Feature Relocating care: negotiating nursing skillmix in a mental health unit for older adults Julie Henderson, a David Curren, b Bonnie Walter, b Luisa Toffoli b and Debra O’Kane b a Discipline of Public Health, Flinders University, Adelaide, SA, Australia, b School of Nursing, Flinders University, Adelaide, SA, Australia Accepted for publication 2 August 2010 HENDERSON J, CURREN D, WALTER B, TOFFOLI L and O’KANE D. Nursing Inquiry 2011; 18: 55–65 Relocating care: negotiating nursing skillmix in a mental health unit for older adults Mental health care in Australia in the last 20 years has moved from stand-alone psychiatric hospitals to general hospitals and the community. This paper reports an action research project exploring the experiences of nurses on an acute mental health unit for older adults staffed with a skillmix of mental health and general nurses, which recently transitioned from a psychiatric to a general hospital. The new service provides comprehensive health care, including the management of physical co-morbidity and a recovery orientation. Recovery acknowledges the role and rights of consumers and carers in planning and management of care, choice and individual strengths (Shepherd). The new ward received additional resources to establish the model of care, including a broader skillmix. The paper explores the dynamics of development of a new model of care and of bringing together staff with different professional orientations, cultures and priorities. Focus groups and interviews were conducted with 18 staff. Analysis resulted in three themes relating to the impact of competing goals and foci of care upon professional boundaries; com- peting organisational cultures and the impact of service change upon work practices. The findings are explored in relation to ideas about health care delivery associated with neoliberalism. Key words: Australia, mental health nursing, participatory action research, professional boundaries, sociology. This paper explores the impact of workforce restructure and movement towards flexibility and multi-skilling of staff through the experiences of nursing staff in a mental health unit for older adults that has recently moved from a stand- along psychiatric hospital into a general hospital. Care for people with chronic mental illness has shifted from long term institutional care to community care supplemented by short term admission. In Australia, this change has been driven by the National Mental Health Strategy (Australian Health Ministers 1992a). The National Mental Health Strategy is associated with the closure of stand-alone psychiatric hospi- tals and establishment of mental health beds within general hospitals. This paper explores the experiences of nurses in the relocated unit, placing these changes within a broader policy context, arguing that they are indicative of a neoliberal approach to health policy. Neoliberalism is typified by the application of ideas and strategies from the private sector to public health care delivery resulting in the subjection of health professionals to demands to achieve efficiencies and provide quality services with fewer resources (Leicht et al. 2009). The encroachment of managerial techniques from the private sector contributes to greater workforce flexibility and multi-skilling. The relocation of the unit in this study was resulted in the employment of a skillmix of mental health and general nurses. The paper explores the impact of multi- skilling and skillmix upon the manner in which nurses in this unit talk about professional identity. The data highlights the way in which nurses define the needs of clients and their role in this setting, demonstrating the impact of competing Correspondence: Julie Henderson, Discipline of Public Health, Flinders University, GPO Box 2100, Adelaide 5001 SA, Australia. E-mail: <Julie.Henderson@flinders.edu.au> Ó 2011 Blackwell Publishing Ltd Nursing Inquiry 2011; 18(1): 55–65