Restructuring: A View from the Bedside

This qualitative study reports on the perspectives of hospital staff nurses regarding the recent restructuring of Canadian healthcare. They were the group on the front lines bearing the brunt of the changes. Yet, mostly they had not been consulted, as the decisions were made elsewhere. Twenty staff nurses working in a variety of Toronto hospitals were interviewed and described the impacts on themselves and their patients. While restructuring focused on deficit reduction and increased efficiency, the factors affecting quality of patient care and work life of nurses were neglected. The major strategies employed -increased workloads, casualization and deskilling -changed nurses' work at the bedside. Stable teams disappeared as nurses were hired into casualized positions. Care was reduced to specific tasks and routinized, to be carried out by a "skill-mix" of workers. The nurses' relationships with patients, the "heart and soul of nursing," became largely limited to managing care for a number of patients over one shift. Lack of time and continuity with their patients left nurses dissatisfied. The voices of bedside nurses and their suggestions for change add some novel perspectives to the restructuring discourse.