Research to Action: an evaluation

The evaluation of the Research to Action project was conducted using an Outcome Mapping (OM) methodology (Earl et al. 2001) with a mixed-methods, repeat survey (before/after) study design. This design uses concurrent measurement of process and outcome indicators at baseline and follow-up. The RTA project proved effective at improving work environments and thereby promoting the retention and recruitment of nurses. Nurses involved in the RTA initiatives had a higher perception of leadership and support in their units, improved job satisfaction, increased empowerment and occupational commitment, and a greater intention to stay on the job.The pilot projects were most successful when there were clearly stated objectives, buy-in from nurses, support from the steering committee and management, and adequate communication among stakeholders. Committed coordination and leadership, both locally and nationally, were central to success.Considerable evidence has documented the challenges facing Canada's nursing human resources and their workplaces, such as high levels of turnover, excessive use of overtime and persistent shortages. There is a growing imperative to translate this research into action, and much of the available evidence presents viable policy alternatives for consideration. For example, a recent national synthesis report (Maddalena and Crupi 2008) recommended that, in consultation with stakeholders, processes should be put in place to share knowledge and best practices in nursing management, practice, staffing models and innovations in workplace health and well-being.Nurses across the country report a desire to be more involved in decisions affecting them and their patients (Wortsman and Janowitz 2006). A recent study on the shortage of registered nurses in Canada (Tomblin Murphy et al. 2009) highlighted the need for collaboration among governments, employers, unions and other stakeholders to improve working conditions for nurses. Another report notes the potential benefits of reduced turnover among nurses, the cost of which has been identified as a major burden on the Canadian healthcare system (O'Brien-Pallas et al. 2010). One of the goals of the pan-Canadian framework for health human resources (HHR) planning adopted by the Federal/Provincial/Territorial Advisory Committee on Health Delivery and Human Resources is to enhance all jurisdictions' capacity to build and maintain a sustainable workforce in healthy, safe work environments (ACHDHR 2005).Within this context, Health Canada's Office of Nursing Policy provided funding to the Canadian Federation of Nurses Unions (CFNU) and partner agencies in October 2008 to develop pilot projects across the country aimed at improving nurse retention and recruitment through various workplace improvement schemes. Each of the provincial partners contributed funds, in-kind support or both to the projects. The initiative was entitled Research to Action: Applied Workplace Solutions for Nurses (RTA). A national steering committee including representation from unions, governments and employers, each pilot project, CFNU and its national partners – the Canadian Nurses Association, the Canadian Healthcare Association and the Dietitians of Canada – was formed to oversee the development of 10 pilot projects. There was one project in each of Newfoundland and Labrador, Nova Scotia, New Brunswick, Prince Edward Island, Ontario, Manitoba, Saskatchewan, Alberta, British Columbia and Nunavut. The pilot projects, led by their own steering committees, focused on various aspects of nursing practice identified as particularly relevant to each jurisdiction, with a specific emphasis on improving the work life of nurses and transforming research knowledge into practice. The goals of the RTA initiative were to promote high-quality workplace environments, improve the retention and recruitment of nurses (RNs and LPNs), enhance the quality of patient care and engage stakeholders in collaborative partnerships. The first project began in May 2009 and the last project was completed in March 2011.