Ann Tourangeau RN, PhD

Professor Emerita

If we know what (and how) nursing structures and care process affect a healthcare outcome, we can manage these factors to improve healthcare outcomes.

Professor Ann Tourangeau is a Professor and the Associate Dean, Academic at Bloomberg Nursing. She is a recognized health services research leader with a focus on outcomes research. She teaches graduate course content on health services research methods, health services management and leadership, and program development and evaluation.

In her research, she focuses on identifying and measuring nursing-related determinants of health care outcomes. Knowledge of nursing structure and process factors that influence outcomes (e.g., patient safety, organizational and nurse outcomes) leads directly to identification of strategies to manage these influencing factors and, thus, improve outcomes.  She examines nursing structures such as nurse staffing, nurse preparation, and manager / leader characteristics as well as processes of care such as work environment characteristics, use of care maps / algorithms, and relationships within the interdisciplinary team. She studies the impact these factors have on health system, organizational and nurse outcomes such as hospital mortality rates, nurse retention, and other quality of care outcomes.

Professor Tourangeau has received significant support to develop her research program through a Career Scientist Award (2003-2008) from the Government of Ontario and a Nursing Senior Career Research Award (2011-2014) from the Government of Ontario.

Professor Tourangeau is an Adjunct Associate Professor at Edith Cowan University in Joondalup, Australia and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES) in Ontario.

Visit Dr. Tourangeau’s Website

  • 2001 – PhD, University of Alberta, Edmonton

  • 1988 – MN, University of Alberta, Edmonton

  • 1981 – BScN, University of Alberta, Edmonton

Dr. Tourangeau’s PubMed link is available here.

Sarah Xiao, RN

Sarah Xiao is a PhD student at the Lawrence Bloomberg Faculty of Nursing at the University of Toronto. Her research interests are in nursing care quality, performance measurement, and quality improvement. Sarah’s doctoral research focuses on developing nursing process healthcare indicators to determine and evaluate the quality of nursing care on patient outcomes. Developing indicators sensitive to nursing care will enable nurses to accurately document patients’ responses directly influenced by their care and focus on nursing care practices that bring about the most improvements in patients. Findings from Sarah’s research will help address current issues around the benefits and costs of nursing services and provide better evidence and support to monitor and improve organizational outcomes. For more information, please contact Sarah at

Nicole Ilavsky, NP

Nicole Ilavsky is a PhD student at the Lawrence Bloomberg Faculty of Nursing at the University of Toronto and a Primary Health Care Nurse Practitioner. Nicole’s graduate work focuses on work environments of Primary Health Care Nurse Practitioners in Ontario. Nicole is exploring determinants of Nurse Practitioners’ intention to stay employed in Primary Health Care settings and the factors influencing retention of Nurse Practitioners. Current literature supports a growing demand for health care services in Primary Health Care settings due to the increasing complexity of patients. Understanding work environments of Nurse Practitioners in Primary Health Care settings may help improve retention of Nurse Practitioners and help with the demands of our health care system today. For more information, please contact Nicole at

Brianna Orava, NP

Brianna Julien Orava is a PhD candidate at the Lawrence Bloomberg Faculty of Nursing at the University of Toronto. Her doctoral research focuses on examining the determinants of retention of Primary Health Care Nurse Practitioners in Ontario. To ensure that the NP role is sustainable and provides access to primary health care for Ontarians, there is a need to better articulate and implement NP health human resource strategies. This includes strategies that are related to work environments and focus on retention. For more information, please contact Brianna at

Margaret Saari, RN

Home and Community-Based Service Utilization Patterns for Seniors with Alzheimer’s Disease and Related Dementias

Margaret Saari is a PhD candidate at the Lawrence Bloomberg Faculty of Nursing at the University of Toronto. Margaret’s graduate work focuses on home and community-based service utilization for seniors with Alzheimer’s disease and related dementias (ADRD). For community dwelling older adults, dementia diagnosis can be a major catalyst for a move to institutional care. However, adults with ADRD may wish to remain living in the community as long as possible. Utilizing clinical and administrative datasets, patterns of home and community-based service utilization will be examined using latent class analysis. Additionally, predictors of these patterns of service use will be identified. Investigating relationships between health service utilization patterns and outcomes will enable more effective care coordination, planning and service allocation for this population. Connect on LinkedIn and ResearchGate. For more information, please contact Margaret at

Erin Patterson, RN

Erin Patterson is a PhD Candidate at the Lawrence Bloomberg Faculty of Nursing at the University of Toronto. Erin’s doctoral research focuses on access to home care services for seniors in the Province of Ontario. Using both clinical and administrative health data Erin is exploring factors affecting access to home nursing and personal support services for seniors. Equity in access across the Province is also being examined. Understanding factors affecting access to home care services can uncover sources of variation in access for seniors. Further, understanding how access varies can inform strategies to address variation, resulting in equitable access for seniors in need across Ontario. For more information, please contact Erin at

Completed PhD Students

Heather Thomson, RN PhD (completed 2015)

In her doctoral studies, Heather Thomson focused on research related to patient safety, specifically handover communication. According to recent literature, communication failures were found to be a major cause of sentinel events in hospitals. By addressing communication breakdowns that occur during critical information exchanges such as handover, it is believed that patient safety outcomes can be improved. For more information, please contact Heather at

Era Mae Ferron, RN PhD (completed 2013)

Era Mae Ferron is interested in retention behaviour of nurses. There is a lack of empirical knowledge of retention and its direct precursor, intent to remain employed, amongst the nurse faculty population. To address this gap in the literature, Era Mae has developed and successfully defended her doctoral dissertation, “Part-time Nurse Faculty Intent to Remain Employed in the Academic Organization”. The purpose of her study, which she is currently conducting, is to develop, test, and refine a theory that explains and predicts part-time nurse faculty intent to remain employed in the academic organization. Quantitative survey and statistical (i.e., structural equation modeling) methodologies will be used to test and refine her theory.

Barbara Wilson RN PhD (completed 2012)

The nature of a RN’s work environment is shaped by a physical dimension, consisting of specific job activities, as well as a psycho-social dimension, comprised of relationships among nurses and other employees. Although a RN may form work relationships with a variety of individuals, a RN-manager relationship is a key relationship within a RN’s realm of work. Supportive work relationships, including RN-manager ones, are established and maintained upon a foundation of trust. Within a subordinate-supervisor work relationship, trust of one’s manager has been significantly linked with stronger intent to remain employed, greater job satisfaction as well as delivery of more effective, safer patient care.

Although trust in one’s manager plays a crucial role in a high-quality subordinate-supervisor relationship and is a defining feature of a healthy work environment, RNs expressed little or no trust towards their leaders. Thought to be a result of organizational restructuring and ongoing emphasis on health care financial efficiency, nurses perceive they are costs to be controlled, rather than resources to be valued. In recognition of the substantial role of trust of one’s manager and minimal degree of managerial trust among RNs, stakeholders have advocated for the immediate creation of workplaces that establish and sustain RN’s trust of their managers. However, the health care research literature has not previously investigated potential influential determinants of a RN’s trust of one’s manager. Therefore, this study aims to test and refine a theoretical model that examines potential individual, managerial, relational and environmental attributes that impact a RN’s decision to trust one’s manager.

Utilizing information from Ontario emergency department staff nurses, analyses of survey data is currently underway and is expected to be completed by June 2011. Results will extend our knowledge of trust within a RN-manager relationship and will enable development and implementation of effective strategies to build and maintain supportive RN-manager work relationships and by extension, healthy nursing practice environments.

Kimberley Widger RN PhD CHPCN(C) (completed 2011)

The purpose of this study is to develop and test an instrument to measure the quality of care provided to children and their families before, at the time of, and following the death of a child in hospital/hospice from the parents’ perspective. The instrument is being developed in three phases. In Phase 1 a literature review was conducted and focus groups with bereaved parents were held to identify the key components of quality pediatric end-of-life care. These components are: connect with families, involve parents, share information, alleviate suffering, and provide bereavement follow-up. In Phase 2 the instrument items were developed and reviewed by health professionals and parents. In Phase 3 the instrument will be assessed for reliability and validity by analysis of the item responses of over 100 mothers recruited from across Canada. For more information please contact Kim at

Mae Squires, RN PhD (completed 2010)

Canadian statistics on patient safety in acute care hospitals are alarming. Hospital safety concerns are not isolated to patient safety. Occupational safety is also important. With increasing shortages of nurses, stress in the work place is growing. Nurses report high levels of absenteeism of 14.5 days per year. The importance of a just and fair culture and the role of nurse leaders have been emphasized in safety literature. Although deemed important, studies of nurse leaders and patient outcomes are limited. The influence of interactional justice in the workplace on nurse and patient safety has not been studied.

The purpose of this study was to test and refine a model developed from the literature which explains the impact of perceived interactional justice, relational leadership, and quality of nurse manager – clinical nurse relationships on the nursing work environment and ultimately patient and nurse safety outcomes.

The model was tested on a random sample of 266 Ontario acute care registered nurses. Findings indicated the model reasonably fit the observed data, however could benefit from further refinement. The addition of 2 pathways (span of control to nurses’ intent to leave and number of medication errors to nurse emotional exhaustion) and trimming of the insignificant paths improved the overall model fit.

The resulting model indicates that resonant leadership style and interactional justice improves the quality of nurse leader-nurse relationships which in turn improves quality of the nurses’ work environment and safety climate. A positive safety climate led to a decrease in the number of medication errors and nurses’ intentions to leave their unit. A higher quality work environment predicted lower nurse emotional exhaustion. Additionally, higher numbers of medication errors led to an increase in nurse emotional exhaustion. This suggests that distress may be associated with making a medication error or fear of consequences. As well, larger manager spans were associated with less nurse intent to leave. As the span increased, the number of support personnel also increased. Contrary to other research findings, this result suggests that supportive personnel may mitigate the effect of large manager spans of control on nurses’ intent to leave their units.