Nurses Are an Essential Resource When Making Staff Mix Decisions, by Paddy Rodney RN

During last June’s Canadian Nurses Association (CNA) Annual General Meeting in Vancouver, all 38 delegates from B.C. proudly put forth and supported an ARNBC Resolution to Promote the Dissemination and Uptake of the Staff Mix: Decision Making Framework for Quality Nursing Care (please see the full Resolution at the bottom of this post).  This Resolution was supported by all CNA delegates from across Canada.

At the most recent 2013 CNA Annual General Meeting (AGM) in Ottawa held June 19, 2013, Canadian nurses– including eight delegates from the ARNBC – received information about the dissemination activities CNA has undertaken to date, as well as further plans for implementation of the Framework.

I believe that the five guiding principles of the Resolution are particularly relevant for nursing in B.C. right now because, like many other places across the country, we are struggling with rapid changes to staff mix. Indeed, in the consultations the ARNBC held with nurses across B.C. in 2012, staff mix changes were flagged by nurses in direct care roles as a major concern—and we know that nurses in management positions find themselves having to navigate conflict and uncertainty as these changes unfold.

The CNA Staff Mix Framework can provide direct care nurses and nurse managers with excellent direction. Staff mix changes ought to be based on client needs; consistent with effective care delivery models; based on the best available evidence; and supported by the structure, mission, and vision of each organization. Perhaps most importantly, I believe that nurses and other health care providers in direct care roles should be involved in/consulted throughout the planning, implementation, and evaluation of staff mix changes. Our profession, as well as the individuals, families and communities we serve, deserve such consideration.


ARNBC RESOLUTION 1 to CNA Biennial Conference and AGM, June 2012: Promoting the Dissemination and Uptake of the Staff Mix: Decision Making Framework for Quality Nursing Care

BE IT RESOLVED THAT the Canadian Nurses Association and its members work collaboratively to promote the dissemination and uptake of the principles articulated in the Staff Mix: Decision-Making Framework for Quality Nursing Care (2012) document authored by the Canadian Nurses Association (CNA), the Canadian Council for Practical Nurse Regulators (CCPNR) and the Registered Psychiatric Nurses of Canada (RPNC). (Submitted by the Association of Registered Nurses of British Columbia [ARNBC]; June, 2012)


In February 2010, the CNA established the Staff Mix: Regulated Nurses and Unregulated Care Providers Working Group. The pan-Canadian group was comprised of RNs, licensed practical nurses (LPNs), registered psychiatric nurses (RPNs), unregulated care providers (UCPs) and a research consultant (CNA et al., 2012, p. 6). In that work they defined staff mix decision-making as the act of determining the mix of the different categories of health-care personnel employed for the provision of direct client care (CNA et al., 2012, p. 4). The guiding principles these groups articulated together are:

1. Decisions concerning staff mix respond to clients’ health-care needs and enable the delivery of safe, competent, ethical, quality, evidence-informed care in the context of professional standards and staff competencies.

2. Decision-making regarding staff mix is guided by nursing-care delivery models based on the best evidence related to (a) client, staff and organizational factors influencing quality care and work environments, and (b) client, staff and organizational outcomes.

3. Staff mix decision-making is supported by the organizational structure, mission and vision and by all levels of leadership in the organization.

4. Direct care nursing staff and nursing management are engaged in decision-making about the staff mix.

5. Information and knowledge management systems support effective staff mix decision-making (p. 7).


Read ARNBC's Issue Statement: Staff Mix Decision Making and Nursing Practice, June 2013.


Paddy Rodney, RN, is a nurse educator with a speciality in ethics. Paddy is currently an Associate Professor at the UBC School of Nursing and is affiliated with the UBC Centre for Applied Ethics, Providence Health Care Ethics Services, and the Canadian Bioethics Society. Over the last 25 years, she has lectured and consulted on nursing ethics for nursing associations and unions.



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Paddy Rodney

As many of you are likely aware, there has been a great deal of news coverage this past week over VIHA's staff mix changes. The following newspaper column from the Times Colonist is informative:


Paddy Rodney

Please see the response I have posted to a recent article by the Times Colonist about forthcoming staff mix changes in VIHA.


Paddy Rodney

As a further update, I wanted to point readers to a recent report from the United Kingdom (UK) that may help to inform all of us (nurse leaders, point of care nurses, nurse educators, nursing associations and nursing unions) in our promotion of the importance of the 2012 CNA Staff Mix Guidelines.

In 2013 the UK reported on the latest in a series of public inquiries revealing serious breaches of duty on the part of the Mid Staffordshire NHS Foundation Trust (Francis, 2013). The failures cited included an institutional culture which ascribed more weight to positive information about the service than to information capable of implying cause for concern; standards and methods of measuring compliance which did not focus on the effect of a service on patients; too great a degree of tolerance of poor standards and of risk to patients; a failure of communications and monitoring between the many agencies to share their knowledge of concerns; a failure to tackle challenges to the building up of a positive culture, in nursing in particular but also within the medical profession; and a failure to appreciate until recently the risk of disruptive loss of corporate memory and focus resulting from repeated, multi-level reorganization (Francis, 2013, p. 4).

As one nurse commentator in the UK has noted, the problems were:
“fuelled by the hospital management being driven by the achievement of targets – set centrally by the Department of Health – that were paper-based indicators of ‘quality care’ and ‘success’. These were inextricably linked to financial imperatives, which created a culture where, if the numbers look right, then it was assumed that the hospital was providing quality care” (Hayter, 2013, e1).

Francis, R. (2013). Letter to the Secretary of State. In The Mid Staffordshire NHS Foundation Trust Public Inquiry, Report of the Mid Staffordshire NHS Foundation Trust
Public Inquiry: Executive summary (pp. 3-5). London: The Stationery Office.

Hayter, M. (2013). The UK Francis report: The key messsages for nursing. Journal of Advanced Nursing, Vol. 69, No. 8, pages e1-e3 [August 2013].
Article first published online: 1 Jul 2013
DOI: 10.111/jan.12206

Paddy Rodney

As further follow up, I want to point to MLA Andrew Weaver’s Town Hall on Island Health's Care Delivery Model Redesign (CDMR). The Town Hall was held in Victoria on February 27th, 2014.

I found that the event generated an excellent exchange of perspectives between members of the public, point of care nurses, student nurses, BCNU, ARNBC and UVic nursing. The insights generated on this complex and urgent issue related to staff mix could be most useful for nurses throughout BC as well as across Canada.

Andrew's summary of the event can be found at:



[…] aware that tensions and stress are rising.  We have written about staff mix previously in our blog and with an issue statement, but we are increasingly concerned about the lack of availability of […]