Future Challenges for the Workforce – Nursing Education Network

Sometimes when faced with current challenges in healthcare, reminiscent of the continued nursing shortage, it’s mandatory to look to the past. The first article by Hall (1997) after which the more moderen one by Jacob et al (2015) highlight the challenges and changes because the skill mix in nursing changes.

“Many of the emerging models appear to be providing workers for the position of registered nurse rather than nurse practitioner.”

• Staff shortages in nursing
• Rising healthcare costs
• Increasing life expectancy and chronic diseases
• Global economy

“The term substitution (in the context of nursing staff) means the deliberate and planned replacement of a registered nurse by nursing support staff or a member of another health profession.” (Royal College of Nursing, United Kingdom)

Royal College of Nursing (UK) position on replacing registered nurses this one appreciating the role of a registered nurse.

It might not be financially prudent to offset the economic savings by reducing the skill mixture of the nursing staff by adding registered nurses, nurse aides, or unregulated healthcare assistants. The impact on patient outcomes, reminiscent of medication errors, pressure ulcers, and prolonged stays, could also be a greater economic burden.

Who educates, role models and supervises newly recruited nurses and nursing graduates if their competencies are fragmented?

Who takes responsibility for potential improvements in quality outcomes for each patients and healthcare staff? Would this be delegated through government, levels of the healthcare system, or pressures down the hierarchy to the clinical team and individual accountability?

What is the associated fee to the nursing team of a healthy work environment and work culture?

Time to Value Nursing – Training and Retention with Indicators of the Economic Impact of the Value of a Qualified Nursing Workforce.

Prof. Alison Leary on X (formerly Twitter)

Hall LM. (1997). Mixed staffing models: complementary or substitute roles for nurses. Nurs Adm Q. 21(2):31-9. DOI: 10.1097/00006216-199702120-00007

Jacob, E. R., McKenna, L., and D’Amore, A. (2015). The Changing Skill Set in Nursing: Considerations for and Against Different Levels of Nursing. Journal of Nursing Management, 23(4), 421-426.

Royal College of Nursing (UK). (2023). RCN position on replacing registered nurses.

Royal College of Nursing (UK) (2021). Position Statement on Maintaining Safety and Protection from Harm – Valuing the Role of the Registered Nurse.