Nursing Skill Mix in Healthcare: Challenges and Impact on Care

This essay explores the challenges associated with nursing skill mix in contemporary healthcare and its subsequent impact on patient care. It begins by defining nursing skill mix as a strategy to optimize client care through the engagement of lower-paid staff for less complex tasks, thereby freeing up highly qualified nurses for professional duties. The essay discusses how nursing shortages have prompted the adoption of skill mix strategies, leading to improvements in nurse satisfaction, patient healthcare, and cost reduction. It also details the stages involved in developing a nursing skill mix, including evaluation, span of control determination, resource assessment, and implementation. The role of Assistants in Nursing (AINs) is examined, highlighting their contributions and the potential risks if not properly supervised. The essay concludes by emphasizing the need for a balanced approach to skill mix, ensuring that patient safety and quality of care are prioritized, especially in cases requiring the expertise of registered nurses, and also acknowledges the global efforts to improve nursing and midwifery through strategic changes and the integration of AINs to address healthcare challenges.

Assignment Title
Introduction
Initially, hospitals have used productivity as a determinant of staffing levels. The World Health
Organization reports that nurses and midwives account for approximately 50% of the health workforce
globally. The publication approximates that the ratio of nurses and a midwife to the population is 1:1000 of
the World Health Organization member states (Wong et al., 2015). The 2017 Global Health Observatory
blueprint clearly states that there is a shortage of nurses, which harms healthcare (Rosseter, 2015).This
shortage of professional nurses creates limitations on the amount of time spent on a single patient by
nurses; therefore, an evolved approach to the staffing of registered nurses has been adopted in the medical
field. Nursing skill mix has been benevolent to patients, nurses, and hospitals. The adoption of nursing skill
mix has led to improving the satisfaction of registered nurses, better patient healthcare, and lower medical
costs (Stalpers et al., 2015). Nurses have experienced a significant improvement in job satisfaction, which
has led to lower staff turnover and wage bill cost savings (Lu, Zhao, & While, 2019). The patients can be
accorded more staff time due to nursing skill mix.
Body
Nursing skill mix is a strategy to optimize client care by engaging lower paid staff to execute fewer
complexes and demanding tasks (Dall'ora et al., 2017). The Skill Mix approach frees up much of the time
for the highly qualified staff to perform the professional duties that they are qualified for. The adoption of the
nursing skills mix was prompted by the shortage of trained and professional nurses. Therefore, the clinical
centres had to undertake a skills substitution and improve the use of currently available skills. The rationale
is that a hospital's capability to optimize patient care is primarily dependent on its frontline personnel
(Hockenberry, & Becker, 2012) he nurses are to be thoroughly skilled and well -aligned within the working
framework, in order to function seamlessly and deliver effectively in a team-based unit. Difficulties were
encountered in coming up with the right nursing skill mix because, both developed and developing
countries are experiencing a shortage of professional clinical care providers, and the contemporary patient
population requires complex care services (Cunningham et al., 2019). Some of the patient needs can be
met by unlicensed staff members who have been adequately trained. The needs include; assisting the
inpatients with Activities of Daily Living (ADLs), such as feeding, ambulation, toileting, bathing, searching
for linen, supplies and equipment, picking up medication from the pharmacy and dropping specimens off at
the lab, the transportation of stable patients and scheduling of diagnostic tests (Franssen, Sarr-Jansman, &
Rowberry, 2018)
Nursing skill mix is an initiative addressing cost containment and quality improvement. There are four
stages of review to develop a nursing skill mix (Powell, Brown, & Smith, 2016). The process should be
done strategically because the skill mix can be used as a tool for change. The first review stage is
evaluating the current status quo and the problem. Evaluation is necessary because some problems, in
practice, may have better solutions than a skill mix review. The evaluation stage is relevant in justifying the
need for a skill mix. The second review stage is the determination of the span of control. The determination
of the span of control is based upon mapping the constraints, flexibility, and autonomy to act. It is important
to highlight areas of change (Aiken et al., 2017). Of critical value is the determination of the consequences
of constraints to action in setting the nursing skill mix. In the third stage, there must be an evaluation of the
resources available and setting the strategic plan. The availability of adequate resources such as technical
resources, human resources, financial resources, information systems and data availability is necessary.
Moreover, the final stage is the approach to skill mix implementation with a view of both short term and
long-term change. Some strategies take years to implement, while others take less than a month. The
implementation approach should be effective and efficient to develop the nursing skill mix within the set
time frames (Freund et al., 2015). The stages are linked to form a cycle of events since the implementation
stage relates to the review stage. The review process should be continuous for the stability of the nursing
skill mix (Berger et al., 2018).
Based on statistics, 36% of the clinical activities can be undertaken by non-registered nursing staff team
members. This is reflected in the ratio of registered nurses to healthcare workers in the diverse clinical
setup. There is no legal provision for what constitutes a healthy ratio between registered nurses and
another healthcare team. However, skill mix variation is to be modelled with integrity and in a professional
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manner (Staggs et al., 2017). The skill mix to be used is determined by the stability and needs of the
patient in order to offer person-centred care; this is because nurses work in a complex, dynamic, and
demanding environment (Lindh Falk et al., 2018). The healthcare team may include non-clinical assistance
(extender clerks) who perform most of the housekeeping duties and non-clinical clerical duties. Vocationally
trained and qualified caregivers are more involved with traditional nursing aides, and they form part of the
healthcare team. The caregivers are engaged at the clinic as they undergo an additional training program.
Another constituent of the healthcare team are the traditional assistants.
The assistants are lined up alongside the registered nurses, and their duties are simplified. The
assistants undergo more training in their daily interaction with their supervisors. The primary nursing
assistants in the healthcare team function alongside primary nurses in the provision of nursing care.
Technical assistants form part of the healthcare team and oversee handling sophisticated technological
equipment and procedures. Each member of the healthcare team has specific duties allotted to them.
However, the team's service delivery is highly flexible. The healthcare team can be used on a substitution
basis because most of its duties are easy to require short term training within the clinic and require close
supervision by a registered nurse.
The healthcare team is faced with a challenge because most clinic settings lack a thriving environment
in which to work. Most of these health workers are not credited for their contribution in the medical field
despite their professional relations with their seniors. Low job satisfaction leaves them demoralized and
with no sense of belonging (Hoff, Carabetta, & Collinson, 2019).
Assistants in nursing bring the division of labour into the nursing skill mix (Twigg et al., 2016). They play
a crucial role in ensuring efficiency and effectiveness in the provision of healthcare. However, the
introduction of assistants into the patient wards should be undertaken within a set code of the nursing
framework (Chen, Zhang, & Fu, 2018). The framework must clearly define the duties of the assistants, the
scope of practice and boundaries, and the code of working relationships with registered nurses. It is highly
recommendable that their activities and the impact on the client should be closely supervised. Varying the
nursing skill mix by reducing the number of hours of care by a registered nurse may have adverse effects
on the patient (Hoff, Carabetta, & Collinson, 2019). However, adding to the patient assistants who are well
monitored may improve the outcome of the healthcare practice (Recio‐Saucedo et al., 2018).
The nursing skill mix impacts the healthcare practice and the operations of the nurses. Most nurses are
highly motivated and fulfilled in their jobs. High motivation levels boost nurses’ morale and impact their
healthcare service delivery (Jason, & Edmund, 2016). Having a proper nurse skill mix enables the nurse to
have a short duration of stay with the patient and still enjoy better outcomes. The results are minimal
patient complications and the ability to attend to most clients and focus more on patient education,
consultation services, and monitoring duties (Snavely, 2016). So far, the nursing skill mix has reduced
cases of burnout that nurses undergo due to the emotional strain of losing patients and extended work
shifts. With a functional and balanced nursing skill mix, the nurse is in a better position to delegate some
lower duties that require less attention to the healthcare workers. The effect of this is a reduction of fatigue
and injury; likewise, the nurse has fewer chances of making medical errors and mistakes (Cunningham et
al., 2019).
The nurse, in collaboration with the entire health workforce, has the obligation of ensuring a favourable
environment for the patient, as a safe and healthy clinical environment, has positive effects on the patient.
The skill mix nursing approach gives the patient optimal care and attention from the healthcare team
through Assistants in Nursing. The nursing skill mix can be attained because of the complementary role of
the other healthcare staff and AINs (Staggs et al., 2017). However, a skill mix in the nursing process may
pose a risk to the patients’ health care because most of them lack expertise in complex medical issues.
Cases, where there is no proper monitoring supervision, may lead to severe medical damages (Halifax,
Miaskowski, & Wallhagen, 2018). In West Australia, AINs have been engaged for an extended period in
performing duties that do not require the expertise of a trained nurse. These duties include monitoring
patients’ temperature, blood sugar (glucose), toileting, surveillance, and aid in activities of daily living
(ADL). These duties can be delegated to less educated health workers. Assistants in Nursing were
introduced to handle such cases. However, the West Australian Department of Health Nursing and
Midwifery restricted AINs from handling acute care cases. Later, an introduction of AINs into the acute
setting was on a complimentary basis rather than a substitutive approach. The restriction of the AINs came
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into play because the Registered Nurse would be more equipped to handle very delicate cases in close
monitoring and supervision as opposed to other subordinate healthcare staff (Berger et al., 2018).
Globally, fewer nursing staff and more reliance on less educated healthcare workers, as opposed to
professionally trained nurses, have had an adverse effect on patients. It impacts on the mortality, and
infection rates, as well as a more extended stay in the clinic and a longer recovery period (Aiken et al.,
2017). An ineffective nursing skill mix may lengthen the hospital stay of patients or cause delays in the
discharge process. A faulty nursing skill mix has an impact on the cost of medical care (Twigg et al., 2015).
The World Health Organization (WHO) has set out a global strategy for labour resources in the healthcare
sector. The global strategy is for nursing and midwifery to develop and attain a set of health goals
(Rosseter, 2015)
Conclusion
Globally, there have been significant improvements in the nursing and midwifery fields. These
improvements have been due to the efforts of local governments and global health institutions, such as the
World Health Organization, to promote good healthcare to humanity. The global shortage of nurses and
midwives has led to some strategic changes in the nursing field. One of the early changes was the
introduction of Assistants in Nursing (AIN), who play a crucial role in ensuring good healthcare. They were
engaged in a substitution basis or complementary/supportive approach. The engagement of AINs has
greatly modified the nursing workload to the duties that require their nursing expertise, as a result of
boosting their job satisfaction. An introduction of the nurse skill mix ensured that there is a multidisciplinary
approach in providing healthcare. The positive effects were the good utility of available resources, such as
finances, human resources, and equipment. The use of AINs has greatly ensured efficiency and
effectiveness; however, in cases of adverse health conditions of a patient, the direct care of a professional
and registered nurse is highly recommendable. Such patients need to be handled with care. A single
careless mistake of a supportive healthcare worker may result in infections, injury, and in some cases, even
death. The use of less skilled healthcare staff as opposed to highly trained professional nurses has been
linked with high mortality rates. More research should be done on the impact of the nursing skill mix to
patients, hospitals, and medical practitioners.
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