Original Article © 2007 The Authors. Journal compilation © 2007 International Council of Nurses 56 Blackwell Publishing LtdOxford, UKINRInternational Nursing Review0020-8132© 2006 The Authors, International Nursing Review (2006) 20065415662Original ArticleNursing skill mix and outcomesT. C. Ayre et al. Correspondence address: 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: tayre@pgrad.unimelb.edu.au Original Article Nursing skill mix and outcomes: a Singapore perspective T. C. Ayre 1 RN, MSN, M. F. Gerdtz 2 RN, PhD, J. Parker 3 RN, PhD & S. Nelson 4 RN, PhD 1 PhD student, 2 Lecturer, 3 Professor, School of Nursing,The University of Melbourne, Melbourne,Victoria, Australia, and 4 Professor, Faculty of Nursing, University of Toronto,Toronto, Canada AYRE T.C., GERDTZ M.F., PARKER J. & NELSON S. (2007) Nursing skill mix and outcomes: a Singapore perspective. International Nursing Review 54, 56–62 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. Keywords: Outcomes, Quality of Care, Registered Nurses, Singapore, Skill Mix Introduction Nursing skill mix is a multidimensional concept, and has been defined as the proportion of different nursing grades, and levels of qualification, expertise and experience (Buchan & Dal Poz 2002; Spilsbury & Meyer 2001). The overall goal of skill mix is to achieve the most effective, flexible and cost-effective use of nursing resources (McGillis Hall 1997). An inappropriate skill mix has implications for the quality of patient care. How does one discern what is the most appropriate nursing configuration in order to provide the ‘best’ care or to ensure job satisfaction? This is not an easy question to answer. Internation- ally, there is increasing interest in seeking evidence on nursing skill mix and quantifying its contribution towards patient, nurse and organizational outcomes (for example McGillis Hall et al. 2001; Needleman et al. 2002). However, the challenge lies in deci- phering emerging knowledge on nursing skill mix to underpin decisions in particular national contexts with different nursing workforce profiles, such as Singapore. As yet, there are no data from Singapore to support international research on nursing skill mix. The aim of this paper is twofold; to summarize key evidence on nursing skill mix in acute care hospitals and its limitations and, the crux of this paper, to identify the gaps in current literature vis- à-vis Singapore’s nursing workforce. As most publications in this topic are derived from the United States of America (USA) and