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

J Nurs Manag. 2015 May;23(4):421-6. doi: 10.1111/jonm.12162. Epub 2013 Sep 23.


Aim: To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.

Background: Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.

Evaluation: Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.

Key issue: The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.

Conclusion: Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.

Implications for nursing management: 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.

Keywords: economic factors; levels of nurse; scope of practise; skill mix; workforce.

Publication types

  • Review

MeSH terms

  • Clinical Competence*
  • Humans
  • Nurses / standards*
  • Nurses / supply & distribution
  • Nursing Care / trends*