the result of the presents of the present study give the impression that the municipalities goal is to mask the RNs delegrate their entire woke to HCAs and instead cover up for the lack of physicians, yet retaining the ethical and legal responsibility for the nursing process of the patients. this situation has also been described by Nilsson et al. form other swedish municipalities. Aiken et al. showed that the quality of the care environment and nurse work had and impact on patient mortality, and it has been suggested that, if RNs staffing, education andcare environments are improved, this will contribute to the best patient outcomes.