NSB305 - Building Professional Capacity: GRN Challenges in Healthcare

This report critically discusses professional practice and leadership challenges for Graduate Registered Nurses (GRNs), focusing on the issue of balanced skill mix within healthcare settings, particularly in the Australian primary care system. It identifies how the increasing number of GRNs and the shift toward task substitution, coupled with a lack of physician support and established clinical governance, can lead to increased workloads and difficulties in providing patient-centered care. The report explores the short and long-term implications of these challenges, including difficulties in achieving high-quality patient care due to an inadequate staffing model. The author advocates for a balanced skill mix to reduce workloads, promote GRN wellbeing, and enhance patient-centered care. References are provided to support the arguments presented, emphasizing the importance of team-based care and clearly defined roles within the healthcare system.

Running head: BUILDING PROFESSIONAL CAPACITY 1
Building Professional Capacity
Student’s Name
Institution

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Building Professional Capacity
Evidence reveals that optimizing nursing skill mix is beneficial for healthcare
organizations, healthcare professionals and patients. These benefits can be realized in the form of
reduced operational costs, improved registered nurse (RN) satisfaction and improved patient
outcomes. Team care is a new approach that gaining much prominence and this model focuses
on integration of allied health professionals under the supervision of nurses and doctors (Huang
et al., 2012). Skill mix under this model also relates to the different roles of team members
required to provide quality and patient centered care. Hence, the lack of balanced skill mix in a
staffing model will result in increased workloads and responsibility for GRNs which will further
hamper their ability to provide patient centered care.
Advocating for a Balanced Skill Mix
Internationally, the declining medical workforce and changing patient demands have
created challenges in primary care systems. Medical graduates entering primary care facilities
are decreasing while the number of patients and their care demands are increasing. In the wake
of these changes, the traditional role concept for healthcare professionals continues to be limited
in the process creating significant challenges in primary care delivery (Everett et al., 2015).
Nurses being the frontline healthcare providers are the most affected with these changing
dynamics.
(Identify and describe the chosen challenge in relation to being a GRN)
To respond to the healthcare developments and associated implications, the primary care
workforce has resorted to expanding the number of non-physician medical professionals
including nurse practitioners and other clinical staff (Jacob, McKenna & D’Amore, 2015;

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Tomajan, 2012). This response although effective is plagued with inadequate skill mix especially
considering that Graduate Registered Nurses (GRNs)
In Australia, primary care has and continues to be the cornerstone of Australia health care
system. The general practice is characterized by two to five care physicians within a
multidisciplinary care team approach that includes nurse practitioners and registered nurses.
Furthermore, the composition and skill mix under this approach is massively shaped by the
increase in the number of GRNs, that is, the percentage of practices employing a GRN has
increased (Everett et al., 2015). This indicates that the Australian primary care system is shifting
from traditional delegated care models to task substitution that is massively GRN-oriented.
The main problem with the model is that more emphasis is still placed on physician-led
care. As such, there is no true shared or team care arrangements within the model. This implies
that primary care physicians have not created a supportive environment for GRNs to perform
their tasks and roles (Rowell, 2013). More specifically, under this model there is limited
appropriate clinical governance and supervisory arrangements (Bargeron, 2015). Hence, with a
lack of established authority to offer guidance, a balanced skill mix in such working
environments is lacking implying that GRNs are not fully supported and capacitated to perform
their tasks.
Challenges for GRN’s in their Transition to Practice
(Critically discuss why the chosen professional practice issue can be a difficulty for all
GRNs)
Unbalanced skill mix corresponds with increase in nurses’ workload and as such, as
GRNs transition during practice they inevitably face workloads. The changing healthcare

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environment has precipitated changes in staffing arrangements. As aforementioned, the primary
care in Australia has become more GRN-oriented as the number of GRNs entering the primary
care continues to increase (Everett et al., 2015). However, with a lack of established authority
and supportive environment to be created by physicians and practicing nurses, these new staff
become overwhelmed with the tasks delegated to them under the new staffing model.
Alternatively, being new RNs, they require centralized authority that can be able to clearly define
their roles and offer guidance as they transition during practice. Failure to create such a working
environment creates burden and fatigue among GRNs since they are not fully capable to manage
different tasks at the same time (Oetelaar et al., 2016). Thus, there is need to advocate for a
balanced skill mix in a bid to ensure that GRNs are not subjected to workloads as they transition
during practice.
The changing patients’ demands also create substantial fatigue to GRNs thereby
impacting negatively on their health and wellbeing. The number of patient hospital stays
continues to decrease implying admissions and discharges are on the rise. GRNs subsequently
face more patients and the traditional fixed patient-nurse ratios offers inflexibility and
inadvertently create workloads (Tomajan, 2012). As such, the unbalanced skill mix further
impacts on the wellbeing of nurses since it create workloads.
In their transition during practice, GRNs working in a suboptimal skill mix model may
face added responsibility in which they will be unable to fulfill given the GRNs’ limited training
and experience. Staffing plans are supposed to take into account the characteristics of the care
team including training and experience levels (Oetelaar, et al., 2016; Berlin, English, Higgins &
Lapointe, 2014). In consideration of these two aspects, GRNs fall short and this may hinder their

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ability to meet their obligations including meeting the complex needs of patients and, providing
safe, patient centered care.
Short and Long Term Implications
(Short and long term implications of the difficulties for GRN to achieve patient centered
care)
The ability high quality and patient centered care is dependent on frontline healthcare
personnel who are registered nurses. These staff needs to be fully engaged and appropriately
skilled to ensure that they can operate efficiently and competently in a team-based care delivery
model (Huang et al., 2012). However, with an inadequate staffing model that lacks the optimum
skill mix, the RNs and especially the newly practicing GRN’s will experience difficulty in
providing the necessitated high quality and patient centered care (Berlin et al., 2014). The GRNs
in such a case are not provided with the opportunity to learn from experienced nursing staff and
physicians a factor which will limit their ability to fully integrate with other nursing staff for
purposes of providing quality and patient centered care.
The absence of balanced skill mix in primary care may also hamper achievement of
patient-centered care since there is a lack of optimal shared responsibility. Notably, within a skill
mix staffing model, each team member’s role is clearly defined (Jacob, McKenna & D’Amore,
2015). This clear-cut definition of roles may in turn facilitate optimal sharing of responsibility
for patient care within the team-based care approach. On the contrary, GRNs become burdened
with excessive responsibilities in the absence of a team-based care model that incorporate
adequate skill mix (Everett et al., 2015). These practitioners will subsequently be unable or
become incapable of quality care delivery.

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Conclusion
The team based care approach that tends to rely on GRNs needs a manipulation of its
skill mix so as to reduce workloads and excessive responsibility while promoting patient
centered care. The changing patient dynamics necessitates the implementation of appropriate
skill mix in staffing models. This is primarily because GRNs become overburdened and face new
responsibilities in a working environment where their roles and tasks are not clearly defined.
Consequently, the ability of these practitioners to provide patient centered care becomes greatly
hampered. Thus, there is need to advocate for a balanced skill mix so as to ensure that the
wellbeing of nurses is promoted and also enhance patient centered care.

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References
Bargeron, R. (2015). Optimal Staffing for Safe Patient Care: What will it take? Retrieved from
https://www.americannursetoday.com/optimal-staffing-safe-patient-care-will-take-2/
Berlin, G., English, C. R., Higgins, H., & Lapointe, M. (2014). Optimizing the Nursing Skill Mix:
A Win for Nurses, Patients and Hospitals. Retrieved from
https://healthcare.mckinsey.com/optimizing-nursing-skill-mix-win-nurses-patients-and-
hospitals
Everett, C., Griffiths, P., Hudon, C., Naccarella, L., & Laurant, M. (2015). Skill Mix, Roles and
Remuneration in the Primary Care Workforce: Who are the Healthcare Professionals in
the Primary Care Teams across the World? International Journal of Nursing Studies,
52(3), 727-743. Retrieved from
https://www.sciencedirect.com/science/article/pii/S0020748914003307
Huang, L. C., Lee, J. L., Liang, Y. W., Hsu, M. Y., Cheng, J.F., & Mei, T. T. (2012). The Skill
Mix Model: A Preliminary Study of Changing Nurse Role Functions in Taiwan. The
Journal of Nursing Research, 19(3), 220-229. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/21857329
Jacob, E. R., McKenna, L., & D’Amore, A. (2015). The Changing Skill Mix in Nursing:
Considerations for and against Different Levels of Nurse. Journal of Nursing
Management, 23(4), 421-426. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/24112358

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Oetelaar, W. F., Stel, H. F., Rhenen, W., Stellato, R. K., & Grolman, W. (2016). Balancing
Nurses’ Workload in Hospital Wards: Study Protocol of Developing a Method to Manage
Workload. BMJ Open, 6(11). Retrieved from
https://bmjopen.bmj.com/content/6/11/e012148
Rowell, P. A. (2013). The Professional Nursing Association’s Role in Patient Safety. The Online
Journal of Issues in Nursing, 18(3). Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/
OJIN/TableofContents/Volume82003/No3Sept2003/AssociationsRole.html
Tomajan, K. (2012). Advocating for Nurses and Nursing. The Online Journal of Issues in
Nursing, 17(1). Retrieved from
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/
OJIN/TableofContents/Vol-17-2012/No1-Jan-2012/Advocating-for-Nurses.html