Nursing skill mix in neonatal care.

A large scale study of neonatal nursing was carried out with data collected from 56 sites (4 hospitals from each of the health regions of England). In the area of skill mix the key findings were: the largest segment of the neonatal nursing workforce is made up of staff nurses and staff midwives, and of these there are greater numbers of staff nurses; the E grade at 31% is the most frequently found, followed by the G (19%) and F grades (16%); vacancies were disproportionately high at staff nurse/staff midwife level; nursery nurses were employed for direct nursing care in 80% of units; nursing auxilliaries were employed in 70% of units, though in only half were they involved in the direct care of babies. Staffing policies were diverse and not clearly related to the type of unit or the numbers of designated intensive and special care costs. There was a tendency to employ more junior staff at night, the use of support staff varied widely, and in many units was at very low levels or absent. In addition to differing service demands that may affect the skill mix required, there is a clear need for the profession to address the questions that arise from changing roles and areas of responsibility in the spheres of management, teaching and clinical practice.