Essay: Challenges with Nursing Skill Mix in Contemporary Healthcare

This essay delves into the contemporary challenges surrounding nursing skill mix in healthcare, exploring its definition, the impact of nursing shortages, and the ratio of registered nurses to other healthcare workers. It examines the role and impact of assistants in nursing (AINs) on skill mix and the subsequent effects on patient healthcare outcomes. The essay highlights the issues associated with skill mix, including potential impacts on nurses and patient safety, citing studies on the effects of skill mix on patient outcomes such as pneumonia, cardiac arrest, and urinary infections. The conclusion emphasizes the need for healthcare providers to carefully manage the use of skill mix to ensure patient safety and maintain quality of care in a competitive healthcare environment.

Running Head: CONTEMPORARY ISSUES IN NURSING
Contemporary issues in nursing
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CONTEMPORARY ISSUES IN NURSING 1
Introduction
It has been seen that in health care centers, nursing staff serves as the largest element in
health care service. Nursing skill mix is basically an effort to reduce the cost associated with the
nursing service in health care centers by cutting nurse care with the help of individuals which are
practicing nurse (Aiken et al., 2017). This kind of approach has been seen in countries like US,
UK, Australia because their workload is more as compared to nursing staff. In situation where
the patient has to stay for a longer time, it increases the cost and there are chances that patient
will not get quality care services due to long process of paperwork, discharge preparation and so
on. As a result, the health care has to depend on the service of the nursing mix which is not able
to offer satisfied service as compared to nursing staff which is completely dedicated to this
service. This essay is focused on the real meaning of nursing mix skill used in health care (Twigg
et al., 2015). In addition, it is also includes impact of nursing shortage on skill mix. It is also
focused on the ratio of RNs related to another level of healthcare workers. It is also focused on
the impact of AIN`s-assistants in nursing on skill mix. In addition to this, it is also includes
impact of skill mix on patient healthcare outcomes.
Nursing skill mix
Nursing skill mix is actually a combination or alliance of various categories of
workforces which are employed mainly in the field of health care. It is considered as the cost-
cutting approach used by present hospitals to offer health care service with minimum investment.
It is mainly interlinked with two types of pattern, one is macro level planning and other is micro
level in framework of service (Staggs et al., 2017). It can be referred as a combination of various
skills which can be used on a particular time in the health care context. In addition to this, it can
be referred as a combination of activities which includes all type of healthcare role. It is an
attempt to offer services which are connected with nursing, physician and some other health care
services in one single format (Jacob, McKenna & D'amore, 2015). It consists of different level of
training along with the different level of wage pattern depending on the importance of the role to
be played. In addition to this nursing skill mix, it is also described as a combination of posts,
scale or occupations within the healthcare organization or in simple words it can be referred to as
grade mixing. It also includes the involvement of various skills which are essential for
completing all type of task in a healthcare organization. In this approach workplace, culture plays

CONTEMPORARY ISSUES IN NURSING 2
a very important role in bringing learning and development environment in the health care
organization in order to take control on all type of task at the same time so that there will be no
need of special person which will be dedicated towards one particular task.
Nursing shortages impacted on skill mix
Shortage in nursing is impacting quality of health care from many years and is being
expected to be rising in upcoming years. This is because very few individuals are interested in
entering this field as a profession and try to generate limits to overtime trend. This job is having
a hundred percent turnover rate due to very low job satisfaction because of which health care are
facing difficulties in recruiting and selection process (Rosenberg, 2019). Nursing shortage has
directly impacted the demand for skill mix. As this profession is receiving very low inflow
therefore, health care system has started focusing on skill mix and has seen it as the only option
to solve this nursing shortage issue in the health care system. Management of the health care
system has introduced new policies related to the formation of skill mix team which consists of
increasing the education and status within this mixture group in order to maintain the quality
service in the health care which is being impacted due to nursing shortage (Duffield et al., 2016).
This new policy has increased the demand for skill mix in the field of health service because it
will offer two types of advantage to the hospital system. One advantage is this type of
individuals are capable of handling multitask at a time and another advantage is that it will help
the health care centers to lower down the expense which they have to invest on their nursing
service (Jacob et al., 2016). This new environment has forced the health education system to
focus their interest into this new stream of skill mix which is in great demand especially in
countries like UK, USA, Australia and so on.
Best ratio of RN’S to other levels of healthcare workers
Every hospital do not record the amount of care which is being delivered to the patient
because hospital do not reimbursed for the amount of care being delivered to every patient. This
measurement is not considered as burden in terms of financial earning (Fields, Bigbee & Bell,
2016). In this situation, most separate level of nurse staffing dimension is made available in the
form of patient care. Two pattern of care can be offered through patient care, one of the best

CONTEMPORARY ISSUES IN NURSING 3
examples combining of five medical care units as single unit. In the similar way all units of
hospital can be combined in same fashion (Jiang, Li Ma & Gu, 2015).
According to research, it has been found that hospital measure RN ratio on the base of numbers
that has been utilized by the staff per patient. In addition to this, their salaries are also linked on
the hourly base as provided by the process information (Pappas & Welton, 2015). These hours
are also known as productive hours and in this paid time related to illness or vacation is not being
included in this overall health service process. In some case, hours are measured in the form of
direct and indirect contact of staff with the patient who conducts these health care activities
directly or indirectly on patients (Dellefield et al., 2015). All the information is kept in the data
storage system. In some case, it is measured on the base of workload on the staff to attend the
patient as per the requirement of the situation.
Impact of AIN’s – assistants in nursing on skill mix
Assistant in nursing was introduced in health care service to offer their support to
registered nurses. Assistant in nursing serves various positions in the healthcare service such as
health care assistant, patient care assistant, unlicensed assistive personnel and healthcare worker
support worker. The key drivers behind this service were shortage of nurses and cost-cutting
business operations (Algoso et al., 2018). Another main reason was people are moving towards
other streams. In addition to this, the healthcare service is demanding new skill and techniques
for the role of nursing. In recent years it has been seen that assistant in nursing are directly
impacting the service of skill mix because they are emerging as another option in healthcare.
Current assistant nursing has emerged as competition for skill mix because both these
professions are almost serving in the same health market. It is believed that assistant in nursing is
able to gain more knowledge and advance skill because they are working continuously in the
work environment which is surrounded by experienced nurses and this helps them to gain more
knowledge and expertise as compared to skill mix (Gabrielsson, Sävenstedt & Olsson, 2016).).
Because skill mix is working in an environment which is not directly connected with healthcare
service so deeply and therefore their chances of learning seem to be contracted as compared to
skill mix.

CONTEMPORARY ISSUES IN NURSING 4
Issues with skill mix can impact on nurses
One of the major issues related to skill mix is that it is meant for handling minor
healthcare service and is not an expert in some particular health service. They have a little bit of
knowledge of all type of health service but still cannot be called an expert. In this situation, if
this service is being used in the major health care service then chances of error increase
automatically because this section of people is not expert, they are just offering helps in the
health care service. In this case, if situation is handed over to this section of people. Then risk
related to the patient will increase along with the image of the health care center (Burdsall et al.,
2017). In addition to this, it will have a very bad impact on the overall performance of the
nursing service because in this service if care is not being taken related to quality. In this
situation, no individual will take risk of their life by using this kind of service. As per the study,
it has been seen that in many cases it has been seen that bad performance of skill mix has
impacted the overall healthcare business in many countries which have panicked the health care
market. Health care market is very competitive and a single mistake made in this service can put
the healthcare service provider out of the market and can lose trust in the market which is one of
the most important aspects of this nursing service. In fact, nursing service is completely working
on trust relationships in the market. This skill mix can convert minor issue into major issue
which will not be able to solve by the nursing expert.
Skill mix impacts on patient healthcare outcomes
As per the study, it has been seen that due to use of skill mix in hospitals there has been
seen a continuous increase in the rate of pneumonia significantly in most of the patients which
were admitted in the hospital. In another case, it has been seen a significant increase in relating
to pneumonia, shock, cardiac arrest and most of the patients were not able to survive. They were
admitted for some other issue but we're getting new disease in return which has cost lives of
many patients. In addition to this, it has been seen that the rate of urinary infection among the
patient also increased due to increased use of skill mix (Tourangeau et al., 2016). But in case of a
patient who has gone through the surgery process, increased use of skill mix has decreased the
rate of pneumonia and sepsis significantly.

CONTEMPORARY ISSUES IN NURSING 5
In most of the case, skill mix has a negative impact on the patient which has availed this service
because this skill mix service has put their life in danger every time they have interacted with
this service. This has forced the healthcare service provider to not make excessive use of skill
mix in their health care service and must limit their service in health care. Due to this use of skill
mix in health care service, patient is feeling a very high amount of pressure on them which is
continuously growing very fast.
Conclusion
Currently health care industry is facing a very high amount of competition in the market
and in order to remain sustainable they have used the strategy of cost-cutting by make use of
skill mix service in place of nursing service. But at the same time growing used of skill mix
service in health service is an increased risk related to the health of the patient because these
sections have knowledge related to all health service but are not expert in health service. As a
result of this, they have increased rate of diseases such as pneumonia and cardiac arrest within
the patient which is not good news for health care industry and must focus on reducing this
service.

CONTEMPORARY ISSUES IN NURSING 6
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