Nurse-to-patient ratios and staffing issues: a qualitative investigation of nurses' perceived work environments in Quebec's integrated healthcare centers

Abstract

Access to primary healthcare is an important challenge in many countries, posing significant problems for population health and health equity. While family physicians' (FPs) dedication is considered essential to increase access to primary care, several indications of a certain demobi-lization, even a deeper disengagement, among FPs has emerged. Using a specific case, that of FPs in the province of Quebec (Canada), this article aims to capture the processes that lead these professionals to redefine their work engagement by exploring various tensions that permeate their practice and impact meaning at work. The findings presented in this article are based on the analysis of 35 individual semi-directed interviews with FPs from three labor market integration cohorts (early-, mid- and late-career) working in various care settings. Our findings suggest that the tensions experienced related to the representation of family medicine, career expectations and personal aspirations lead many FPs to redefine their work engagement over the course of their professional journey. While physicians consistently demonstrate strong commitment to their patients, many disengage from work environments that impose practices contrary to their professional values and how they define high-quality family medi-cine, as well as conditions that hinder their involvement in family life.