HOSPITAL RESTRUCTURING INITIATIVES IN CANADA

OBJECTIVES. Recent changes in the organization, staffing, and utilizat ion of acute hospitals in Canada are reviewed with regard to the poten tial implications for quality of care, national nurse workforce requir ements, and research. METHODS. Available national and selected provinc ial data and trends in hospital utilization, capacity, and staffing ar e synthesized. RESULTS. Health system reform in Canada has resulted in lower utilization of acute inpatient resources, excess hospital capac ity, and increased budgetary constraints in the hospital sector. In re sponse, there is widespread hospital restructuring, which includes mod ifications in nurse staffing ratios and skill mix. Little is known abo ut the potential impact of these changes on patient outcomes. From a w orkforce perspective, changes in the hospital sector have reduced dema nd for registered nurses but nursing schools have not modified enrollm ents. As a result, new graduates are experiencing difficulty obtaining registered nurse positions. CONCLUSIONS. Research should be undertake n to evaluate the impact of changes in the organization and staffing o f hospitals on patient outcomes, and on the future requirements for nu rses.