Trends in nursing staff allocation: the nurse‐to‐patient ratio and skill mix issues in Israel

Abstract

This article describes a case study relating to trends in nurse-to-patient ratios and nursing staff mix in Israel. In recent years, there has been a worldwide trend towards changing nurse-to-patient ratios and nursing staff mixes. On the one hand, the patient's status has become more complex and requires a more professional nursing staff to maintain treatment, safety and quality, on the other hospitals have become more economically focused. In light of this, the need to re-examine the issues of nurse-to-patient ratio and nursing staff mix are of primary importance to the health system. Legislation of nurse-to-patient ratios is being widely discussed in nursing circles, and nurse-to-patient ratios are now mandatory in the State of California, USA, and the State of Victoria, Australia. The trend in nursing staff mix in Israel has been towards increased hiring of academic registered nurses, leading to the clinical development of quality treatment programmes and decreased mortality rates. Subsequently, license practical nurses are phased out, and where necessary auxiliary staff, which represents a cheaper work force, provides unskilled care. Today, the staff mix distribution in Israeli general governmental hospitals consists of 73% registered nurses, 11% licensed vocational nurses, and 16% auxiliary staff. In addition, there is a special collective agreement related to the allocation of nursing positions, including a classification method involving 10 categories of inpatient wards.