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The objective of this study was to investigate the relationship between the characteristics of home-care contracts, as indicators of employment relationships, and nurses'job satisfaction and perceived job security. A cross-sectional design was used to collect data on the study variables.The setting was 11 Community Care Access Centres and 11 nursing provider agencies in the Canadian province of Ontario. The sample included 700 nurses. A mailed survey was used to collect data from CCACs on length of contract awarded to provider agencies, potential for renewal, volume of service awarded, and profit status of the agency. Data were collected, via a mailed survey, on nurses' age, gender, work status, and years of employment in the community and at the current agency. The Nursing Job Satisfaction Scale was used to collect data on nurses'job satisfaction. Perceived job security was assessed using a single item measured on a 5-point Likert scale. Significant differences were found among provider agencies in nurses' perception of the quality of care, work enjoyment, satisfaction with time for care, and job security. Older nurses rated work enjoyment higher than younger nurses. Nurses paid on an hourly basis were more satisfied with their time for care than those paid on a per-visit basis. Nurses employed on a casual basis were less satisfied with job security than those employed on a full-time basis. Differences in nurse outcomes were observed among nursing provider agencies, but these were not related to the profit status of the agency. Further research is needed on the best practices within agencies that result in more satisfied staff.

The purpose of this study was to investigate the impact of the Request for Proposal (RFP) process - specifically, the profit status of provider agencies awarded contracts, the service volume awarded and contract duration - on the quality of home care services and outcomes. A cross-sectional (contract characteristics) and repeated measures (clients) design was used to collect data on the study variables. Primary data were collected in 2002-2003 from 11 Community Care Access Centres (CCACs) and 11 nursing provider agencies in Ontario. The sample included 750 home care clients recruited consecutively from home care referrals. Follow-up assessments were completed on 498 clients. CCACs and provider agencies completed written questionnaires about profit status, contract volume, duration of contract, potential for renewal, number of visits made by a principal nurse and number of visits made by a registered nurse. Data were collected on client health outcomes either at admission to home care service for new clients or at entry to the study for long-term clients, and then at discharge from service or at the end of six weeks, whichever came first, using the eight subscales of the Medical Outcome Study SF-36. Analysis was conducted using hierarchical linear modelling.For the most part, contract characteristics were not related to the consistency of principal nurse visits or client outcomes. Where differences existed, they were small. Clients of agencies awarded longer contracts received greater consistency in principal nurse visits than clients of agencies awarded shorter contracts. Clients cared for by for-profit agencies reported slightly higher satisfaction with care and better mental health outcomes than clients cared for by not-for-profit agencies. The percentage of visits made by a registered nurse was positively associated with social function outcome for clients at follow-up. In conclusion, the study findings suggest that contract characteristic variables had a small effect on home care client outcomes.