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Nursing is a high risk profession for injury. A Canadian survey reports many nurses are in poor physical and emotional health; they sustain more musculoskeletal and violence related injuries than other occupational groups. In Ontario, an injury management approach called Early Return to Work (RTW) requires injured workers, including nurses, to go back to work before full recovery. The Workplace Safety and Insurance Board cite this approach as beneficial to both the employer and employee. This study uses an institutional ethnographic approach to examine critically the RTW process from the standpoint of injured registered nurses. Through interviews and mapping activities with nurses, other health professionals and managers, a rendering of the social organization of hospital injury management emerges. The findings suggest that the implementation of RTW is complicated and difficult for nurses, their families and hospital employers. Injured nurses engage in significant amounts of domestic, rehabilitation and accommodation work in order to participate in the RTW process. When the returning nurse is unable to engage in full duties hospital operations become disorganized. Collective agreements and human resources procedures limit the participation of injured nurses in creative and/or new roles that could utilize their knowledge and skills. As a result, nurses are assigned to duties, which hamper them from returning to their pre-injury positions and cause their employment with the hospital to be reconsidered. The unsuccessful return of injured nurses to employment is counter to provincial retention initiatives, which seek to sustain an adequate cadre of nurses ready and able to care for the increasing health care needs of an aging population. Sites of change which could support and promote the successful return of these injured workers to nursing work are identified in this study.