Practice Environment: A healthy practice environment for nurses starts with a manageable workload. Nurses also need to feel valued and respected and have a sense of autonomy within their practice. The key quality work issues for nurses revealed in Lowe's survey: �autonomy and control, stress and burnout, work hours and workload, skills and responsibilities, feeling valued and respected, occupational health and safety and work life balance� (Lowe-C.N.A 2001).
According to Canadian Nurse's Association, �professional practice environment has a direct correlation with job satisfaction, work production, recruitment and retention, the quality of care, and ultimately client outcomes� (C.N.A. 2002).
Increased number of patients requiring nursing care, coupled with no increase in nursing staff, have contributed to an unsafe practice environment. Consequently, the end result is nurse apathy, �burnout� and nurses off on stress leave.

Patient Acuity and Complexity Treatment: Treatments and supportive care once provided by tertiary care facilities are now being shifted to the ambulatory and community care settings. Technological advancements and complex symptomatology related to treatments and/or disease have impacted nurse's workload. Nurses now are challenged with staying current with their practice and maintaining their competencies, within the limitations of healthcare reform.
Chamorro & Tarulli (1990) collectively agree, � in the current health care climate, the pressures of providing quality care under the intense demands of sicker patients, complexity of treatments and sophisticated equipment augment the predicament. Financial and manpower constraints and consumers with high expectations are negative influences� (p. 916).

Nursing Shortage: The many contributing factors to our national nursing shortage include: a fall in nursing student enrollment, aging population of nurses, nurses leaving the country or the profession and health care cutbacks. The nursing shortage is predicted to peak with in the next 10-15 years, at which time the number of nurses eligible for retirement will outweigh the number of new graduating nurses (RNABC 2002). �According to the Canadian Institute for Health Information, if registered nurses were to retire at age 55, one half (49.4%) of Canada's entire registered nurse workforce will be eligible for retirement within the next ten years� (RNABC 2002).