Healthcare nursing executives in all 140 adult acute care hospitals in Ontario, Canada, were surveyed to identify the strategies that determine nursing costs after restructuring and the processes being used to strengthen nursing now that the restructuring has been completed. The most common restructuring strategies were changing the nursing staff mix through layoffs, offering voluntary retirement packages to senior nurses, cross training registered nurses to other clinical areas, floating staff to other clinical areas, decreasing the number of full-time nurses employed, increasing the utilization of part-time, casual, temporary, and agency nursing staff, and increasing the use of unregulated workers.

It is evident from this study that focused initiatives to rebuild nurse staffing levels were needed after restructuring. At the same time, nurse executives are faced with the challenge of being accountable for expenditures related to nursing. The challenge for nurse executives and managers will be to balance the monitoring of nursing expenditures that may be perceived as focused solely on negative cost outcomes (eg, overtime utilization, absenteeism rates, and safety claims) with more positive cost outcomes (eg, costs of providing ongoing education to the nursing staff, reimbursement costs for courses that nurses take toward degree education, and bursary and scholarship programs).

Research supported by a grant from Canadian Institutes of Health Research, 2001-2004.