National Survey of the Work and Health of Nurses (NSWHN)
Detailed information for 2005
The National Survey of the Work and Health of Nurses (NSWHN) focuses on the work and health of nurses in Canada.
Data release - December 11, 2006
- Questionnaire(s) and reporting guide(s)
- Data sources and methodology
- Data accuracy
The main objective of the 2005 National Survey of the Work and Health of Nurses is to provide an overall picture of the health and working conditions of regulated nurses in Canada.
A total of 18,676 nurses were interviewed, representing registered nurses (RN), licensed practical nurses (LPN) and registered psychiatric nurses (RPN) employed in a variety of health care settings and in all provinces and territories. The survey's impressive response rate of 80% reflects the enthusiasm and support of nurses across the country.
The survey collected information on a rich array of topics reflecting the physical and emotional challenges nurses face in delivering patient care today. Nurses answered many questions about the quality of patient care, working relations with co-workers and managers, the amount of time they work to get their jobs done, and the way they feel about their jobs and careers as nurses. Data from the 2005 NSWHN will provide an invaluable resource for researchers, health care providers, policy makers and anyone with an interest in human resources, particularly in the health care field.
The 2005 NSWHN was developed in collaboration with organizations representing practicing nurses, health care researchers, health information specialists and federal government departments. The survey was conducted by Statistics Canada in partnership with the Canadian Institute for Health Information and Health Canada.
- Diseases and health conditions
- Health care services
- Hours of work and work arrangements
- Lifestyle and social conditions
- Mental health and well-being
- Workplace organization, innovation, performance
Data sources and methodology
The 2005 NSWHN was designed to be representative of nurses who were registered and employed in nursing in Canada at the time of the interview. Data from the survey were weighted to permit representative estimates of each of three nursing bodies -- registered nurses, licensed practical nurses and registered psychiatric nurses -- at the provincial level. Because of the relatively small number of nurses employed in the Yukon Territory, the Northwest Territories and Nunavut, estimates were produced for the territories combined. While RNs and LPNs are employed throughout Canada, RPNs are found almost exclusively in Manitoba, Saskatchewan, Alberta and British Columbia. The survey did not include retired or unemployed nurses.
The questionnaire was conceived in collaboration with specialists from Statistics Canada, the Canadian Institute for Health Information (CIHI), Health Canada and other organizations involved in health human resources. In order to compare the characteristics of nurses to the general population, many questions were asked exactly as they were on other Statistics Canada surveys (i.e., Canadian Community Health Survey (CCHS), Workplace Employee Survey (WES) and Labour Force Survey (LFS)). Additional comparisons are possible due to questions taken from other nursing studies.
Qualitative testing of the survey questions was conducted in both official languages through focus groups in Regina, Halifax and Montreal in May 2004 and again in Ottawa in October 2004. The main objectives were to evaluate acceptance of the survey content, and to test questionnaire wording and flow.
The questions were designed for computer-assisted interviewing (CAI), meaning that, as the questions were developed, the associated logical flow into and out of the questions was programmed. This included specifying the type of answer required, the minimum and maximum values, on-line edits associated with the question and what to do in case of item non-response.
With CAI, the interview can be controlled based on answers provided by the respondent. On-screen prompts are shown when an invalid entry is recorded and thus immediate feedback is given to the respondent and/or the interviewer to correct inconsistencies. Another enhancement is the automatic insertion of reference periods based on current dates. Pre-filling of text or data based on information gathered during the interview allows the interviewer to proceed without having to search back for previous answers. This type of pre-fill includes such things as using the correct name or sex within the questions themselves. Allowable ranges/answers based on data collected during the interview can also be programmed. In other words, the questionnaire can be customized to the respondent based on data collected at that time or during a previous interview.
The computer application used for data collection was extensively tested in-house in order to identify any errors in the program flow and question text. Testing of the computer application was an ongoing operation from its development for the pilot survey up to the start of the main survey.
A pilot survey was conducted in late April / early May 2005, representing nurses in all of the survey domains: nursing group, age group, sex, place of work and province/territory. The test was conducted in both official languages, and was done through the Sherbrooke and Edmonton Regional Offices. The main objectives of the test were to observe respondent reaction to the survey, to determine the time required to complete various sections of the questionnaire, and to test the computer application. Collection operations and interviewer training were also evaluated.
This is a sample survey with a cross-sectional design.
The sample frame was created using administrative information from the 26 provincial/territorial registrars. The sample was based on a stratified design employing probability sampling. The stratification was done at the province and national level. Information was collected from the selected nurse and proxy response was not permitted. A total of 18,676 nurses were interviewed, representing registered nurses (RN), licensed practical nurses (LPN) and registered psychiatric nurses (RPN) employed in a variety of health care settings and in all provinces and territories.
Data collection for this reference period: 2005-10-03 to 2006-01-29
Responding to this survey is voluntary.
Data are collected directly from survey respondents.
An introductory letter was mailed to the selected nurses prior to a telephone interview. Interviews were conducted in three regional offices using the computer-assisted telephone interviewing (CATI) collection method. Responses to the survey questions were captured directly by the interviewer at the time of the interview using a computerized questionnaire. In each case, the interviewer asked to speak to the selected nurse and if the selected nurse was not available, the interviewer arranged for a convenient time to phone back. Proxy response was not allowed. The computer application also facilitated tracing for nurses who had moved. Interviewing was extended into January to allow the interviewers enough time to contact the selected nurses.
View the Questionnaire(s) and reporting guide(s) .
The sample of selected nurses was screened for duplicate records before collection began as nurses can be registered in more than one nursing group or more than one province. Removal of duplicates eliminated over-coverage and response burden.
Research was undertaken to obtain missing contact information (e.g., address and telephone number) to facilitate the mailing of introductory letters and interviewing by phone.
Some editing was done directly at the time of the interview. Where the information entered was out of range (too large or too small) of expected values, or inconsistent with the previous entries, the interviewer was prompted by a message on the computer screen to modify the information. For questions where interviewers had the option of bypassing the edits or of skipping questions if the respondent did not know the answer or refused to answer, the response data were subjected to further edit and imputation processes in head office.
Error detection and edits were also applied during processing at head office. The main steps were: clean-up (removal of records with insufficient data), relationship edits (ensuring the household profile was correct), flow edits (to correct any wrong paths that may have been followed by the application), and consistency edits (to ensure the responses made sense).
In the case of the NSWHN, imputation was done for only one variable: income. Response to the household income question was 93%, therefore donor imputation was used to impute missing income values for 7% of the nurses. The weighted imputation rate was 6.2%.
All imputations involved donors that were selected using a score function. For each item non-response or partial non-response records (also called recipient records), we compared certain characteristics to characteristics from all the donors. When the characteristics were the same between a donor and the recipient, a value was added to the score of that donor. The donor with the highest score was deemed the "closest" donor and was chosen to fill in missing pieces of information of the non-respondents. If there was more than one donor with the highest score, a random selection occurred. The pool of donors was made up in such a way that the imputed value assigned to the recipient, in conjunction with other non-imputed items from the recipient would still pass the edits.
The principle behind estimation in a probability sample is that each person in the sample "represents", besides himself or herself, several other persons not in the sample. For example, in a simple random 2% (1/50) sample of the population, each person in the sample represents 50 persons in the population. In the terminology used here, it can be said that each person has a weight of 50. The weighting phase is a step that calculates, for each person, his or her associated sampling weight. This weight must be used to derive meaningful estimates from the survey. For example, if the number of individuals who had a major depressive episode is to be estimated, the weights of survey respondents having that characteristic should be summed. In order for estimates produced from survey data to be representative of the covered population and not just the sample itself, a user must incorporate the survey weights into their calculations.
For the NSWHN, the starting point for weighting is the theoretical sub-weight (Nh/nh) where Nh is the number of nurses in stratum h according to the frame and nh is the size of the sample initially selected from that stratum. The strata are used as non-response groups because: (1) they contain information about the province of registration and type of nurse as well as the domains of interest identified by the clients, and (2) using the strata as non-response groups does not complicate the formula for exact variance calculation.
The weighting was done in five steps:
Step 1: The weights of the non-contacted cases are re-distributed across the remaining sample.
Step 2: The weights of the refusal/non-respondents that are known to be in-scope are re-distributed across the respondents (sharers and non-sharers).
Step 3: The weights of the refusal/non-respondents where we are unsure if they are in-scope are re-distributed across the out-of-scope cases and the respondents (sharers and non-sharers).
Step 4: At this point, the out-of-scope cases are dropped.
Step 5: The weights of the non-sharers are re-distributed across the sharers.
In order to determine the quality of an estimate, the variance must be calculated. Because the NSWHN uses a simple survey design, a simple formula can be used to calculate variance estimates. Coefficient of variation, standard deviation and confidence intervals can then be calculated from the variance.
The initial analysis conducted by Statistics Canada, allowed for an in-depth look at the many survey variables and represented a very effective way to find errors.
Key tables were prepared and were subjected to an external validation process by the Canadian Institute for Health Information and Health Canada. The expert advisory group contributed to a second external validation of the survey results.
Wherever possible, the nurses' work characteristics and health were compared with those of all employed men and women. In most cases, these comparisons were made using data from Statistics Canada's Canadian Community Health Survey. Statistics Canada's Workplace and Employee Survey and Labour Force Survey were used to compare various employment and job characteristics. When important differences with other sources were found, the NSWHN team investigated and documented possible causes.
Last, the survey share file was sent to CIHI and Health Canada for a three-week validation period. The data could then be scrutinized and Statistics Canada informed of any concerns or anomalies related to data quality.
Statistics Canada is prohibited by law from releasing any data which would divulge information obtained under the Statistics Act that relates to any identifiable person, business or organization without the prior knowledge or the consent in writing of that person, business or organization. Various confidentiality rules are applied to all data that are released or published to prevent the publication or disclosure of any information deemed confidential. If necessary, data are suppressed to prevent direct or residual disclosure of identifiable data.
A Public Use Microdata File (PUMF) will not be created for the NSWHN. This is a result of the sampling strategy used for the survey, that is, the selection of nurses from a frame that was created using registration information held by the 26 provincial/territorial regulatory bodies.
The survey results were released on December 11, 2006 in Statistics Canada's The Daily. The main report entitled, Findings from the 2005 National Survey of the Work and Health of Nurses (83-003-XIE), contains a high level description of the survey results and 51 summary tables. A second report containing provincial profiles (11-621-MWE2006052) was released simultaneously in Statistics Canada's Analysis in Brief.
Users requiring additional information may purchase custom tabulations. These outputs are reviewed for confidentiality before they are given to users.
Users can also do their own research by accessing the master release file through the Research Data Centres program. To protect the anonymity of individual nurses, some sensitive variables have been regrouped, capped or completely deleted from the master release file. Outputs based on research using the master release file are vetted for confidentiality by Statistics Canada before users can release them.
Before releasing and/or publishing any estimate from these files, users should first determine the number of sampled respondents who contribute to the calculation of the estimate. If this number is less than 30, the weighted estimate should not be released regardless of the value of the coefficient of variation for this estimate. For weighted estimates based on sample sizes of 30 or more, users should determine the coefficient of variation of the rounded estimate.
Users may also obtain custom tabulations or request access to the share file containing the records of nurses who agreed to share their information with the Canadian Institute of Health Information and Health Canada. The conditions described above also apply to the release and/or publication of any estimate from the share file.
Statistics Canada prohibits users from working with both the master release file and share file to do their research.
Revisions and seasonal adjustment
This methodology does not apply to this survey.
While considerable effort is made to ensure high standards throughout all stages of collection and processing, the resulting estimates are inevitably subject to a certain degree of error. These errors can be broken down into two major types: non-sampling and sampling.
About the non-sampling errors:
In order to achieve the objectives of the survey, a steering committee and national advisory group defined the content requirements and developed an analytical plan. They recommended proven questions and indices that are recognized as valid measures of contemporary concepts such as depression, work stress and chronic pain. Variables collected in other Statistics Canada surveys were also recommended in order to evaluate the outcome of nurses compared to the general population.
Timely registration information was used to evaluate the sample frame and select the nurses for the survey, thus minimizing coverage error.
High response rates are essential for quality data. A comprehensive communication and training strategy contributed to the high response rates in each of the survey domains (see the link "Additional documentation" below).
About the sampling errors:
Sampling error occurs because population estimates are derived from a sample of the population rather than the entire population. Sampling error depends on factors such as sample size, sampling design, and the method of estimation. An important property of probability sampling is that sampling error can be computed from the sample itself by using a statistical measure called the coefficient of variation (CV). The assumption is that over repeated surveys, the relative difference between a sample estimate and the estimate that would have been obtained from an enumeration of all units in the universe would be less than twice the CV, 95 times out of 100. The range of acceptable data values yielded by a sample is called a confidence interval. Confidence intervals can be constructed around the estimate using the CV. First, we calculate the standard error by multiplying the sample estimate by the CV. The sample estimate plus or minus twice the standard error is then referred to as a 95% confidence interval.
For a more detailed discussion of the sampling and non-sampling errors, refer to Chapter 10 of the User Guide accessible through a link in the Documentation section below.
- Codebook - National Survey of the Work and Health of Nurses, 2005 Master File