etry units, 22 medical-surgical units, 6 pediatric units, 6 obstetric-gynecological units, 4 long-term care/rehabilitation units, and 7 other (type not specified) units. Findings supported a relationship between patient infections and staff RN absenteeism. No other organizational variable evidenced a significant relationship with the outcome variable.

Both of these studies indicate that nurse staffing has some effect on the incidence of nosocomial infection rates. These increased rates were also associated with increased length of hospital stay in the Flood and Diers (1988) research. Disruption in the continuity of care due to absences and inadequate staffing were cited as reasons for the increased incidents of infections.

Other research has examined the effect of practice models on complications. Mitchell and colleagues (1989) found that complications related to infections, immobility, and fluid balance represented nonresolution of problems on admission to the intensive care unit rather than new problems. Brett and Tonges (1990) in a one-unit pilot evaluation of the ProACTTM Model at the Robert Wood Johnson University Hospital found no increase in nosocomial infections despite the planned decrease in the number of RNs.

Two of the intervention studies reported at the invitational conference also included nosocomial infections as part of their research. Neither study found a significant relationship between infection rates and any other included study variable.

Adverse Incidents

Adverse incidents that occur during hospitalization include errors in medication delivery (wrong patient, wrong drug, wrong dose, wrong route, wrong time), patient falls, treatment errors, and skin injury or breakdown. Again, two of the demonstration projects included these items in their research model with no significant findings. The study by Taunton and colleagues (1994) cited earlier also examined the effect of organizational variables on patient falls and medication errors. No significant associations were discovered.

A comprehensive investigation by Wan and Shukla (1987) examined the relationship of contextual and organizational variables with the quality of nursing care. Contextual variables were considered to be attributes of the hospital and region that are beyond control of the hospital. Organizational variables include structural and design variables. Only the design variables are amenable to change. These variables include the nursing care delivery model, staff skill mix, and staffing levels. The patient incidents included in the study were rates of medication errors, patient falls, patient injuries, and testing or treatment errors. Forty-five community acute care hospitals were included in the study. Results indicate that the independent variables did not account for a large portion of the variation in incident rates. Nursing skill mix, nursing model, and nursing resource consumption were not significantly related to any of the dependent variables. The



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