Changes to health care in Canada over the latter part of the 1990s have resulted in a number of new challenges for hospital nurse executives and health care leaders. In response to fiscal constraints and funding reductions, many health care settings restructured and downsized in an effort to reduce costs and improve the efficiency of services provided. These changes, coupled with the nursing shortage, have prompted concern in the nursing community regarding the work environment of nurses, and how this may influence nurse and patient safety outcomes.