Paper
Saturday, 22 July 2006
This presentation is part of : Nursing Leadership Strategies
Nursing Organization and Outcomes: A Theoretical and Empirical Review
Christian Rochefort, RN, Faculty of Nursing, Montreal University, Montreal, QC, Canada
Learning Objective #1: discuss how the relationships between nursing organizational/structural variables, process of care indicators and various types of outcomes have been conceptualized in the theoretical literature.
Learning Objective #2: name at least three effects the organization of nursing care is known to have on processes of care as well as patient or staff outcomes.
Introduction : In the past few years, many researchers have examined the effects of nursing organizational / structural variables on various process and outcome indicators in hospital settings.  
Objectives : The objective of this review is to synthesize the theoretical and empirical literature on the topic and to explore avenues for further research.  
Theoretical framework : We propose a theoretical framework that is based on a synthesis of nine frameworks found in the nursing, medical and health services research literature. These frameworks, which are all based on Donabedian’s (1966; 1980) structure, processes and outcomes model, also allowed us to identify the relevant nursing organizational variables and patient and staff outcome indicators for the empirical review.
Method : We searched the Medline and Cinahl databases between 1980 and 2005 to find studies on the relationships between the variables and indicators included in our theoretical framework.  The reference lists of the reviewed articles were also searched to find any other relevant publications.
Results : Three major findings emerged from the empirical review.  First, nursing structural variables such as staffing, skill mix or a professional work environment have been both directly and indirectly associated, through their effects on process of care indicators, to various patient and staff outcomes.  Second, process of care indicators, such as caregivers interactions, have been found to be associated with patient and staff outcomes.  Finally, some evidence also suggests that staff outcomes, such as job satisfaction and burnout, have an effect on process of care as well as patient outcome indicators.  
Conclusion : There is now strong evidence that nursing organizational variables have an effect on various outcomes, although the mechanism through which this effect operates has been less well-investigated.  There is a need for causal modeling studies to better understand the relationships between these two sets of variables.

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