CRITICAL CARE NURSING SYSTEMS, RETENTION & PT OUTCOMES

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We propose to expand on the findings of two recent studies that suggest the organization of nursing care and collaboration between nurses and physicians are as important as the organization of medical care and technology in determining compelling clinical outcomes such as excess mortality. The primary objective of the research is to extend the findings of the American Association of Critical Care Nurses (AACN) Demonstration Project by delineating combination of organizational structure and process factors at the work unit level that are the best predictors of desired organizational and patient care outcomes, including outcomes as nursing retention and patient mortality. This regionally based work is sen as a foundation for examining such determinants in a large scale national probability sample of critical care nursing units. The study will use an hypothesis-testing correlational design with the critical care unit as the primary unit of analysis. The degree to which a unit departs from an "ideal-type" discretionary pattern of work design and operation is hypothesized to be correlated with various measures of organizational and clinical performance. We expect that the closer a unit is to the "ideal- type" the better will be its performance in terms of organizational outcomes (retaining nurses and shorter length of stay) and clinical outcomes (quality of nursing care, less excess mortality, and more satisfied patients). We will survey and observe patients, nurses and physicians in each of 27 critical care units in 14 hospitals in Washington State regarding a variety of organizational and clinical factors believed to be associated with organizational outcomes, such as nurse retention and clinical outcomes such as quality of care, patient satisfaction, and excess mortality.