Interdisciplinary Health Research Group

The Impact of Paid and Unpaid Work on Nurses' Well Being. ($51,693)

Funded by: Social Sciences and Humanities Research Council 1992-1997.
Principal investigator: Vivienne Walters (Sociology)
Co-investigators: John Eyles (Geography) and Susan French (Nursing).


The aim of this research was to investigate the combined effects of paid and unpaid work roles on nurses' health and well-being. We also aimed to explore gender differences, documenting differences in men's and women's nursing roles, family composition and domestic responsibilities.

The research was conducted by means of a mail questionnaire. Our sample was made up of RNs and RPNs who were registered in 1992 in three regions of Ontario: the Northwest, Eastern and Central West regions. At our request the College of Nurses of Ontario generated a proportional random sample of women RNs and RPNs in each of these regions. In addition, they provided us with all the names of men who were registered in the province. In January 1993, we mailed questionnaires to 5,205 nurses and a total of 2,288 usable questionnaires were returned: 1,188 from women RNs; 646 from women RPNs; 451 from men working as RNs and 3 from men RPNs. After taking into account nurses who were ineligible, this represents a response rate of 44.7%.

The following publications report on our analyses of the data.


1. Walters, V., Beardwood, B., Eyles, J., and French, S. "Paid and unpaid work roles of male and female nurses". In K. Messing et al Invisible: Issues in Women's Occupational Health Charlottetown, PEI, Gynergy Press, 1995.

In this article we report on the first stage of the data analysis for a study of 2,285 nurses in Ontario. The sample includes women and men Registered Nurses (RNs) and women Registered Practical Nurses (RPNs). We focus on nurses' concerns, rewards, stress, control and social support with respect to paid and unpaid work, identifying common themes and variations with respect to sex and job (RN/RPN). In documenting features of nursing work and home responsibilities, we establish a basis for future analyses of the effects on health of paid and unpaid work - an issue that has received relatively little attention in research on women's occupational health.

Several themes were common to RNs and RPNs. Both expressed concerns about overload, exposure to hazards in the workplace, rotating shifts and lack of support from supervisors. These were often seen as a source of stress. On the other hand, nurses acknowledged the rewards of helping others and of decision authority. Generally, they also considered their home responsibilities to be rewarding. There were also some pronounced differences between RNs and RPNs. For example, RPNs were less likely to experience control in their work, they were more likely to view their job as "dead-end", and more likely to report stress from dealing with death and dying and from caring for patients and their families. Women RNs experienced greater control at work than RPNs, but they identified stress in heavy workloads, uncertainty concerning treatments and the fear of being blamed for mistakes. Men RNs described their jobs as "dead-end", they felt their work environment was not supportive and they were more likely to express concerns about sex, race and ethnic discrimination. It was striking that home responsibilites were very traditionally gendered. Women spent significantly more time on domestic tasks, did not have enough time for themselves and faced problems in meeting diverse demands on their time.

2. Walters, V., Lenton, R., French, S., Eyles, J., Mayr, J. and Newbold, B., "Paid work, unpaid work and social support: a study of the health of women and men nurses". Social Science and Medicine, Vol. 143, No. 11, 1996, pp. 1627-1636.

Paid work, unpaid work in the home and social support are important elements of the social production of health and illness, though their combined effects on both women and men have only recently become a focus of research. This paper examines their association with the health problems of nurses, presenting data from a survey of a proportional random sample of 2285 male and female nurses registered in the Province of Ontario. The data are first analysed for the full sample and then multiple regression analyses are run separately for male and female Registered Nurses.

The demands of paid work (overload, exposure to hazards), unpaid work (time pressures, caring for a dependent adult) and overall stress in life are associated with greater health problems. There is also evidence of significant links between social support and health. A poor relationship with a supervisor is associated with health problems. On the other hand, enjoying a confiding relationship with a friend and having up to 4 children reduces the likelihood of experiencing health problems. The features of nursing associated with fewer health problems are challenge, satisfaction with work and working under 20 hours a week.

Several common themes emerge in the analyses of women and men: overload, hazard exposure, satisfaction with work, having 3-4 children and level of overall stress in life. Yet the models are also very different and point to the need for further analyses of the social production of health problems in relation to gender. They also suggest that women nurses, in particular, may suffer the effects of restructuring in the health care sector. Workload issues are especially important for women. Younger women, those reporting time pressures and caring for a dependent adult are more likely to report health problems. Having a confiding relationship with a friend is associated with fewer health problems for women. Among men, those who dislike housework are more likely to experience health problems. Satisfaction with work and overall stress in life were associated with health problems for both men and women, though there may be gender differences in what generates satisfaction and stress.

Reprinted from Social Science and Medicine Vol 143, No 11, Walters, V., Lenton, R., French, S., Eyles, J., Mayr, J. and Newbold, B., "Paid work, unpaid work and social support:: a study of the health of women and men nurses", pp 1627-1636, 1996, with permission from Elsevier Science.

3. Walters, V., French, S., Eyles, J., Lenton, R., Newbold, B., and Mayr, J., "The effects of paid and unpaid work on nurses' well-being: the importance of gender", Sociology of Health and Illness Vol. 19, No. 3, 1997, pp. 328-347. (Abstract reprinted with permission of the editors.)

A handful of studies have started to explore the effects on health of both paid and unpaid work among women and men. This paper reports on a survey of a proportional random sample of 2285 women and men nurses from three regions in Ontario. We examine the effects of paid and unpaid work on their well-being. The data were analysed for the full sample and then multiple regression analyses were run separately for men and women. In our discussion we emphasise several points: unless such data are analysed in terms of gender, as well as controlling for sex, marked differences between the experiences of men and women may be neglected; that in understanding health, it is important to take into account the influence of both paid and unpaid work; and that certain features of paid and unpaid work are often associated with well-being - control over work, the degree of challenge that work presents, recognition, satisfaction with work, social support, number of children and the level of overall stress experienced. Workload issues are also associated with women's well-being.