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Skill-mix and HCAs

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Skill mix is a crucial part of having an effective team in the NHS whether in a hospital or a community setting, but there is probably no such thing as an optimum skill mix as it is always changing to adapt to particular circumstances.

The right skill mix and staffing levels will have a large impact on the quality of care provided to patients and this has prompted debate over nurse to patient ratios.

Unlike parts of the US and Australia, where fixed nurse to patient ratios have existed for some time and been welcomed by nurses in those countries, the UK is still debating the pros and cons of such an approach.

Trusts in the UK have very different ratios because it is left to local organisations to decide on staffing levels based on several factors including the setting (ward/unit), field of practice and type of care, patient dependency and acuity, time of day/night, and the physical layout of a ward.

Unfortunately, other factors are often not taken into account regularly enough, such as improving standards of care, new technology, expanding nursing roles, and waiting list targets. A good manager will carry out periodic reviews of staffing and skill mix.

The Healthcare Commission has studied this issue and while it concluded that there are no precisely right or wrong staffing levels, they provided a tool for calculating national averages for nurse establishment depending on ward type and number of beds.

The national average, for example, of posts for a general medical ward with 28 beds is 15 qualified nursing staff, 10 non-qualified and about 3.5 agency or bank staff, says the Commission.

The RCN in Scotland is keen on local areas deciding on their own staffing levels by taking into account the number of patients, the experience of nurses on the unit, the staff skill mix, the severity of patients’ conditions, the availability of support services and resources, and local geography.

Skill mix is also changing as healthcare assistants are increasingly taking on roles normally done by nurses such as taking blood, dressing wounds, giving injections, and performing electrocardiograms (ECGs).

HCAs are a large part of nursing – they represent 17% of the NHS’s 1.3 million workforce – and it is estimated that half of them consider progressing into qualified nursing. They are often prevented, however, from doing so because of a lack of secondment opportunities at their place of work

Updated: September 2006

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