title: Hospital restructuring initiatives in Canada.
abstract: OBJECTIVE
  Recent changes in the organization, staffing, and utilization of acute hospitals in Canada are reviewed with regard to the potential implications for quality of care, national nurse workforce requirements, and research.
  
  
  METHODS
  Available national and selected provincial data and trends in hospital utilization, capacity, and staffing are synthesized.
  
  
  RESULTS
  Health system reform in Canada has resulted in lower utilization of acute inpatient resources, excess hospital capacity, and increased budgetary constraints in the hospital sector. In response, there is widespread hospital restructuring, which includes modifications in nurse staffing ratios and skill mix. Little is known about the potential impact of these changes on patient outcomes. From a workforce perspective, changes in the hospital sector have reduced demand for registered nurses but nursing schools have not modified enrollments. As a result, new graduates are experiencing difficulty obtaining registered nurse positions.
  
  
  CONCLUSIONS
  Research should be undertaken to evaluate the impact of changes in the organization and staffing of hospitals on patient outcomes, and on the future requirements for nurses.
authors.affiliation: WHO Collaborating Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Shamian
authors.forename: E Y
authors.initials: EY
authors.lastname: Lightstone
mesh_terms: D002170:Canada; D018672:Community Health Planning; D003159:Community-Institutional Relations / Q000639:trends; D003266:Continuity of Patient Care / Q000458:organization & administration; D018166:Health Care Reform / Q000458:organization & administration / Q000639:trends; D006302:Health Services Research; D006754:Hospital Restructuring / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D009313:National Health Programs; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards / Q000600:supply & distribution; D017149:Private Sector / Q000458:organization & administration / Q000639:trends; D017150:Public Sector / Q000458:organization & administration / Q000639:trends; D011787:Quality of Health Care; D000078329:Workforce