Learning Objective 1: describe the challenge of studying the work of nurses in hospitals - multilevel organizations by nature.
Learning Objective 2: Understand the importance of data collection and analysis methods which reflect the multi-level structure of hospitals and how this impacts data interpretation and results.
This study examined structural variables believed to affect a key inpatient nursing process; staff nurse care coordination, which has global importance bearing on patient outcomes and hospital readmissions. The work environment and patient mix were examined for an impact on staff nurses’ ability to coordinate patient care, up to and including the care to be received after discharge.
A descriptive, cross-sectional design was employed, using a multiple questionnaire survey regarding the work environment and activities of nurse care coordination. Over 750 hospital staff nurses at 5 different southeastern metro area hospitals comprised the sample. Administrative data was also collected over a period of three months describing the patient mix on the participating units.
Overall, there was greater than 40% staff nurse participation. However, in the process of data collection many challenges presented to meeting an adequate sample size per unit and to using a single level of analysis. There were also barriers to collecting data from the individual nurses. Considerations were made a priori, yet many tactics were necessary to address these challenges. Various multi-level analysis techniques were employed to accommodate the nested nature of the data and assure that results represented an appropriate understanding of staff nurse care coordination as it naturally occurs.
A concordance between the multi-level nature of the work of nurses and research methods and model of analysis employed to explain this work can extend our basic understanding that nurse staffing is related to better patient care. This study provides one example of the methodological issues that present when studying hospital nurses and their work. The lessons learned related to the study design, data collection and data analyses promoting more inquiry to further the understanding of the critical work of nurses in hospital settings.
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