Long-Term Care Staff Quality of Work Life in Atlantic Canada (QWL-AC) 

A total of 2305 staff surveys from 53 care homes collected between November 2023 and May 2024

First manuscript Examining Quality of Work Life in Atlantic Canadian Long Term Care Homes: Protocol for a Cross-Sectional Survey Study published in March 2025 detailing the project protocol

In-person Research Team Meeting at MSVU June 5th & 6th, 2025

 

           

 

 

 

 

 

An Underrepresented, Undervalued Workforce: Understanding and Supporting Quality of Work Life in Long-term Care

 

CIHR funded April 2023 – March 2027

WHAT

This study, An Underrepresented, Undervalued Workforce: Understanding and Supporting Quality of Work Life in Long-term Care, seeks to understand how the conditions of work in Atlantic Canadian long-term care (LTC) may affect the conditions of care of the residents. The study is assessing how work environment impacts the quality of work life (QWL) of staff in LTC and ultimately, resident quality of care outcomes in Atlantic Canada. The work extends research happening in Western Canada through the Translating Research in Elder Care (TREC) program.

WHO

This study is being led by Dr. Janice Keefe, Mount Saint Vincent University, and co-led by Dr. Rick Audas, Memorial University of Newfoundland, Dr. Carole Estabrooks, University of Alberta, Dr. Rose McCloskey, University of New Brunswick, and Dr. Gail Tomblin-Murphy, Nova Scotia Health with co-investigators from various disciplines and universities, and knowledge users and sector collaborators from across the Atlantic region. Dr. Keefe and colleagues were awarded a $2.1 million CIHR project grant in April 2023 for this multi-site study. The study is funded from April 2023- March 2027.

HOW

The research team surveyed a mix of LTC staff including care aids, nurses, allied health professionals, and managers in 53 randomly selected care homes across Atlantic Canada using established survey tools from TREC. Staff were asked questions about their physical and mental health, and key features about their work environment. Twenty-five percent of eligible LTC homes in New Brunswick (NB) and Nova Scotia (NS) were recruited with Newfoundland & Labrador (NL) and Prince Edward Island (PE) being over sampled to obtain a minimum of 8 LTC homes per province.

Relationships between staff QWL and resident outcomes will be examined by linking staff survey results with resident assessment data (interRAI). Linking data will help us understand if or how the working environment affects the quality of care received by LTC residents.

WHEN

This project is funded from April 2023 to March 2027. Data collection with LTC staff took place November 2023 – May 2024. InterRAI data will be obtained and linked to staff survey data in 2025. Dissemination activities for the project include individualized site reports for each participating LTC home, publishing in academic journals, presentations at scholarly conferences, and webinars. Activities and publications will be posted in “Project Updates” and “Results & Dissemination” sections below.

Study Timeline:

Contacts:

Paula Richardson, Atlantic Region Project Manager
Email: arcltc@msvu.ca Telephone: 902-457-6235

Emily Hubley, Knowledge Mobilization Manager & NS/PEI Coordinator
Email: Emily.Hubley1@msvu.ca Telephone: 902-457-5529 https://www.researchprotocols.org/2025/1/e66338

Caitlin Robertson, NB Coordinator
Email: Caitlin.Robertson@unb.ca

 

Funded by CIHR and partner funders:

 

 

 

 

Project Updates

2025

July & August

· Postdoctoral Fellow, Dr. Ogochukwu Onyeso, joins study team to support data analyses and dissemination activities.

· Participant feedback infographic #2 summarizing findings for care aides, nurses, and managers by province sent to participants and sites.

· 12 Manuscripts in preparation.

· 4 Trainee theses in progress.

· Analysis for ongoing manuscripts and upcoming conference presentations.

· Process to access to InterRAI in varying stages across the three provinces

  • NB: IRDT received InterRAI data from CIHI. Data is being reviewed and cleaned in preparation for analysis.
  • NS: Work is beginning with care homes to acquire consent to access their InterRAI data.
  • NL: In preparation of an ethics submission the NL team is working with NLCHI on the process for accessing CIHI InterRAI data.

June

· 1 oral and 1 poster presentation at the Atlantic Region – Canadian Association of Schools of Nursing (ARCASN) in St. John, NB.

· 1 oral presentation at the Northwood Research Symposium in Dartmouth, NS.

· Regional webinar hosted by the Public Health Agency of Canada looking at care aide and manager well-being with cross-provincial exchange among decision-makers. · In-Person Team Meeting at Mount Saint Vincent University where 36 team members met over 2 days to discuss ongoing analyses, engage sector representatives, and discuss next steps.

· 1 symposium, 2 oral, and 1 poster presentation at Our Future is Aging Conference in Halifax, NS.

 

 

· Meeting of Co-Principal Investigators.

May

· 1 poster presentation at the Canadian Association for Health Services and Policy Research (CAHSPR) conference in Ottawa, ON.

· Meeting of Co-Principal Investigators.

· Analysis and presentation preparation for upcoming conferences.

· Planning continues for the in-person team meeting being held in Halifax June 5th and 6th.

April

· Postdoctoral Fellow, Dr. Heather Dicks, joins study team to support data analyses and dissemination activities.

· Presentation at the Nursing Homes of Nova Scotia Association (NHNSA) Spring Conference in Halifax, NS.

· PEI provincial webinar looking at quality of work life and well-being differences among care aides, nurses, allied health, and managers.

· Site Feedback Report number three, summarizing descriptive results of staff work environment sent to participating care homes.

· Analysis and presentation preparation for upcoming conferences.

· Planning underway for the in-person team meeting being held in Halifax June 5th and 6th.

March

· NB, NL, and NS provincial webinars looking at quality of work life and well-being differences among care aides, nurses, allied health, and managers.

· First manuscript on project protocol published Examining Quality of Work Life in Atlantic Canadian Long Term Care Homes: Protocol for a Cross-Sectional Survey Study in JMIR Research Protocols.

February

· 4 descriptive reports of staff quality of work life and mental health and well-being sent to respective provincial government in NB, NL, NS, and PEI.

January

·Meeting of Co-Principal Investigators

2024

December

· Site Feedback Report number two, summarizing descriptive results of staff responses to health and well-being questions sent to participating care homes.

November 
· Postdoctoral Fellow, Dr. Kazeem Adefemi, joins study team to support data analyses and dissemination activities.

· Individualized Site Feedback Report number one summarizing results on quality of work life (the first in a series of three individualized site reports) sent to participating care homes.

· 1 poster presentation at the New Brunswick Health Research Symposium in Moncton NB.

October
· Participant feedback infographic, summarizing final survey numbers across Atlantic Canada sent to participants and sites.

September

· NB Lead, Rose McCloskey (left) and research staff Emily Hubley and research staff Annika Wiebe (centre) and Emily Hubley (right) at an information table at the Aging Care and Research Symposium on September 26th in Fredericton, NB.

 

 

 

· Ethics for NS InterRAI work approved September 24 and submitted to the Privacy Office for review.

· Descriptive analyses begin for individualized site reports.

July & August

· Planning and preparation for the first in a series of three individualized site reports.

· Initial descriptive analysis of project data begins

· Data cleaning conducted by TREC data management group.

June

· Full team meeting held with a check-in from sectors, update on recruitment and data collection, overview of year 2 timeline, objective 3 (InterRAI) update and discussion of KT and dissemination activities.
· TREC data management group and the data begin data cleaning process.
· Facility and unit surveys wrap-up.

May

· Staff survey data collection ends May 31st.
· Meeting of principal investigators to discuss year 2 project activities, building trainee capacity, dissemination and team engagement.

April 

· As of mid-April, 53/54 randomly selected care homes have been recruited across Atlantic Canada.

· Principal Investigators will be meeting this month to discuss year 2 timelines and work plans

March 

· 43/54 care homes have been recruited across Atlantic Canada

· 636 Interviews with care aides have been completed by interviewers

· 288 Online surveys have been completed by regulated staff (Nurses, Managers & Allied Health Professionals.

February

· Data collection starts in PEI.

January

· Data collection starts in NB

· Memorial University of Newfoundland HREA ethics approval received and submitted to Research Proposals Approval Committee (RPAC).

2023

December 

· A full team meeting held to discuss regional LTC sector landscapes, progress on site recruitment and data collection, remaining year 1 project timeline and dissemination and knowledge translation activities.

November 

· Principal Investigators and Co-Investigators met to discuss project timelines, finalized surveys, and plans for promotion, building research capacity, and dissemination.

· University of New Brunswick ethics approval received and site recruitment begins in NB.

September 

· Ethics approval received from ethics Board of Record (MSVU)

June-August 

· Project submitted to ethics Board of Record (MSVU), Health PEI, and UNB

· Hiring and staff training for all Hubs

May 

· Atlantic Research Project Manager hired

 

Fieldwork Updates

New Brunswick

April 2024

· 17/18 care homes recruited

· Data collection completed in 6 care homes

· Total surveys completed: 94 CA, 71 Regulated

March 2024

· All 6 randomly select French care homes have been recruited.

· The Translating Research in Elder Care (TREC) staff surveys are being translated to French for data collection starting April/May 2024.

· Data collection completed in 3 care homes

· Total surveys completed: 94 CA, 71 Regulated

February 2024

· All 12 randomly selected English care homes have been recruited.

· Data collection completed in a total of 2 care homes.

· Total surveys completed: 34 CA, 22 Regulated

· Pre-data collection & In-person site visits are in-progress for remaining recruited homes.

· Site recruitment of 6 randomly selected French care homes begins.

January 2024

· Data collection completed in first English care home.

· Total surveys completed: 14 CA, 17 Regulated

December 2023

· First care homes recruited.

· Data collection scheduled to start January 2024.

November 2023

· Ethics Approval received from UNB.

· Site recruitment of 12 randomly selected English care homes begins.

October 2023

· Project submitted to UNB ethics for approval.

· French translation process begins for TREC staff surveys.

 

Newfoundland & Labrador

April 2024

· Data collection starts

· All 8 homes recruited and scheduled for data collection

March 2024

· RPAC approval received

· Recruitment of the 8 randomly care homes started.

January 2024

· MUN ethics approval granted

November 2023

· Project submitted to MUN for ethics approval

Nova Scotia

April 2024

· 19/20 homes recruited.

· Total surveys completed: 204 CA, 110 Regulated

 

March 2024

· Data collection in 8 homes

· Total surveys completed: 204 CA, 110 Regulated

· 17/20 homes recruited.

February 2024

· Data collection completed in 7 homes

· Total surveys completed: 200 CA, 99 Regulated

· 14/20 homes recruited

January 2024

· Data collection completed in 6 homes

· Total surveys completed: 198 CA, 98 Regulated

· 14/20 homes recruited

December 2023

· Data collection completed in 3 homes

· Total surveys completed: 70 CA, 30 Regulated

· 14/20 homes recruited

November 2023

· DC training is completed

· 12/20 homes recruited

· Total surveys completed: 22 CA, 10 Regulated

· Data collection starts in first home

· In-person site visits start

October 2023

· 4/20 homes recruited

 

PEI

April 2024

· Data collection complete in 8/8 homes

· Total surveys completed: 212 CA, 96 Regulated

March 2024

· Data collection complete in 2 homes

· Total surveys completed: 212 CA, 96 Regulated

· 8/8 homes recruited

February 2024

· Data collection completed in 1 home

· Total surveys completed: 61 CA, 35 Regulated

· 8/8 homes recruited

January 2024

· 8/8 homes recruited and scheduled for data collection for March & April

December 2023

· 5/8 homes recruited

· Data collection scheduled to start in February

November 2023

· 2/8 homes recruited

October 2023

· Ethics approval granted from Health PEI

· First PEI homes contacted for facility recruitment

Results & Dissemination

Manuscripts

Keefe, J., McCloskey, R., Hodgins, M. J., McArthur, C., MacKenzie, A., Weeks, L. E., & Estabrooks, C. A. (2025). Examining quality of work life in Atlantic Canadian long-term care homes: Protocol for a cross-sectional survey study. JMIR Research Protocols, 14. https://doi.org/10.2196/66338

Conference Presentations

McCloskey, R., & Keefe, J. (2025, June 24-26). Staff intentions to leave their current positions in New Brunswick’s nursing homes: A cause for concern? [poster presentation]. Atlantic Region Canadian Association of Schools of Nursing (ARCASN) Conference, Saint John, NB, Canada.

Keefe, J. (2025, June 20). Understanding and supporting quality of work life in long-term care [oral presentation]. Northwood Research Symposium, Dartmouth, NS, Canada.

Audas, R., Adefemi, K., O’Brien, K., Waddleton, D., & Wilson, R. (2025, June 3-4). Attachment, burnout, and stress in the LTC sector in Newfoundland and Labrador – Preliminary results from an Atlantic Research on Collaboration (ARC LTC) study [oral presentation]. Our Future is Aging Conference, Halifax, NS, Canada.

Duynisveld, A., Hubley, E., & Keefe, J. (2025, June 3-4). Understanding relationships between job satisfaction and work environment for Nova Scotia CCAs [poster presentation]. Our Future is Aging, Halifax, NS, Canada.

Keefe, J., Estabrooks, C., McCloskey, R., Hodgins, M., Weeks, L., MacKenzie, A., O’Brien, K., Andrew, M., Boudreau, D., Weir, J., & Rutledge, E. (2025, June 3-4). Atlantic research in LTC: Understanding the working conditions and wellbeing of staff in LTC in Atlantic Canada & Alberta [symposium]. Our Future is Aging, Halifax, NS, Canada.

McCloskey, R., Morris, P., & Keefe, J. (2025, June 3-4). Does residents’ responsive behaviours affect care aides’ quality of work life in long term care (LTC) homes in Atlantic Canada [oral presentation]. Our Future is Aging, Halifax, NS, Canada.

MacKenzie, A., Hodgins, M., Weir, J., & Keefe, K. (2025, May 27-29). Factors associated with nurse outcomes in Atlantic Canadian long-term care facilities [poster presentation]. Canadian Association for Health Services and Policy Research (CAHSPR), Ottawa, ON, Canada.

Webinars & Invited Presentations

Keefe, J. (2025, June 16). Knowledge exchange webinar on the mental health of long-term care staff in the Atlantic Region [webinar]. Public Health Agency of Canada (PHAC).

Keefe, J. (2025, April 29). An underrepresented, undervalued workforce: Understanding and supporting quality of work life in long-term care [oral presentation]. Nursing Homes of Nova Scotia Association Spring Conference and Trade Show, Halifax, NS, Canada.

Keefe, J. (2025, April 15). Prince Edward Island long-term care: A look at staff work life and health and well-being in 2024 [webinar]. Atlantic Research Collaboration on Long-Term Care (ARC LTC).

Keefe, J., & Aduas, R. (2025, March 20). Newfoundland and Labrador long-term care: A look at staff work life and health and well-being in 2024 [webinar]. Atlantic Research Collaboration on Long-Term Care (ARC LTC).

McCloskey, R. (2025, March 19). New Brunswick long-term care: A look at staff work life and health and well-being in 2024 [oral presentation]. New Brunswick Association of Nursing Homes (NBANH) Annual General Meeting & Conference, Fredericton, NB, Canada.

Keefe, J. (2025, March 5). Nova Scotia long-term care: A look at staff work life and health and well-being in 2024 [webinar]. Atlantic Research Collaboration on Long-Term Care (ARC LTC).

Trainee Projects

D’Entremont, C., Audas, A., & Keefe, J. (in progress). Examining Work-Life Quality in Long-Term Care: Differences Between Registered and Licensed Practical Nurses in Newfoundland and Labrador. [Unpublished Thesis]. Memorial University of Newfoundland.

MacLeod, K., McCloskey, R., Durepos, P., & Morris, P. (in progress). Exploring the relationship between physician presence on nurses’ job satisfaction and retention in New Brunswick nursing homes: A cross-sectional study. [Unpublished Thesis]. University of New Brunswick.

Xin, L., & Keefe, J. (in progress). How Ethnic Density Shapes Care Aides’ Well-Being: A Study of Mental Health, Job Satisfaction, and Burnout Disparities in Long-term Care Homes of NS and PEI. [Unpublished Thesis]. Mount Saint Vincent University.

Briefs & Summaries

Participant Feedback #2 – Findings from NB – All Staff Combined – Atlantic Research Collaboration on Long-Term Care: Findings from the TREC Staff Survey for New Brunswick Resident Attendants, Nurses, and Managers

Participant Feedback #2 – Findings from NL – All Staff Combined (2) – Atlantic Research Collaboration on Long-Term Care: Findings from the TREC Staff Survey for Newfoundland and Labrador Personal Care Attendants, Nurses, and Managers

Participant Feedback #2 – Findings from NL – All Staff Combined (2) Participant Feedback #2 – Findings from NS – All Staff Combined – Atlantic Research Collaboration on Long-Term Care: Findings from the TREC Staff Survey for Nova Scotia Continuing Care Assistants, Nurses, and Managers

Participant Feedback #2 – Findings from PEI – All Staff Combined – Atlantic Research Collaboration on Long-Term Care: Findings from the TREC Staff Survey for Prince Edward Island Resident Care Workers, Nurses, and Managers[EH1]

Participant Feedback Infographic #1 – Atlantic Research Collaboration on Long-Term Care TREC Staff Survey: Project Update (2024, September)

Research Team

Nominated Principal Investigator

Dr. Janice Keefe, Mount Saint Vincent University

 

Co-Principal Investigators

Dr. Rick Audas, NLCAHR at Memorial University of Newfoundland

Dr. Carole Estabrooks, University of Alberta

Dr. Rose McCloskey, University of New Brunswick

Dr. Gail Tomblin-Murphy, Dalhousie University

Co-Investigators

Dr. Marilyn Hodgins, University of New Brunswick

Dr. Adrian MacKenzie, Nova Scotia Department of Health & Wellness

Dr. Caitlin McArthur, Dalhousie University

Dr. Kathleen Norman, Nova Scotia Health

Dr. Lori Weeks, Dalhousie University

Dr. Robert Wilson, Memorial University of Newfoundland

Kelli O’Brien, Newfoundland & Labrador Health Services

Sector Collaborators

Department of Health and Community Services Newfoundland & Labrador
Department of Community Health & Senior Care, Health PEI
MacLeod Group
New Brunswick Association of Nursing Homes (NBANH)
Nursing Homes Services, Department of Social Development, Government of New Brunswick
Newfoundland & Labrador Eastern Health
Nova Scotia Health (NS Health)
Nova Scotia Department of Seniors and Long-term Care
Nova Scotia Department of Health and Wellness
Nursing Homes of Nova Scotia Association (NHNSA)
Prince Edward Island Long-term Care Private Operators Association
Shannex

Trainees

Kazeem Adefemi, Postdoctoral Fellow, Memorial University of Newfoundland (November 2024—Present)

Liam Bennett, Nova Scotia Research Assistant, Mount Saint Vincent University (September 2024—June 2025)

Caleb D’entremont, MSc candidate Memorial University of Newfoundland (September 2024—Present)

Heather Dicks, Postdoctoral Fellow, Mount Saint Vincent University (April 2025—Present)

Amber Duynisveld, MA candidate, Mount Saint Vincent University (April 2023—Present)

Isaiah Hipel, PhD candidate Saint Mary’s University (September 2023—Present)

Kayla MacLeod, MA candidate, University of New Brunswick (September 2024—Present)

Ogochukwu Onyeso, Postdoctoral Fellow, University of New Brunswick (July 2025—Present)

Emily Rutledge, MHA, Dalhousie University (November 2024—Present)

Lanlan Xin, MA candidate, Mount Saint Vincent University (January 2025—Present)

 

Research Staff

Paula Richardson, Atlantic Region Manager, Mount Saint Vincent University (May 2023—Present)

Emily Hubley, Knowledge Mobilization Manager & NS/PEI Coordinator, Mount Saint Vincent University (June 2023—Present)

Caitlin Robertson, NB Research Coordinator, University of New Brunswick (May 2025—Present)

Simranpreet Kaur, Research Assistant, Mount Saint Vincent University (December 2024—Present)

Former Research Staff:

Jane Logan, NB Coordinator, University of New Brunswick (September 2024—April 2025)

Annika Wiebe, NS Research Assistant/NB Coordinator, Mount Saint Vincent University (February 2024—January 2025)

Marlene Robichaud, NB Manager, University of New Brunswick (September 2023—June 2024)

Katie Edgar, NB Coordinator, University of New Brunswick (September 2023—August 2024)

Colin Walsh, NL Manager, Memorial University of Newfoundland (October 2023—January 2024)

Emily Doyle, NL Coordinator, Memorial University of Newfoundland (January 2024—August 2024)

Callie Thomson, Research Assistant, Mount Saint Vincent University (September 2023—May 2024)