The primary purpose of this project is to examine the relationships among hospital characteristics and numerous unit characteristics (e.g., the hospital's context), nursing unit structure (defined in this research as structural integrity, a latent variable with the empirical indicators of decentralization, autonomy, nurse physician collaboration, and availability and responsiveness of support services), administrative outcomes (nurse satisfaction, turnover, perceived team performance, and cost efficiency), and patient outcomes (rates of medication errors, falls, and patient satisfaction). The research questions are: 1) After controlling for the effects of context, does structural integrity exert a significant effect on administrative outcomes? 2) After controlling for the effects of context, does structural integrity exert a significant effect on patient outcomes? 3) What is the relationship between administrative outcomes and patient outcomes? 4) How stable are the measurement models of the theoretical constructs over time? 5) How stable is the structural equation model over time? 6) What """"""""sentinel contextual events"""""""" between data collection points are reported by study coordinators? The project is a multi-site longitudinal panel study. Data about context, structural integrity, administrative outcomes and patient outcomes are collected twice, with a six month interval. A multi-stage sampling plan was used to select 146 medical- surgical units in 73 non-federal, non-psychiatric, not-for-profit accredited acute care hospitals over 150 beds in 10 southeastern states and the District of Columbia. In order to accomplish the project, chief nursing officers were contacted prior to proposal submission to ascertain their willingness to participate and their ability to provide data in the needed format. Study coordinators will be selected at each participating hospital. They will attend a training session at Virginia Commonwealth University, and will bear primary responsibility for management of data collection in their hospitals. Structural equation modeling with latent variables using the LISREL statistical package is the analytic strategy. Findings from the research will furnish information to assist nurse executive decision-making about the enactment of organizational structures that enhance administrative and patient outcomes.
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