The changing skill mix in nursing: considerations for and against different levels of nurse

Abstract

When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.

Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting

“…[5,22,23] The sample of participants was drawn from five clinical medical/surgical units in three separate locations in rural New South Wales Australia. Nursing staff included registered nurses, enrolled nurse, assistants in nursing, nurse unit managers and clinical (ward based) nurse educators.…”

“…[1,2] In Australia, registered nurses find themselves in a position of supervising other registered (including new graduate) and enrolled Nurses [3][4][5] as well as other unregulated and non-credentialed health care workers. [5][6][7] In order to manage the increased demands of responsibility and supervision of this range of varied staff classifications, team nursing as a model of care was introduced in five clini-cal units medical/surgical in a rural region in Australia as a way to address this varied skill mix. A team nursing model of care in this context refers to all levels of nurses who contributed to the direct nursing care (NC) of patients including registered and unregistered staff.…”

“…[11] Adopting models of care that capitalise on the skill mix of staff available is a feature of global contemporary nursing workplaces largely resulting from workforce shortage [4,6] and desire to contain health care costs. [5,12] In Australia, there are two levels of regulated nurses; registered and enrolled nurses. [11,13] The Australian nursing workforce is ageing and has a large percentage of part-time employees.…”

“…It is therefore logical to suggest that in controlling health expenditure, that reconsidering models of care is inevitable. [5,6,11] Health Workforce Australia [11] temper Governments fiscal constraint commentary as a driver of health care change with a positive outcome for regulated nurses (registered nurses [RNs] and enrolled nurses [ENs]). They highlight scenarios that incorporate greater numbers of unregulated nurses which will improve opportunities for registered nurses and enrolled nurses to take on more complex practice activities that may support increased JS and reduce leakage from the system.…”

Nursing staff sizing in the emergency room of a university hospital

“…The lack of financial resources in health care institutions is reflected by reduced spending on these professionals, reflecting on the quality of care provided to the population (5) . Studies have shown better results where the ratio between nurses and patients is adequate (5)(6)(7) , including reduced mortality and customer satisfaction. The situation of emergency services is worrisome because its features, such as fluctuating demand and occupancy rate, complicate the choice of an instrument for the measuring of nursing human resourses in this area (8) .…”