Français
What shapes the well-being at of Quebec Nurses?Insights from their reported experiences
Design by PresentationGO.com
Key insights from the study
What happened
- We synthesized the reported experiences of Quebec nurses to understand what shapes their work-related wellbeing.
- Nurses’ well-being is shaped mainly by system and organizational factors, not individual coping skills.
- Nurses are continuously adapting to system constraints in order to protect patient care. This adaptive work is largely invisible, undervalued, and unsustainably absorbed by individuals.
- Nurses most commonly report organizational issues: workload, unclear roles, leadership, and scheduling.
- Supportive practice environments (collaboration, autonomy, effective teams) help buffer stress and sustain nurses’ ability to deliver high-quality care.
Why is it important?
- Nurses in Quebec face growing system pressures that affect well-being and care delivery. Evidence from nurses’ experiences shows why these challenges persist and where system changes can have the greatest impact.
What now?
- Findings can inform organizational planning and workforce support, including improving scheduling flexibility, digital tools, clerical support, task-shifting, and recognition of nursing contributions.
Nurse Story
Nurse well-being is essential for high-quality care. Safe, effective, patient-centred, timely, and equitable health systems depend on it.
In Quebec, nurse burnout has reached crisis levels, with thousands of nurses on sick leave and many leaving the public system. This reflects everyday pressures such as:
- Heavy workloads and chronic understaffing
- Growing administrative and documentation demands
- Limited support and flexibility
Well-being is not an individual problem. It is a system design issue that requires system action.
We need actionable strategies to support our nurse well
From an evidence-and-gap map of 652 qualitative studies on clinician well-being, we selected the 14 studies including experiences reported by Québec nurses and nurse practitioners. We organized these experiences using the National Academy of Medicine (NAM) Framework , which includes external factors (learning and practice environment, organizational factors, healthcare responsibilities, society and culture, and rules and regulations) and individual factors (personal factors and skills and abilities) that influence clinician well-being.
Who was representedRegistered Nurses (in 11 studies)Nurse Practitioners (in 5 studies)Where they workUrban primary care, community health, long-term care, and rural/remote settingsStudy focus areasRole integration and new care models; interprofessional collaboration; culturally safe care; infectious disease management; COVID-19 adaptationsReported experiences aligned with 44 of the NAM factors, covering each of the seven factor groups.
Explore the National Academy of Medicine (NAM) Framework
How often nurses reported experiences related to the NAM factors
- Outer bubbles = factor categories
- Inner bubbles = specific factors
- Size = frequency across studies
- Hover to explore specific factors
- Click on a circle to zoom in
- Most reported: Organizational factors & practice environment
Bubble Plot of Reported Nurses’ Experiences Across NAM Factors
View
Learn about the experiences nurses reported for each of these factors
Next
Nurse and nurse practitioner experiences related to external factors that influence their well-being
Organizational Factors
Practice Environment
Healthcare Responsibilities
Workload: Heavy workloads, scheduling pressure & added responsibilities created unsustainable demands.
Power dynamics: Role clarity supported nurses; loss of autonomy & hierarchical tensions undermined credibility. Staff engagement: Recognized contributions supported engagement; undervaluation of FMG roles discouraged nurses.
Bureaucracy: Rigid procedures & administrative delays limited timely care.
Compensation: Unpaid overtime & inadequate pay left nurses unsupported.
Organizational mission & values:
Alignment with patient-centred values supported nurses; gaps between values & practice undermined morale.
Professional development: Practical training supported nurses; generic, overly theoretical education & limited coaching left them underprepared.Scope of practice: Autonomy & advocacy roles supported well-being, but restrictive regulations & hierarchies limited practice.Organizational support: Mentorship & collaboration were supportive; limited supervision & weak infrastructure led to isolation. Leadership: Clear, supportive leadership helped, while poor communication & limited recognition undermined well-being.
Professional relationships: Trust, peer alliances, and supportive physicians fostered validation and belonging; weak or absent relationships led to stress, role ambiguity, and isolation. Health IT interoperability & usability:
Electronic records and secure platforms improved efficiency; non-standard systems and uneven access disrupted continuity and equitable care.
Clinical responsibilities: Expanded front-line roles supported professional meaning, while clinical complexity increased strain.Alignment of responsibility & authority: Community nurses felt their roles were often misunderstood or minimized, creating tension between responsibility and recognition. They were cautious not to appear imposing while still asserting the value of their contributions locally.
Collaborative environment: Open communication, trust, & teamwork supported care continuity; poor communication, isolated practices, & limited physician awareness of nursing roles made collaboration fragileTeam structure & functionality: Understaffing & unclear roles strain teamwork and overload nurses. Autonomy: Independence in managing patient care supported creative, patient-centred practice. For some nurses, autonomy felt precarious and unsupported without supervision or recognition.
Patient population:
Advocacy, counseling, & creative strategies supported engagement with vulnerable patients; Advanced Access models, monitoring needs, poverty, unstable housing, lack of insurance, and resistance to new booking models undermined care.Administrative responsibilities:
Flexible appointment organization (adjusted length, simplified categories, urgent slots) supported patient needs; administrative burden & tension with organizational constraints required constant negotiation.
Title
Title
Title
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Subtitle
Subtitle
Subtitle
Rules & Regulations
Society & Culture
HR policies & compensation:
Rigid rules on hours and overtime, misalignment with nurse practitioner roles, limited support for advanced practice, and physician remuneration models reduced flexibility and constrained autonomy.Documentation, reporting: Administrative requirements helped secure resources & legitimize work. But heavy documentation, overlooked community contribution & unclear legal frameworks limited telehealth use & increased burden.Reimbursement structure: Reimbursement incentives pushed teams toward high patient volumes and shaped how care was delivered.
Alignment of societal expectations & clinical roles: Outreach & advocacy offered opportunities to demonstrate nursing’s broader value, but were often perceived as undervalued. Culture of safety and transparency: Poor internet connectivity in rural settings undermined safe & equitable telehealth & created a sense of inequity. Discrimination and bias: Systemic discrimination in Indigenous communities hindered trust-building & challenged the delivery of culturally safe care.
Patient behaviours and expectations: Resistance to Advanced Access, preference for traditional booking or emergency department use, and digital or age-related barriers increased workload and frustration.Social determinants of health: Poverty, housing instability, and immigration status compromised adherence and follow-up, requiring nurses to adapt care, advocate for services, and provide support beyond clinical care.
National & provincial policies: Policies both enabled change and restricted roles. Productivity demands, prescribing limits, and unclear insurance coverage for some patients increased pressure on nurses.Shifting systems of care & administrative requirements: Deinstitutionalization, dehospitalization and repeated system changes increased patient acuity and disrupted practice, leaving nurses feeling powerless and reactive.
Title
Title
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Subtitle
Subtitle
Flip the cards to explore additional factors and details.
Learn about the experiences nurses reported for Individual factors
Next
Strengths
Nurse and nurse practitioner experiences related to Individual factors that influence their well-being
Skills & Abilities
Personal Factors
Personal values, ethics & morals:
Tension arose when professional values conflicted with structural limits and deprivation contexts. Flexibility & responsiveness to change;
Adapting care delivery and communication (e.g., telehealth) helped sustain relationships and trust over time. Inclusion & connectivity:
Limited access to supportive teams left nurses feeling discouraged and undervalued. Work–life integration:
Teleconsultation and flexible work arrangements supported balance between professional and personal demands.
Coping skills:
Managing patient resistance, sensitive situations, and emotional strain was part of nurses’ professional growth. Optimizing workflow:
Scheduling adaptations improved efficiency, but limited time and resources constrained workflow. Mastering new technologies:
Digital tools supported practice adaptation, though security concerns created uncertainty. Resilience & reflective practice: Reflective practice helped nurses learn from challenges and sustain commitment to care.
Clinical competency & experience:
Growing experience transformed early uncertainty into confident, efficient practice, with stronger judgment and less reliance on physicians.Empathy:
Empathy was central to care, helping nurses build trust, reduce stigma, and support patient autonomy through emotional as well as clinical care. Communication: Open, nonjudgmental communication supported trust and adherence, while poor or rigid communication limited understanding and influence.
Engagement & connection to meaning at work: Going beyond clinical tasks (accompanying vulnerable clients, community support) strengthened professional identity and sense of value.Physical, mental & spiritual well-being: Overwhelming workloads, exposure to suffering, and moral distress led to exhaustion and doubts about their competence. Sense of meaning: Advocacy and therapeutic relationships supported meaning at work, while limited recognition and uncertainty sometimes led to isolation.
Title
Title
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Subtitle
Subtitle
Flip the cards to explore additional factors and details.
Strengths
This is a paragraph of text waiting to be awesome content
Nurse and nurse practitioner experiences related to factors that influence their well-being
Organizational Factors
Practice Environment
Healthcare Responsibilities
HR policies & compensation:
Rigid rules on hours and overtime, misalignment with nurse practitioner roles, limited support for advanced practice, and physician remuneration models reduced flexibility and constrained autonomy.Documentation, reporting: Administrative requirements helped secure resources & legitimize work. But heavy documentation, overlooked community contribution & unclear legal frameworks limited telehealth use & increased burden.Reimbursement structure: Reimbursement incentives pushed teams toward high patient volumes and shaped how care was delivered.
Rules & Regulations
Workload: Heavy workloads, scheduling pressure & added responsibilities created unsustainable demands.
Power dynamics: Role clarity supported nurses; loss of autonomy & hierarchical tensions undermined credibility. Staff engagement: Recognized contributions supported engagement; undervaluation of FMG roles discouraged nurses.
Bureaucracy: Rigid procedures & administrative delays limited timely care.
Compensation: Unpaid overtime & inadequate pay left nurses unsupported.
Organizational mission & values:
Alignment with patient-centred values supported nurses; gaps between values & practice undermined morale.
Professional development: Practical training supported nurses; generic, overly theoretical education & limited coaching left them underprepared.Scope of practice: Autonomy & advocacy roles supported well-being, but restrictive regulations & hierarchies limited practice.Organizational support: Mentorship & collaboration were supportive; limited supervision & weak infrastructure led to isolation.Leadership: Clear, supportive leadership helped, while poor communication & limited recognition undermined well-being.
Professional relationships: Trust, peer alliances, and supportive physicians fostered validation and belonging; weak or absent relationships led to stress, role ambiguity, and isolation. Health IT interoperability & usability:
Electronic records and secure platforms improved efficiency; non-standard systems and uneven access disrupted continuity and equitable care.
Clinical responsibilities: Expanded front-line roles supported professional meaning, while clinical complexity increased strain.Alignment of responsibility & authority: Community nurses felt their roles were often misunderstood or minimized, creating tension between responsibility and recognition. They were cautious not to appear imposing while still asserting the value of their contributions locally.
Collaborative environment: Open communication, trust, & teamwork supported care continuity; poor communication, isolated practices, & limited physician awareness of nursing roles made collaboration fragileTeam structure & functionality: Understaffing & unclear roles strain teamwork and overload nurses. Autonomy: Independence in managing patient care supported creative, patient-centred practice. For some nurses, autonomy felt precarious and unsupported without supervision or recognition.
Patient population:
Advocacy, counseling, & creative strategies supported engagement with vulnerable patients; Advanced Access models, monitoring needs, poverty, unstable housing, lack of insurance, and resistance to new booking models undermined care.Administrative responsibilities:
Flexible appointment organization (adjusted length, simplified categories, urgent slots) supported patient needs; administrative burden & tension with organizational constraints required constant negotiation.
National & provincial policies: Policies both enabled change and restricted roles. Productivity demands, prescribing limits, and unclear insurance coverage for some patients increased pressure on nurses.Shifting systems of care & administrative requirements: Deinstitutionalization, dehospitalization and repeated system changes increased patient acuity and disrupted practice, leaving nurses feeling powerless and reactive.
Title
Title
Title
Title
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Subtitle
Subtitle
Subtitle
Subtitle
Society & Culture
Skills & Abilities
Personal Factors
Personal values, ethics & morals:
Tension arose when professional values conflicted with structural limits and deprivation contexts. Flexibility & responsiveness to change;
Adapting care delivery and communication (e.g., teleconsultation) helped sustain relationships and trust over time. Inclusion & connectivity:
Limited access to supportive teams left nurses feeling discouraged and undervalued. Work–life integration:
Teleconsultation and flexible work arrangements supported balance between professional and personal demands.
Coping skills:
Managing patient resistance, sensitive situations, and emotional strain was part of nurses’ professional growth.Optimizing workflow:
Scheduling adaptations improved efficiency, but limited time and resources constrained workflow. Mastering new technologies:
Digital tools supported practice adaptation, though security concerns created uncertainty. Resilience & reflective practice: Reflective practice helped nurses learn from challenges and sustain commitment to care.
Alignment of societal expectations & clinical roles: Outreach & advocacy offered opportunities to demonstrate nursing’s broader value, but were often perceived as undervalued. Culture of safety and transparency: Poor internet connectivity in rural settings undermined safe & equitable telehealth & created a sense of inequity. Discrimination and bias: Systemic discrimination in Indigenous communities hindered trust-building & challenged the delivery of culturally safe care.
Clinical competency & experience:
Growing experience transformed early uncertainty into confident, efficient practice, with stronger judgment and less reliance on physicians.Empathy:
Empathy was central to care, helping nurses build trust, reduce stigma, and support patient autonomy through emotional as well as clinical care. Communication: Open, nonjudgmental communication supported trust and adherence, while poor or rigid communication limited understanding and influence.
Engagement & connection to meaning at work: Going beyond clinical tasks (accompanying vulnerable clients, community support) strengthened professional identity and sense of value.Physical, mental & spiritual well-being: Overwhelming workloads, exposure to suffering, and moral distress led to exhaustion and doubts about their competence. Sense of meaning: Advocacy and therapeutic relationships supported meaning at work, while limited recognition and uncertainty sometimes led to isolation.
Patient behaviours and expectations: Resistance to Advanced Access, preference for traditional booking or emergency department use, and digital or age-related barriers increased workload and frustration.Social determinants of health: Poverty, housing instability, and immigration status compromised adherence and follow-up, requiring nurses to adapt care, advocate for services, and provide support beyond clinical care.
Title
Title
Title
Use this side to give more information about a topic.
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Use this side to give more information about a topic.
Subtitle
Subtitle
Subtitle
Flip the cards to explore additional factors and details.
Strengths
Core priorities to support nurse and nurse practitioner well-being
- Reduce workload & administrative burden
- Strengthen team structure, collaboration & role clarity
- Align responsibility with professional authority
Supporting actions
- Improve scheduling flexibility
- Enhance digital infrastructure
- Increase clerical & team support
- Support effective task-shifting
- Embed nursing contributions in quality metrics
REFERENCES
Research Team
- Abou Malham et al. (2017). What are the factors influencing implementation of advanced access in family medicine units? A cross-case comparison of four early adopters in Quebec. Int. J. Fam. Med., 2017, Article 1595406. https://doi.org/10.1155/2017/1595406
- Abou Malham et al. (2020). Changing nursing practice within primary health care innovations: The case of advanced access model. BMC Nurs., 19(1), Article 1. https://doi.org/10.1186/s12912-020-00504-z
- Bélanger & Rodríguez (2014). Stories and metaphors in the sensemaking of multiple primary health care organizational identities. BMC Fam. Pract., 15(1), Article 41. https://doi.org/10.1186/1471-2296-15-41
- Chouinard et al. (2017). Supporting nurse practitioners’ practice in primary healthcare settings: A three-level qualitative model. BMC Health Serv. Res., 17(1), Article 810. https://doi.org/10.1186/s12913-017-2363-4
- Côté et al. (2019). New understanding of primary health care nurse practitioner role optimisation: The dynamic relationship between the context and work meaning. BMC Health Serv. Res., 19(1), Article 4731. https://doi.org/10.1186/s12913-019-4731-8
- Girard et al. (2017). Primary care nursing activities with patients affected by physical chronic disease and common mental disorders: A qualitative descriptive study. J. Clin. Nurs., 26(9–10), 1385–1394. https://doi.org/10.1111/jocn.13695
- Giroux et al. (2016). A qualitative study of perceived needs and factors associated with the quality of care for common mental disorders in patients with chronic diseases: The perspective of primary care clinicians and patients. BMC Fam. Pract., 17(1), Article 131. https://doi.org/10.1186/s12875-016-0531-y
- Guillaumie et al. (2020). Perspectives of Quebec primary health care nurse practitioners on their role and challenges in chronic disease management: A qualitative study. Can. J. Nurs. Res., 52(4), 317–327. https://doi.org/10.1177/0844562119862735
- Kilpatrick et al. (2019). Implementing primary healthcare nurse practitioners in long-term care teams: A qualitative descriptive study. J. Adv. Nurs., 75(6), 1306–1315. https://doi.org/10.1111/jan.13962
- McCready & Laperrière (2024). The advocacy process in Canadian community health nursing: A collaborative ethnography. J. Adv. Nurs., 80(7), 2847–2859. https://doi.org/10.1111/jan.15896
- Regragui et al. (2023). Nursing practice and teleconsultations in a pandemic context: A mixed-methods study. J. Clin. Nurs., 32(17–18), 6339–6353. https://doi.org/10.1111/jocn.16756
- Richard (2013). Modélisation systémique d’une pratique infirmière d’interface en contexte de vulnérabilité sociale [Thèse de doctorat, Université de Montréal]. Université de Montréal.
- Rouleau et al. (2019). Nursing practice to support people living with HIV with antiretroviral therapy adherence: A qualitative study. JANAC, 30(4), e20–e37. https://doi.org/10.1097/JNC.0000000000000103S
- Santella et al. (2022). Perceptions of Inuit women and non-Inuit healthcare providers on the implementation of human papillomavirus self-sampling as an alternative cervical cancer screening method in Nunavik, Northern Quebec. Qual. Health Res., 32(8–9), 1259–1272. https://doi.org/10.1177/10497323221090805
This project was completed by Dat V. T. Nguyen with the support of a summer bursary from the McGill University Ingram School of Nursing and under the supervision of Paula L. Bush and Sylvie D. Lambert. The interactive lay summary was prepared by Dorsa Salimi
Cite
Nguyen, D. V. T., Bush, P. L., Lambert, S. D., & Salimi, D. (2026). What shapes the well-being of Quebec nurses? Insights from their reported experiences [Interactive presentation]. Genially. https://view.genially.com/65fadeb15953dd0014da5a52
To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
National Academy of Medicine (NAM) Framework
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How often nurses’ experiences were reported across NAM factors
Across 14 qualitative studies, nurses described how their well-being was shaped less by individual factors and more by organizational, regulatory, and practice conditions. Heavy workloads, unclear roles, administrative demands, and policy constraints created ongoing pressure, while supportive teams, autonomy, and meaningful patient relationships helped sustain practice. Nurses frequently adapted their roles to bridge system gaps—particularly for vulnerable populations—absorbing emotional and organizational labour that was often invisible and unsupported.
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Nurses are central to the Québec primary care system. They are often the first point of contact, the main source of continuity of care, and the link between clinical care, social realities, and community life. Their work rarely fits neatly into roles or schedules. A single day may involve managing chronic illness, responding to urgent needs, navigating social vulnerability, and coordinating care across teams and settings. Over time, responsibilities have expanded, expectations have increased, documentation has grown and policies have shifted. This has often occurred without parallel increases in authority, resources, or support. Many nurses describe systems that depend on their flexibility and commitment, while offering limited space to recover or feel heard. The result is not simply fatigue, but a gradual erosion of their well-being shaped by workload, role ambiguity, team dynamics, and broader social pressures.
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Transcript
Français
What shapes the well-being at of Quebec Nurses?Insights from their reported experiences
Design by PresentationGO.com
Key insights from the study
What happened
Why is it important?
What now?
Nurse Story
Nurse well-being is essential for high-quality care. Safe, effective, patient-centred, timely, and equitable health systems depend on it.
In Quebec, nurse burnout has reached crisis levels, with thousands of nurses on sick leave and many leaving the public system. This reflects everyday pressures such as:
Well-being is not an individual problem. It is a system design issue that requires system action.
We need actionable strategies to support our nurse well
From an evidence-and-gap map of 652 qualitative studies on clinician well-being, we selected the 14 studies including experiences reported by Québec nurses and nurse practitioners. We organized these experiences using the National Academy of Medicine (NAM) Framework , which includes external factors (learning and practice environment, organizational factors, healthcare responsibilities, society and culture, and rules and regulations) and individual factors (personal factors and skills and abilities) that influence clinician well-being.
Who was representedRegistered Nurses (in 11 studies)Nurse Practitioners (in 5 studies)Where they workUrban primary care, community health, long-term care, and rural/remote settingsStudy focus areasRole integration and new care models; interprofessional collaboration; culturally safe care; infectious disease management; COVID-19 adaptationsReported experiences aligned with 44 of the NAM factors, covering each of the seven factor groups.
Explore the National Academy of Medicine (NAM) Framework
How often nurses reported experiences related to the NAM factors
Bubble Plot of Reported Nurses’ Experiences Across NAM Factors
View
Learn about the experiences nurses reported for each of these factors
Next
Nurse and nurse practitioner experiences related to external factors that influence their well-being
Organizational Factors
Practice Environment
Healthcare Responsibilities
Workload: Heavy workloads, scheduling pressure & added responsibilities created unsustainable demands. Power dynamics: Role clarity supported nurses; loss of autonomy & hierarchical tensions undermined credibility. Staff engagement: Recognized contributions supported engagement; undervaluation of FMG roles discouraged nurses. Bureaucracy: Rigid procedures & administrative delays limited timely care. Compensation: Unpaid overtime & inadequate pay left nurses unsupported. Organizational mission & values: Alignment with patient-centred values supported nurses; gaps between values & practice undermined morale.
Professional development: Practical training supported nurses; generic, overly theoretical education & limited coaching left them underprepared.Scope of practice: Autonomy & advocacy roles supported well-being, but restrictive regulations & hierarchies limited practice.Organizational support: Mentorship & collaboration were supportive; limited supervision & weak infrastructure led to isolation. Leadership: Clear, supportive leadership helped, while poor communication & limited recognition undermined well-being.
Professional relationships: Trust, peer alliances, and supportive physicians fostered validation and belonging; weak or absent relationships led to stress, role ambiguity, and isolation. Health IT interoperability & usability: Electronic records and secure platforms improved efficiency; non-standard systems and uneven access disrupted continuity and equitable care.
Clinical responsibilities: Expanded front-line roles supported professional meaning, while clinical complexity increased strain.Alignment of responsibility & authority: Community nurses felt their roles were often misunderstood or minimized, creating tension between responsibility and recognition. They were cautious not to appear imposing while still asserting the value of their contributions locally.
Collaborative environment: Open communication, trust, & teamwork supported care continuity; poor communication, isolated practices, & limited physician awareness of nursing roles made collaboration fragileTeam structure & functionality: Understaffing & unclear roles strain teamwork and overload nurses. Autonomy: Independence in managing patient care supported creative, patient-centred practice. For some nurses, autonomy felt precarious and unsupported without supervision or recognition.
Patient population: Advocacy, counseling, & creative strategies supported engagement with vulnerable patients; Advanced Access models, monitoring needs, poverty, unstable housing, lack of insurance, and resistance to new booking models undermined care.Administrative responsibilities: Flexible appointment organization (adjusted length, simplified categories, urgent slots) supported patient needs; administrative burden & tension with organizational constraints required constant negotiation.
Title
Title
Title
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Subtitle
Subtitle
Subtitle
Rules & Regulations
Society & Culture
HR policies & compensation: Rigid rules on hours and overtime, misalignment with nurse practitioner roles, limited support for advanced practice, and physician remuneration models reduced flexibility and constrained autonomy.Documentation, reporting: Administrative requirements helped secure resources & legitimize work. But heavy documentation, overlooked community contribution & unclear legal frameworks limited telehealth use & increased burden.Reimbursement structure: Reimbursement incentives pushed teams toward high patient volumes and shaped how care was delivered.
Alignment of societal expectations & clinical roles: Outreach & advocacy offered opportunities to demonstrate nursing’s broader value, but were often perceived as undervalued. Culture of safety and transparency: Poor internet connectivity in rural settings undermined safe & equitable telehealth & created a sense of inequity. Discrimination and bias: Systemic discrimination in Indigenous communities hindered trust-building & challenged the delivery of culturally safe care.
Patient behaviours and expectations: Resistance to Advanced Access, preference for traditional booking or emergency department use, and digital or age-related barriers increased workload and frustration.Social determinants of health: Poverty, housing instability, and immigration status compromised adherence and follow-up, requiring nurses to adapt care, advocate for services, and provide support beyond clinical care.
National & provincial policies: Policies both enabled change and restricted roles. Productivity demands, prescribing limits, and unclear insurance coverage for some patients increased pressure on nurses.Shifting systems of care & administrative requirements: Deinstitutionalization, dehospitalization and repeated system changes increased patient acuity and disrupted practice, leaving nurses feeling powerless and reactive.
Title
Title
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Subtitle
Subtitle
Flip the cards to explore additional factors and details.
Learn about the experiences nurses reported for Individual factors
Next
Strengths
Nurse and nurse practitioner experiences related to Individual factors that influence their well-being
Skills & Abilities
Personal Factors
Personal values, ethics & morals: Tension arose when professional values conflicted with structural limits and deprivation contexts. Flexibility & responsiveness to change; Adapting care delivery and communication (e.g., telehealth) helped sustain relationships and trust over time. Inclusion & connectivity: Limited access to supportive teams left nurses feeling discouraged and undervalued. Work–life integration: Teleconsultation and flexible work arrangements supported balance between professional and personal demands.
Coping skills: Managing patient resistance, sensitive situations, and emotional strain was part of nurses’ professional growth. Optimizing workflow: Scheduling adaptations improved efficiency, but limited time and resources constrained workflow. Mastering new technologies: Digital tools supported practice adaptation, though security concerns created uncertainty. Resilience & reflective practice: Reflective practice helped nurses learn from challenges and sustain commitment to care.
Clinical competency & experience: Growing experience transformed early uncertainty into confident, efficient practice, with stronger judgment and less reliance on physicians.Empathy: Empathy was central to care, helping nurses build trust, reduce stigma, and support patient autonomy through emotional as well as clinical care. Communication: Open, nonjudgmental communication supported trust and adherence, while poor or rigid communication limited understanding and influence.
Engagement & connection to meaning at work: Going beyond clinical tasks (accompanying vulnerable clients, community support) strengthened professional identity and sense of value.Physical, mental & spiritual well-being: Overwhelming workloads, exposure to suffering, and moral distress led to exhaustion and doubts about their competence. Sense of meaning: Advocacy and therapeutic relationships supported meaning at work, while limited recognition and uncertainty sometimes led to isolation.
Title
Title
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Subtitle
Subtitle
Flip the cards to explore additional factors and details.
Strengths
This is a paragraph of text waiting to be awesome content
Nurse and nurse practitioner experiences related to factors that influence their well-being
Organizational Factors
Practice Environment
Healthcare Responsibilities
HR policies & compensation: Rigid rules on hours and overtime, misalignment with nurse practitioner roles, limited support for advanced practice, and physician remuneration models reduced flexibility and constrained autonomy.Documentation, reporting: Administrative requirements helped secure resources & legitimize work. But heavy documentation, overlooked community contribution & unclear legal frameworks limited telehealth use & increased burden.Reimbursement structure: Reimbursement incentives pushed teams toward high patient volumes and shaped how care was delivered.
Rules & Regulations
Workload: Heavy workloads, scheduling pressure & added responsibilities created unsustainable demands. Power dynamics: Role clarity supported nurses; loss of autonomy & hierarchical tensions undermined credibility. Staff engagement: Recognized contributions supported engagement; undervaluation of FMG roles discouraged nurses. Bureaucracy: Rigid procedures & administrative delays limited timely care. Compensation: Unpaid overtime & inadequate pay left nurses unsupported. Organizational mission & values: Alignment with patient-centred values supported nurses; gaps between values & practice undermined morale.
Professional development: Practical training supported nurses; generic, overly theoretical education & limited coaching left them underprepared.Scope of practice: Autonomy & advocacy roles supported well-being, but restrictive regulations & hierarchies limited practice.Organizational support: Mentorship & collaboration were supportive; limited supervision & weak infrastructure led to isolation.Leadership: Clear, supportive leadership helped, while poor communication & limited recognition undermined well-being.
Professional relationships: Trust, peer alliances, and supportive physicians fostered validation and belonging; weak or absent relationships led to stress, role ambiguity, and isolation. Health IT interoperability & usability: Electronic records and secure platforms improved efficiency; non-standard systems and uneven access disrupted continuity and equitable care.
Clinical responsibilities: Expanded front-line roles supported professional meaning, while clinical complexity increased strain.Alignment of responsibility & authority: Community nurses felt their roles were often misunderstood or minimized, creating tension between responsibility and recognition. They were cautious not to appear imposing while still asserting the value of their contributions locally.
Collaborative environment: Open communication, trust, & teamwork supported care continuity; poor communication, isolated practices, & limited physician awareness of nursing roles made collaboration fragileTeam structure & functionality: Understaffing & unclear roles strain teamwork and overload nurses. Autonomy: Independence in managing patient care supported creative, patient-centred practice. For some nurses, autonomy felt precarious and unsupported without supervision or recognition.
Patient population: Advocacy, counseling, & creative strategies supported engagement with vulnerable patients; Advanced Access models, monitoring needs, poverty, unstable housing, lack of insurance, and resistance to new booking models undermined care.Administrative responsibilities: Flexible appointment organization (adjusted length, simplified categories, urgent slots) supported patient needs; administrative burden & tension with organizational constraints required constant negotiation.
National & provincial policies: Policies both enabled change and restricted roles. Productivity demands, prescribing limits, and unclear insurance coverage for some patients increased pressure on nurses.Shifting systems of care & administrative requirements: Deinstitutionalization, dehospitalization and repeated system changes increased patient acuity and disrupted practice, leaving nurses feeling powerless and reactive.
Title
Title
Title
Title
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Use this side to give more information about a topic.
Subtitle
Subtitle
Subtitle
Subtitle
Society & Culture
Skills & Abilities
Personal Factors
Personal values, ethics & morals: Tension arose when professional values conflicted with structural limits and deprivation contexts. Flexibility & responsiveness to change; Adapting care delivery and communication (e.g., teleconsultation) helped sustain relationships and trust over time. Inclusion & connectivity: Limited access to supportive teams left nurses feeling discouraged and undervalued. Work–life integration: Teleconsultation and flexible work arrangements supported balance between professional and personal demands.
Coping skills: Managing patient resistance, sensitive situations, and emotional strain was part of nurses’ professional growth.Optimizing workflow: Scheduling adaptations improved efficiency, but limited time and resources constrained workflow. Mastering new technologies: Digital tools supported practice adaptation, though security concerns created uncertainty. Resilience & reflective practice: Reflective practice helped nurses learn from challenges and sustain commitment to care.
Alignment of societal expectations & clinical roles: Outreach & advocacy offered opportunities to demonstrate nursing’s broader value, but were often perceived as undervalued. Culture of safety and transparency: Poor internet connectivity in rural settings undermined safe & equitable telehealth & created a sense of inequity. Discrimination and bias: Systemic discrimination in Indigenous communities hindered trust-building & challenged the delivery of culturally safe care.
Clinical competency & experience: Growing experience transformed early uncertainty into confident, efficient practice, with stronger judgment and less reliance on physicians.Empathy: Empathy was central to care, helping nurses build trust, reduce stigma, and support patient autonomy through emotional as well as clinical care. Communication: Open, nonjudgmental communication supported trust and adherence, while poor or rigid communication limited understanding and influence.
Engagement & connection to meaning at work: Going beyond clinical tasks (accompanying vulnerable clients, community support) strengthened professional identity and sense of value.Physical, mental & spiritual well-being: Overwhelming workloads, exposure to suffering, and moral distress led to exhaustion and doubts about their competence. Sense of meaning: Advocacy and therapeutic relationships supported meaning at work, while limited recognition and uncertainty sometimes led to isolation.
Patient behaviours and expectations: Resistance to Advanced Access, preference for traditional booking or emergency department use, and digital or age-related barriers increased workload and frustration.Social determinants of health: Poverty, housing instability, and immigration status compromised adherence and follow-up, requiring nurses to adapt care, advocate for services, and provide support beyond clinical care.
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REFERENCES
Research Team
This project was completed by Dat V. T. Nguyen with the support of a summer bursary from the McGill University Ingram School of Nursing and under the supervision of Paula L. Bush and Sylvie D. Lambert. The interactive lay summary was prepared by Dorsa Salimi
Cite
Nguyen, D. V. T., Bush, P. L., Lambert, S. D., & Salimi, D. (2026). What shapes the well-being of Quebec nurses? Insights from their reported experiences [Interactive presentation]. Genially. https://view.genially.com/65fadeb15953dd0014da5a52
To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
National Academy of Medicine (NAM) Framework
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How often nurses’ experiences were reported across NAM factors
Across 14 qualitative studies, nurses described how their well-being was shaped less by individual factors and more by organizational, regulatory, and practice conditions. Heavy workloads, unclear roles, administrative demands, and policy constraints created ongoing pressure, while supportive teams, autonomy, and meaningful patient relationships helped sustain practice. Nurses frequently adapted their roles to bridge system gaps—particularly for vulnerable populations—absorbing emotional and organizational labour that was often invisible and unsupported.
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Nurses are central to the Québec primary care system. They are often the first point of contact, the main source of continuity of care, and the link between clinical care, social realities, and community life. Their work rarely fits neatly into roles or schedules. A single day may involve managing chronic illness, responding to urgent needs, navigating social vulnerability, and coordinating care across teams and settings. Over time, responsibilities have expanded, expectations have increased, documentation has grown and policies have shifted. This has often occurred without parallel increases in authority, resources, or support. Many nurses describe systems that depend on their flexibility and commitment, while offering limited space to recover or feel heard. The result is not simply fatigue, but a gradual erosion of their well-being shaped by workload, role ambiguity, team dynamics, and broader social pressures.