Nursing skill mix and outcomes: a Singapore perspective


Tracy Ayre, School of Nursing, The University of Melbourne, 723, Swanston Street, Level 1, Carlton, Victoria 3053, Australia; Tel: 61-3-8344-0714; Fax: 61-3-9347-4172; E-mail:


Aim:  To summarize key evidence on nursing skill mix in acute care hospitals and their limitations; and identify the gaps in current literature vis-à-vis Singapore’s nursing workforce.

Background:  Nursing skill mix has been theorized to be a factor influencing patient, nurse and organizational outcomes. While there is a growing body of literature explicating associations between nursing skill mix and positive outcomes, the evidence does not as yet provide firm directions in determining the best configuration. In addition, differences in nursing workforce characteristics also make it difficult to apply findings from one healthcare setting to another.

Conclusions:  In reviewing key evidence from the United States of America and Canada, this paper highlights three critical gaps in the nursing skill mix literature when examined in the context of Singapore’s nursing workforce. Issues related to the interface between local and foreign nurses, the impact of speciality education, and the possible effects that work roles and distribution may have on quality of care need to be further examined. This knowledge should provide a robust evidence base with which to inform national policy on skill mix and maximize nursing resources in order to achieve optimal outcomes.