Nursing and Midwifery Workload and Workforce Planning
Nursing & Midwifery Workload and Workforce
Planning
Skill Mix
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
What is Skill Mix?
• Gibbs et al (1991) defined grade/
band mix as a mix of differing
grades of staff in a particular
working environment, their costs
and activities.
• Grade mix does not reflect the
skills of the staff concerned or the
needs of their clients
• Skill mix refers to the skills and
experience of staff, their
continuing education and
professional development, years
of experience and how they bring
these together to influence their
professional judgement.
• Skill mix connects “needs” with
skills available and outcomes in a
particular working environment
with a specific client group
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
Definition
The term ‘skill mix’ can refer to:
• the mix of posts in the establishment; the mix of
employees in a post;
• the combination of skills available at a specific time;
• or alternatively, it may refer to the combinations of
activities that comprise each role, rather than the
combination of different job titles.
Buchan J, Ball J, O’May F, 2000
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
Skill Mix: Considerations
• good skill mix contributes to the quality of patient care, patient
satisfaction and clinical outcomes.
• nursing staff costs are rising and the labour market shrinking
• does a rich skill mix of mostly registered staff give a higher quality of care
than cheaper skill mix of mostly unregistered staff?
• skill mix estimation includes the competency of staff matched to the care
needs of patients
• can be a sensitive issue
• can be seen as an opportunity to maximise effectiveness of budget and/or
enhance the quality of care
• no such thing as optimum skill mix
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
Reviewing and Determining Skill
Mix
Consider:
• what type of work needs to be carried out?
• how many staff so we need?
• what type of staff do we need?
• could another (less skilled) member of staff do this activity?
• should an non-registered member of staff be given responsibility for this
activity – would a registered nurse be more appropriate?
• are staff with such skills available?
• can quality of care be maintained?
• what are the budgetary constraints?
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
Time Frames
Skill mix can be planned over four overlapping timeframes:
• operationally – the mix of staff actually deployed on duty
• short term – the plan for the mix of skills to be utilised on the
roster
• medium term – the plan to make adjustments to an
establishment’s skill mix to reflect changing priorities,
changing case mix or changing workload
• long term – the strategic plan of the numbers of staff and
skills required
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
The Skill Mix Cycle
Evaluating the need
for change
(define the problem)
Making change happen
(identify and implement solution)
Identifying opportunities
for change
(span of control)
Planning for change
(assess resources)
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
New and Enhanced Roles
• roles change as professionals expand existing roles other staff are required to take on some aspects of
a previous role
• healthcare professionals may develop new roles
which are designed to fit within their scope of
practice, e.g. new clinical nurse specialist roles and
emergency nurse practitioner roles:
• extension of professional practice for an individual
group
– partnership approach to developments will be vital in such
circumstances
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
New and Enhanced Roles
• completely new roles may be developed which do not fit
existing professional boundaries, e.g. healthcare support staff
who work between nursing, physiotherapy and occupational
therapy. Filled by:
– existing healthcare staff
– staff new to the health service with appropriate training
and education
Quality Education for a healthier Scotland
Nursing and Midwifery Workload and Workforce Planning
Framework for Framework for
Developing Nursing Roles Consultation
(SEHD, 2004b)
• “The distinction between role development and role
expansion should no longer be a key issue for the profession.
•
The critical issues are
– ensuring the delivery of high quality care
– safe practice for patients and communities
– reflecting health needs
• The expansion and development of professional practice and
skills should be focused on the needs of the patient and the
community based on sound evidence, to enhance clinical
credibility and the exercise of professional autonomy.”
Quality Education for a healthier Scotland