Relationships between nursing unit contextual-structural fit and unit-level patient outcomes

The purpose of this research was to answer two questions: What are the relationships among contextual (unit size, workload, support service availability, work complexity and patient acuity) and structural (relational coordination) fit and effectiveness (length of patient stay and number of severe medication errors) on medical-surgical nursing units in acute care hospitals? Second, what are the relationships among relational coordination as a structural variable and length of patient stay and number of severe medication errors as manifestations of effectiveness? This study was guided by structural contingency theory which suggests that structure influences effectiveness and that organizational effectiveness depends on the congruence or fit between context and structure. This study was conducted using data from the Outcomes Research in Nursing Administration-II study (B. Mark, principal investigator). The sample was 285 nursing units at 144 hospitals across the U.S. Mixed models were tested to analyze the data for patient length of stay. Negative binomial models were tested to analyze the data for severe medication errors. The fit between workload and quality of relational coordination was the only statistically significant finding. The result indicated that, when workload was high, higher quality relational coordination was associated with longer lengths of patient stay. Although statistically significant, the direction of this relationship was opposite of that hypothesized. Continued research is needed to better understand the relationship between contextual-structural fit and effectiveness on nursing units in acute care hospitals.