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Aims The overall aims of the paper are to provide an overview of the subject, illustrate the need for further research and to raise awareness of the ongoing limitations of existing knowledge and present these to those involved in skill mix decision making. Background Over the last 20 years health care organizations across the globe have seen an increase in the pace of change. The continuing drive towards cost-effectiveness, quality of care and the clinical governance agenda are causing more and more managers to examine closely the mix of staff skills. This paper demonstrates that, despite 20 years of research and skill mix management in practice, there continues to be a tension between the use of qualified and unqualified staff, particularly, the cost and quality dimensions. Conclusion The evidence which currently exists offers some limited support for the suggestion that redistribution of certain tasks in nursing could be possible and could contribute to strategies for meeting the demands of changes within health care delivery. Any reallocation of task, and substitution of qualified by unqualified staff, should be based on sound evidence and not merely on staff availability, service demand or apparent costs.

Effective strategic management is the means by which organizations achieve their desired levels of performance. There is a need to explore and describe the relationship between the profession of nursing and strategic management, with particular reference to nurses' participation in the field of strategy development and implementation. This paper aims to 'set the scene' in relation to such an exploration. The concept of strategic management is discussed and some possible definitions are explored. The need for nurses to be involved in strategic management is then considered, drawing on literature from nursing and general management sources. The overall aim of the paper is to provide a basis for further discussion and to generate ideas for research in the area.

Aim To discuss the theoretical concept of strategic management and explore its relevance for healthcare organisations and nursing management. Background Despite being a relatively new approach, the growth of strategic management within organisations has been consistently and increasingly promoted. However, comprehensive definitions are scarce and commonalities of interpretation are limited. Method This paper presents an exploratory discussion of the construct of strategic management, drawing on the literature and questioning its relevance within health-care organisations. Evaluation Literature relating to strategic management across a number of fields was accessed, drawing primarily on meta-studies within management literature, to identify key concepts and attempt to present a consistent definition. The concept within health care is explored in relation to nursing management. Conclusions Inconsistency in definitions and utilisation of key concepts within this management approach results in the term being loosely applied in health-care organisations without recourse to foundational principles and a deep understanding of the approach as a theory as opposed to an applied term. Implications for Nursing Management Nurse managers are increasingly asked to adopt the ‘next-best-thing’ in managerial theories, yet caution needs to be taken in nurses agreeing to use systems that lack an evidence base in terms of both efficacy and relevance of context.