An approach for decreasing nursing RN skill mix was implemented in a "one size fits all" approach across organizations in the 1990s. These changes in skill mix led to:
a. decreases in RN workload.
b. increased nursing satisfaction.
c. decreased patient satisfaction.
d. decreased patient safety concerns.
C
The approach for decreasing nursing RN skill mix was implemented in a "one size fits all" ap-proach across organizations and often lacked evaluation of the skill mix change and other changes on the quality of care and nurse job satisfaction and retention (Eck, 1999; Norrish & Rundall, 2001). This was most apparent in California where a leaner RN skill mix was tried by Kaiser Permanente Northern California in the early 1990s. Skill mix was reduced from 55% RNs to 30% RNs in 1995 (Robertson & Samuelson, 1996). The changes in skill mix led to widespread real and perceived increases in RN workload, patient safety concerns, and nurse and consumer complaints.
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