title: Instability in patient and nurse characteristics, unit complexity and patient and system outcomes.
abstract: OBJECTIVE
  To explore key factors related to nursing unit instability, complexity and patient and system outcomes.
  
  
  BACKGROUND
  The relationship between nurse staffing and quality of patient outcomes is well known. The nursing unit is an important but different aspect that links to complexity and to system and patient outcomes. The relationship between the instability, complexity and outcomes needs further exploration.
  
  
  METHODS
  Descriptive.
  
  
  METHODS
  Data were collected via a nurse survey, unit profile and review of patient records on 62 nursing units (wards) across three states of Australia between 2008-2010. Two units with contrasting levels of patient and nurse instability and negative system and patient outcomes, were profiled in detail from the larger sample.
  
  
  RESULTS
  Ward A presented with greater patient stability (low occupancy, high planned admissions, few ICU transfers, fewer changes to patient acuity/work re-sequencing) and greater nurse instability (nurses changing units, fewer full-time staff, more temporary/casual staff) impacting system outcomes negatively (high staff turnover). In contrast, Ward B had greater patient instability, however, more nurse stability (greater experienced and permanent staff, fewer casuals), resulting in high rates for falls, medication errors and other adverse patient outcomes with lower rates for system outcomes (lower intention to leave).
  
  
  CONCLUSIONS
  Instability in patient and nurse factors can contribute to ward complexity with potentially negative patient outcomes. The findings highlight the variation of many aspects of the system where nurses work and the importance of nursing unit managers and senior nurse executives in managing ward complexity.
authors.affiliation: Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, New South Wales, Australia.|Clinical Nursing and Midwifery Research Centre, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Perth, Western Australia, Australia.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Duffield
authors.affiliation: Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Roche
authors.affiliation: Centre for Health Services Management, Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Sofia
authors.initials: S
authors.lastname: Dimitrelis
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Caroline
authors.initials: C
authors.lastname: Homer
authors.affiliation: School of Health, Queen Margaret University, Edinburgh, UK.|University of Technology, Sydney, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Buchan
mesh_terms: D006801:Humans; D009723:Nurse-Patient Relations; D009740:Nursing Staff; D017063:Outcome Assessment, Health Care
keywords: nursing; nursing unit complexity; nursing unit manager; patient care delivery model; patient outcomes; system outcomes