• variables on the development of nosocomial infection rates. It is likely, however, that when continuity of care is assured through various staffing mechanisms infection rates are lower.
  • (8)  

    Despite the existence of some research, there is currently no evidence that nurse staffing variables have an effect on adverse patient incidents. There is some indication, however, that nurse competence may have a positive effect on these rates.

  • (9)  

    There is sufficient evidence to suggest that innovative nursing delivery patterns (e.g., case management; transitional models of hospital to home care) will reduce utilization of health care services through either decreased length of hospital stay or reduced readmissions.

  • (10)  

    Findings on the effect of nursing on patient satisfaction are inconsistent. Published studies indicate that satisfaction is stable or increased with professional practice environments even when staffing levels are reduced; current unpublished research as presented at the invitational conference does not support this conclusion.

  • (11)  

    In outpatient and inpatient psychiatric settings there is a relationship between job satisfaction and client satisfaction; this result has not been supported for acute care hospitals and does not hold for outcomes other than client satisfaction.

In addition to needing more research to further support or clarify some of the tentative findings indicated above, research is needed to fill the gaps in the state of the science. Some of the gaps in our current empirical knowledge include:

  • (1)  

    Whether satisfied staff in acute care give better care, resulting in improved client outcomes.

  • (2)  

    Whether there is a link between professional practice and staffing needs.

  • (3)  

    Whether there is a relationship between professional practice environments and patient outcomes other than mortality.

  • (4)  

    Whether there is a connection between staffing mix and client outcomes of health status.

  • (5)  

    What the interaction is between productivity and quality care and the main effect and interactive effect of these variables on client outcomes.

  • (6)  

    What the influence of leadership is on the productivity and quality of nursing care.

Methodological Issues

A number of methodological problems and issues in research involving the investigation of nursing's effect on client outcomes were identified at the invitational conference. Only those that directly relate to the impact of nursing on

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