Conclusion
The relationship between nursing skill mix and outcomes is undeniably
complex. Essentially, what constitutes effective skill mix
depends on a host of factors. While much has been discussed
about nursing skill mix, gaps exist in current evidence when
examined vis-à-vis Singapore’s nursing workforce. The implictions on outcomes as a result of the interface between local and
foreign nurses, differences in education and changes in roles and
work distribution remain unanswered. Potential questions that
need to be considered in future research are: Does the ratio of local
to foreign nurses impact on outcomes; and if so, which specific
characteristic explains the difference? How might differences in
educational qualifications across different nursing grades affect
outcomes? Do the utilization of nurses and the distribution of
their time on nursing activities explain variation in outcomes?
This knowledge should provide a more robust evidence base on
which to inform national policy on skill mix and maximize
nurses’ contributions to the healthcare system.a