Staff mix models: complementary or substitution roles for nurses.

In response to the need to improve health care efficiency and effectiveness, hospital organizations are exploring and implementing restructured patient care delivery models. The shift away from traditional patterns creates an opportunity for redesign of health care resource utilization and creation of new staff mixes. Many emerging models appear to provide substitute workers for the RN rather than complement the nursing role. One concern evident in the literature is the lack of evaluation of these staff mix models as they become more prevalent. The outcomes for patient, hospital system, and nurse remain unclear.