Challenges with Nursing Skill Mix and Patient Care Outcomes

This essay examines the multifaceted challenges associated with nursing skill mix in contemporary healthcare settings and their direct impact on patient care outcomes. It defines nursing skill mix as the integration of varied human resources, including registered nurses, licensed practical nurses, and nursing aides, in the provision of patient care. The essay delves into the repercussions of nursing shortages, the economic pressures leading to the employment of fewer registered nurses, and the resulting implications for patient safety and quality of care. It highlights the importance of appropriate delegation of duties based on expertise. The essay discusses the effects of nursing skill mix on patient outcomes, emphasizing that a higher ratio of registered nurses to nursing aides correlates with reduced adverse events, decreased mortality rates, and increased patient satisfaction. It also touches on the challenges faced by nurses in leadership and supervisory roles, and the need for adequate training and in-service education to ensure the effective application of nursing aides while maintaining high standards of care. The essay concludes by advocating for skill mix nursing models in nursing curricula to train nurses on effectively utilizing aides, ultimately improving patient outcomes and the overall quality of healthcare.

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NURSING SKILL MIX
Student’s Name
Institutional Affiliation

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In clinical medicine and nursing, there is need to incorporate adequate human resource
and staff that work together to ensure patient care and safety. Division of labor is important in
clinical practice as there are some people who are better skilled to handle a certain situation than
others. Nursing skill mix refers to the incorporation of varied human resources in the care of a
patient and in the execution of nursing duties (Needleman, 2017). In order to ensure the best
outcome for a patient, it is important to ensure proper delegation of duties. Various clinicians in
any hospital have an area of expertise that they are well suited to perform tasks. They are often
called to action in cases whereby their expertise is required in clinical situations and they act to
the best of their knowledge. As stated by Staggs et al (2017), all medical practitioners and nurses
cannot have the same knowledge in all fields of medical practice. It is important to ensure
adequate division of labor by deploying specialization in order to save resources and ensure
quick recovery of patients. The aim of this essay is to clearly discuss the challenges with nursing
skill mix in contemporary healthcare and how this impacts patients.
Hospitals and healthcare centers require adequate clinicians and nurses in order to
effectively manage patients and ensure every patient is well attended to. In order to ensure
adequate nurses, there is need for hospitals to deploy more nursing staff and this requires
increased financial resources. The nursing staff in hospitals represent the largest element of cost
(Jacob, McKenna & D'amore, 2015). In order to cut hospital costs, the management often
employ less registered nurses. Human resources in hospitals just like any other resource can also
be scarce and this may negatively affect patients receiving care and lead to poor patient
outcomes. The number of registered nurses in a hospital can be limited and many patients may
not be adequately attended to and cared for. According to Shadmi et al, (2017), the shortage of

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nurses can significantly lead to increased workload for the available nurses and this may reduce
the quality of care provision.
In addition to this, there is increased job dissatisfaction associated with shortage of
nurses. Due to being overworked and having limited time to rest, they tend to do shady work
which may negatively impact the patient. The approved and most effective ratio of a registered
nurse to a patient should be 1:1 (Tourangeau et al, 2016). However due to shortage of registered
nurses in a single hospital, this ratio cannot be achieved hence hospitals recruit other unlicensed
nursing assistants in an attempt to ensure adequate care delivery. In order to contain hospital
costs associated with recruiting professional nursing staff, hospitals may opt to recruit other
personnel such as licensed practical nurses and nurse aides. The recruiting of other people apart
from registered nurses to assist in nursing of patients in hospitals forms the basis of nursing skill
mix and has several repercussions (Lovink et al, 2019).
All patients in a hospital or a health center are directly affected by nursing actions.
Nurses spend a lot of time with their patients and therefore understand the patients better than
anyone in the health facility. The quality of care therefore depends on the knowledge and skills
of the care provider in the field. Nursing skill mix directly affects patient outcome in that
inclusion of more nurse aides and unregistered nurses to provide care might lead to increased
errors and adverse happenings (Dall'ora et al, 2017). Replacement of registered nurses in
hospitals in order to cut costs might lead to poor patient outcome as the nursing assistants might
not be well trained. This has negative consequences on the patient outcome as the nurse assistant
might not have enough knowledge and skills to provide the correct nursing intervention as
compared to a trained registered nurse.

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The probability of an adverse happening and errors in the management of a patient are
higher when a nurse aid is offering care as compared to a professional registered nurse (Freund et
al, 2015). Some of these adverse events that can be avoided if a registered nurse offers care
include infections, longer stay in the hospital and patient mortality. Healthcare associated
infections due to lack of adequate care provision and longer stay in hospitals by patients can lead
to increased hospital costs (Dellefield et al, 2015). The costs resulting from these adverse events
is normally higher than the cost for employing more registered nurses. There is therefore need to
invest in more registered nurses instead of seeking cheaper alternatives such as employing
unregistered nursing assistants as this may lead to more adverse events that affect patients.
Hospitals that have a nursing skill mix whereby there are more registered nurses as
compared to nursing aides tend to produce better patient outcome. The royal college of nursing
in the United Kingdom is calling for a mandatory skill mix ratio of 65:35 for registered nurses to
healthcare assistants. This ratio can significantly aid in achieving better care outcomes as more
registered nurses get to attend to patients. Registered nurses often improve their level of
education and undergo training to enhance their skills as required by the ANA code of ethics.
Dabney & Kalisch, (2015) states this significantly makes them more educated and at a better
position to offer quality care to patients as compared to nursing aides and assistants. Registered
nurses are also encouraged to seek updates in the medical field and adapt to changes in medical
technology that makes them better skilled and knowledgeable. The training of nursing aides on
the other hand is often not intense and therefore they get to acquire limited skills and basic
knowledge in the field. A skill mix that encourages more nursing aides in practice results into
low healthcare quality and patient dissatisfaction.

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Nursing skill mix can has an impact on the nurses providing care to the patients as well.
Registered nurses are taking more leadership roles in hospitals and care centers (Simonetti,
Aiken & Lake, 2018). This has led to less participation in directly offering care to patients. Since
more hospitals are employing more nursing aides to perform nursing duties in an attempt to cut
off labor costs, the registered nurses working in the same hospitals are taking over supervisory
roles. The registered nurses most often guide the nursing aides on how to perform certain care
giving tasks that directly affect the patients. This has led to less interactions between registered
nurses and patients in hospitals as they delegate roles to the nursing aides. The quality of
healthcare delivery given by these nursing aides often tends to be lower than that of the
registered nurse. Delegation must therefore be followed by adequate supervision of the nursing
aid by the registered nurse in order to ensure that there is better patient outcome and that the
aides improve their skills in the process.
The notion that registered nurses are `too posh’ to perform certain tasks has resulted to
the incorporation of more nursing aides in clinical practice. The consideration that some tasks
such as washing and bandaging patient wounds do not require expertise of a registered nurse
have led to lower contact time between registered nurses and patients in hospitals. On the other
hand, the nursing aides spend more time tending to the needs of the patients. The nursing aides
might not be in a position to offer an all rounded care thus leading to a gap in the needs of the
patient. Health care provision should always be patient-centered rather than provider-centric
(Deravin et al, 2017). Registered nurses are trained to offer care that is all rounded by not only
focusing on the physical well-being of the patient but also their social, emotional and
psychological well-being (Hegney et al, 2019). Nursing skill mixes might provide challenges
when it comes to ensuring all these areas are incorporated in the nursing care plan. This is

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because nursing assistants and aides might not be in a position to provide this care as opposed to
trained registered nurses. Having more nursing aides in an institution would mean that some
aspects of care for patients are neglected hence leading to low quality care provision.
Nurses have the responsibility of safeguarding patient health and safety. Having a higher
skill mix in hospitals that involves a higher number of registered nurses helps in ensuring that
patients are satisfied and that their safety is guaranteed (Smith et al, 2019). This is opposed to
having more nursing aides that have undergone short periods of training. Patient feedback is an
important means by which a hospital management can scrutinize the quality of care given within
a hospital. Aiken et al, examined the association of skill mix with patient mortality rate, patient
rating of hospitals and the possibility of adverse events using data from hospitals in six European
countries. The data of hospitals with a higher number of registered nurses as compared to nursing
aides revealed better outcomes within a 30 day observation. The data revealed that there were
more incidences of deaths among patients for hospitals that had a relatively higher number of
nursing aides as opposed to registered nurses. This deaths were linked to negligence among
nursing aides and poor level of knowledge to approach certain aspects of care. The rating of
hospitals that had a skill mix involving more nursing aides to professional nurses were lower
thus indicating increased patient dissatisfaction.
Patient satisfaction in clinical settings is important as it shows the possibility of a patient
recommending treatment of their friends and relatives to the same hospital (Allen & Hughes,
2017). In cases where the patients are not satisfied with the quality of care given, the likely hood
of recommending others to the same facility becomes low. An increased job burnout and
dissatisfaction among the nurses were observed in hospitals that had a low number of nurses.
This is because the available registered nurses were being overworked since there expertise was

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a priority. In Taiwanese medical system for example, nurses are faced with a heavy burden of
duties to meet the accreditation of the high quality of care giving that is required. The shortage of
nurses and high turnover rate results into a need to incorporate nursing aides into practice. The
nursing staff are faced with the responsibility of ensuring professional care is offered to patients
within a specified amount of time. In order to minimize the workload, nursing aides are
incorporated into the nursing practice. The application of the nursing aides without
compromising the quality of care given has however remained a major issue.
In conclusion, the allocation of roles and duties that best suit a particular nursing aid is
important in order to ensure improved healthcare quality. Some of the nursing aides might have
limited knowledge in a particular field and delegation of duties related to such fields might lower
the quality of care. There is need to ensure in-service education that enables the nursing staff to
better understand the functions and roles of nursing aides. This is significant in that it will help
them delegate appropriate tasks that do not affect the quality of care given to patients. Skill mix
nursing models should be included in the nursing schools curriculum in order to train nurses on
how to effectively instruct and apply aides in performing standard nursing skills. This will help
improve patient outcomes and ensure better quality of healthcare is achieved in hospitals and
other care centers.

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