Skill mix in nursing: a selective review of the literature

Abstract

The issues surrounding skill mix are often highly contentious and, not surprisingly, various interest groups either welcome or reject attempts to examine the different combinations of staff, qualified and unqualified, experienced and inexperienced, in relation to costs, outcomes and quality of nursing care. Despite the strong passions aroused by the debate, other factors, most notably demographic changes and the possible shortage of nurses, new demands on health care services and the call for more cost-effective use of resources, have kept skill mix foremost on the policy agenda. The review covers manpower planning, an area where considerable efforts have been made to determine the number but rarely the mix of nurses required to provide the necessary care for patients. In addition, previous work on staff turnover, and the possibility of substituting less qualified for more qualified staff, are examined in relation to cost-containment, recruitment and demography, and the creation of a new single level of nurse. These factors, along with the introduction of health care assistants, will have an important influence on the future shape and structure of nursing and, of course, the composition of the skills available. While calling for further work on skill mix, the review provides a timely reminder that the issues are complex and often highly political.

Relationship between quality of care, staffing levels, skill mix and nurse autonomy: literature review

“…2002, Berliner & Ginzberg 2002, Newman & Maylor 2002, Tierney 2003), and an ageing nursing workforce (Buchan 2002, Goodin 2003). Furthermore, the introduction of health care assistants in the UK and unlicensed practitioners in the USA has led to alterations in skill mix, with some commentators suggesting that such changes may also negatively affect quality (Gibbs et al. 1991, Morris 1992, Davison 1994, Cahill 1995, Blegen et al.…”

Too busy to lead? Current challenges for German nurse leaders

“…While this has been part of the leadership agenda in countries like the United Kingdom since the 1990s (Gibbs et al 1991) and has also been identified by the World Health Organisation as a major challenge for most health care organisation (Buchan et al 2000), Germany is a latecomer on this this topic because of two unique developments: Firstly, the late and still incomplete move of nurse education into the university sector, as university graduates only now become increasingly available, raising the question what their roles in clinical care should be. Secondly, a traditionally all-RN workforce in hospitals that in the light of nurse shortages and cost containment needs to be supplemented with Enrolled Nurses and auxiliary staff.…”

Workforce planning incorporating skills: State of the art

“…This is very helpful since many researchers, e.g., Buchan and Dal Poz [30], Markes [94] and Gibbs et al [61] complain about the haziness concerning the effects of skill decisions. Markes [94] also mentions that there still remains some uncertainty concerning the impact of different ways to manage the skill pool.…”