History:

• In its fifteen year history, the nursing research unit has had three names, reflecting its evolving research emphases as it responded to changing health services priorities. The unit was first established as the Quality of nursing Worklife Research Unit (QWL) in 1990 with a 5 - year base funding from the Ontario Ministry of Health and Long-Term Care (MOHLTC). The unit was renamed the Nursing Effectiveness Utilization and outcomes Research Unit (NEUORU) in 1996 and funded for another 5 years. This funding was later extended to 2004. In 2004, the unit was refunded for an additional five years as the Nursing Health Services Research Unit (NHSRU).

The overall goals of the research unit are to:

• Conduct research and other forms of inquiry, to provide the information necessary for evidence-based policy and management decisions about the effectiveness, quality, equity, utilization, and efficiency of health care and health services in Ontario with a particular focus on nursing services.
• Develop a joint mechanism for knowledge transfer between the MOHLTC and the NHSRU to ensure the best and most recent evidence is used to guide evidence-based policy and management decision making.

• Conduct population-based nursing health services research with a focus on population health needs and patient, system, and provider outcomes to determine the number and type of nurses and potentially other health disciplines needed to meet future health needs. The readiness and nature of the nursing workforce required to deal with unanticipated infectious diseases such as SARS would be modeled here. The results of these analyses will provide MOHLTC with a state-of-the-art method and knowledge about the needs of the population, distribution of needs, and the resources required to meet those needs.

• Document province-wide and Canadian-wide patterns and trends in health care delivery, nursing service utilization, and the impact of these and other services on population health and safety outcomes, nursing health and safety outcomes, and the system as a whole. We have several studies exploring different questions. The most recent trends report “Stepping to Success and Sustainability” (O’Brien-Pallas, Thomson, Alksnis et al., 2003) provides decision makers at all levels with a user-friendly reference to the facts about nurse supply, utilization and future supply requirements to replace losses. Due to the impact of the aging workforce this document will be developed in 2005 and 2007 so that a compendium of information is available for decision at regular intervals.

• Determine the work environment factors, system characteristics, and management behaviour most likely to help improve nurse recruitment and retention for all age cohorts of RNs and RPNs and conduct multi-site studies to test their overall effectiveness. These studies may have provincial, national, and/or international foci and will provide decision makers with information to inform targeted policies to retain nurses and attract potential new nurses into the workforce.

• Provide evidence to inform decision-making by policy makers, managers, clinicians, health planners, and consumers in the health arena. For example, this could include ongoing analysis of secondary databases to describe performance of hospitals and other sectors of the health system, the health of the population, and organizational performance in creating quality workplaces and the health of nurses. These activities would also include diffusion of individual researchers’ study findings. Responding to MOHLTC-generated requests related to nursing and health in Ontario , Canada , and internationally will also be supported as part of this objective.

• Train researchers, future researchers, and decision-makers; promote a wider understanding of nursing and health service research. In order to have a strong cadre of future interdisciplinary health service researchers, the research unit would serve as a centre of excellence for knowledge development and transfer related to nursing and health services research. Regular knowledge transfer sessions with co-investigators, graduate students, and decision-makers would be used for training and are consistent with the goals of the “Ontario Health Services Training Centre” and the “Health Care, Technology, and Place: Transdisciplinary Research Training Program”.

• Analyze nursing and patient safety outcomes, and costs of nursing turnover from six countries to determine which macro and micro level policy initiatives are likely to have the greatest impact on reducing costs and improving outcomes for nurses, patients, and the system This international comparison will allow us to test the relative efficacy of initiatives tried in other countries but not yet used in Ontario in order to provide additional evidence to support policy change.

• Evaluate the impact of the shift to baccalaureate prepared registered nurses, especially in relation to expectations, work effectiveness, and retention.

Objectives for the McMaster site:

• Develop and disseminate applied research evidence to inform policy makers, managers, clinicians, health planners and consumers.

• Monitor, analyze and report nursing workforce trends to inform policy and planning.

• Evaluate existing models to explore nursing human resources, describing characteristics and assessing roles of nurses in contemporary healthcare systems; and identify optimum strategies for investing in the human, intellectual and social capital of nurses.

• Evaluate alternative models for nursing care delivery/patterns of practice, scopes of practice and the effects of human resource policies on healthcare.

• Analyze and evaluate selected databases relevant to nursing workforce planning.

• Facilitate knowledge transfer by building capacity for nursing research through: short courses (provincially, nationally and internationally); educating undergraduate, masters, doctoral and post-doctoral nurses from McMaster and from other partner organizations; hosting visiting scholars; and supporting career reorientation candidates funded by organizations such as the CHSRF.

• Facilitate knowledge transfer through networking, collaboration, and partnerships with healthcare organizations, researchers and other healthcare disciplines. For example, partnerships with hospitals may include shared funding of staff engaged in research projects of mutual interest.

• Supply rapid-response information and time-limited studies in answer to Ministry requests for background data and evidence to support policy development. (25% of the budget will be dedicated to these requests.)