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In the last 15 years, the health care system has undergone significant restructuring. The study's objective was to examine the psychosocial work environment and the health of nurses after major restructuring in comparison with two reference populations.This cross-sectional study involved 2,006 nurses from 16 health centers. A questionnaire measured current work characteristics: psychological demands, decision latitude, and social support at work from Karasek's Job Content Questionnaire, organizational changes, and health effects. Prevalence ratios and binomial regression were used to examine the associations between current work characteristics, changes and psychological distress (PSI).There was a considerable increase in the prevalence of PSI and of adverse psychosocial work factors in comparison to the prevalence reported by a comparable group of nurses in 1994. These adverse factors were also more prevalent among nurses than among Québec working women and they were independently associated with psychological distress.Workplace interventions should be based on elements identified by many nurses as being problematic. Am. J. Ind. Med. 47:54–64, 2005. © 2004 Wiley-Liss, Inc.