Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

Does a mixture of nursing skill-levels affect quality of care?

  • Comments (3)
  • Article: Robb E et al (2011) How skill mix affects quality of care. Nursing Times; 107: 47, 12-13.
  • Author: Elizabeth Robb is chief executive, the Florence Nightingale Foundation; Elaine Maxwell is visiting fellow, London South Bank University; Karen S Elcock is head of programmes - pre-registration nursing, Kingston University and St George’s, University of London.

Although the media have reported failings in patient care as failures in nursing, they have not distinguished between care delivered by registered nurses and that delivered by unregistered healthcare assistants and other support staff.

Follow the debate on Twitter #NTjournalclub

Key points

  1. Healthcare assistants increasingly provide fundamental care
  2. The nurses/ HCA boundary is blurring
  3. The media has reported care failures as failures in nursing
  4. There is a correlation between low nurse-to-patient ratios and high rates of mortality, morbidity and adverse events, but increasing ratios alone would not solve the problems
  5. Hospitals with the right culture, workforce, and leadership improve patient satisfaction and save money by reducing adverse events

Let’s discuss

  • Do we need an entirely registered nursing workforce?
  • Do you agree tasks delegated from managers, doctors and others have an unintended consequence of reducing the perceived value of fundamental nursing care?
  • What is the role of the clinical leadership in providing individualised care?
  • How would you define safe, minimum staffing levels?


  • Comments (3)

Readers' comments (3)

  • Anonymous

    Problem with minimum is they quickly become maximum and we end up working with basic levels rather than optimal levels

    Unsuitable or offensive? Report this comment

  • Anonymous

    Anonymous | 29-Nov-2011 12:41 pm

    I agree with that observation.

    And my instinct is that all 5 points are correct: but point 3 is complicated because patients are unlikely to see 'care' in such demarcated terms as nurses do (so, probably, neither will the media see the subtleties of the differences between who does what) and I think 5 is probably very relevant to best practice, but not so easy to achieve everywhere.

    I agree that the delegation of tasks 'onto nurses from above' will tend to lead to nurses having 'less perceived independence/authority' than doctors and senior managers, but I'm not sure that equates to the perception of nursing care as being 'less valued'.

    Unsuitable or offensive? Report this comment

  • 1. Yes they do, that is their job description. To perform the BASIC care to ASSIST Staff Nurses. But that does not mean Staff Nurses are lacking in this area, we just have to prioritise clinical care sometimes and still perform basic care too.

    2. No it isn't. Staff Nurses are fully qualified and registered, HCAs are not.

    3. True, and most of the time this is wrong.

    4. Yes there is a correlation, clinical evidence shows this. But you are wrong, improving staffing ratios, especially of QUALIFIED staff, WOULD improve those problems. It is not the entire answer, but it is a huge, huge part of it.

    5. Not necessarily.

    Unsuitable or offensive? Report this comment

Have your say

You must sign in to make a comment.

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.