are needed, seriously caution should be paid to the ways in which ratios are implemented. Alternative models of healthcare institutions, such as Magnet hospitals or other models, should be examined. [Publisher's Text].