Overview
Staff mix is the combination of different categories of health-care personnel employed for the provision of direct patient care (McGillis Hall, 2005). “Health-care providers and organizations strive to deliver safe, competent, ethical, quality, “If we continue to work with current policies and delivery models, the gap between health-care needs and our ability to address them will grow.” The Next Decade: CNA’s Vision for Nursing and Health (CNA, 2009) evidence-informed care, which includes meeting their clients’ needs across the continuum of care and bringing about positive health outcomes for them. Researchers and decision-makers have long recognized the role of nurse staffing in the delivery of safe and competent client care, and many individuals and organizations are actively re-evaluating and re-designing staff mix to optimize the use of health human resources so as to respond to the changing health-care context. Determining a suitable mix of staff education, competencies and experience in order to optimize client, staff and organizational outcomes continues to be a complex and challenging process” (Canadian Nurses Association [CNA], Canadian Council for Practical Nurse Regulators [CCPNR] & Registered Psychiatric Nurses of Canada [RPNC], 2012, p. 5).
The process of staff mix decision-making requires smart decisions by nurse leaders, direct-care providers, health-care administrators and policy-makers about nursing care delivery models and staff mix based on reliable evidence. To establish models that maximize outcomes for clients, staff and organizations, we need to understand:
“Nursing: It’s the service nurses provide to individuals, groups and nations in many different care delivery models. Our desire is to nurse in environments and care delivery models that offer the maximum benefit for individuals to achieve optimum, healthy, productive and meaningful lives.” Judith Shamian, CNA President (CNA, 2010, p. 1)
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Client factors, such as health-care needs (acuity, complexity, predictability, stability, variability, dependency)
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Staff factors, such as type, number and experience of direct-care providers (registered nurse, licensed/practical nurse, registered psychiatric nurse, unregulated care provider)
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Organizational factors, such as the physical environment, resources, support services and practice setting (CNA, CCPNR & RPNC, 2012)
Educational tools and organizational support are necessary to make effective staff mix decisions and to develop effective interprofessional teams. We know that staff mix decisions should be made are made within the context of a nursing care delivery model (see Invitational Round Table. Nursing Care Delivery Models and Staff Mix: Using Evidence in Decision-making). Getting the right mix is the key to achieving positive client, staff and organizational outcomes. If the staff mix isn’t aligned with client, staff and organizational factors, as well as with guiding principles, outcomes can be in jeopardy. Examples of outcomes include:
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Client outcomes, such as patient safety incidents, readmissions and access to care provider
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Staff outcomes, such as overtime, absenteeism, turnover and quality of work-life
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Organizational outcomes, such as the adoption of evidence-informed practice, provision of safe and quality care, human resources costs (retention and recruitment), and case/service unit cost (CNA, CCPNR & RPNC, 2012)
CNA co-authored the new Staff Mix Decision-making Framework for Quality Nursing Care with the Canadian Council for Practical Nurse Regulators and the Registered Psychiatric Nurses of Canada, with funding from the government of Canada’s Foreign Credential Recognition Program. The framework is based on the following:
The staff mix framework presents a systematic approach to creating the right mix of direct-care staff — specifically, nurses and unregulated care providers. Based on evidence-informed guiding principles, this versatile resource helps optimize staff mix configurations to meet the needs of clients, staff and organizations across the continuum of care. It also provides information that supports efforts to maximize effective teamwork.
This new framework is an update of Evaluation Framework to Determine the Impact of Nursing Staff Mix Decisions, which was based on Nursing Staff Mix: A Literature Review, Staffing Decisions for the Delivery of Safe Nursing Care and a national consultation. The application of the 2005 framework in long-term care in Newfoundland (Kennedy, 2009), as well as anecdotal and survey data, indicate the usefulness of such a framework when making and evaluating changes to staff mix.
The Staff Mix Decision-making Framework for Quality Nursing Care is based on updated information and will guide nurse managers, direct-care providers and others to optimize staff mix. It is also useful for nurse researchers and educators to inform their work on staffing.
The complex tasks of designing nursing care delivery models and getting the right staffing mix have a long-term positive impact on clients, staff, organizations. Getting it right is pivotal to the future of nursing and health care in Canada — and it’s all in the interest of the public.
Listen to CNA’s top leaders speak about the value of staff mix decision making
CNA president Barbara Mildon (English podcast)
CNA CEO Rachel Bard (French podcast)
View other expert contributions
Staffing: A Perspective of the Chief Nursing Officer with the Saskatchewan Ministry of Health
Lynn Digney Davis, Saskatchewan Ministry of Health
Staffing: Getting the Right Mix – A Nurses Union Perspective
Canadian Federation of Nurses Unions
Staffing For Excellence in Long-term Care
Rayma O’Donnell, York Care Centre, New Brunswick
Home Care Reflections on Staff Mix Decision-making.
Nancy Lefebre, Saint Elizabeth Health Care and Cheryl Reid-Haughian, Paramed
The new right way: Introducing new staffing models on Vancouver Island
Rita den Otter and Robyne Maxwell, Vancouver Island Health Authority, B.C.
References
Canadian Nurses Association. (2009). The next decade: CNA’s vision for nursing and health. Ottawa: Author.
Canadian Nurses Association. (2010). Invitational round table. Nursing care delivery models and staff mix: Using evidence in decision-making. Ottawa: Author.
Canadian Nurses Association (CNA), Canadian Council for Practical Nurse Regulators and Registered Psychiatric Nurses of Canada. (2012). Staff mix decision-making framework for quality nursing care. Ottawa: Authors.
Kennedy, A. (2009). Evaluating nursing staff mix in long-term care: A comprehensive framework for decision-makers. Healthcare Quarterly, 12(4), 46-53.
McGillis Hall, L. (2005). Nurse staffing. In L. McGillis Hall (Ed.), Quality Work Environments for Nurse and Patient Safety (pp. 9-37). Sudbury, MA: Jones and Bartlett.
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Social Determinants of Health
