Senior nurse role expectations of graduate registered and enrolled nurses on commencement to practice
Elisabeth R. Jacob A D , Lisa McKenna B and Angelo D’Amore CA School of Nursing and Midwifery, Federation University, Gippsland Campus, Churchill, Vic. 3842, Australia.
B Monash University, School of Nursing and Midwifery, Clayton Campus, Vic. 3800, Australia. Email: lisa.mckenna@monash.edu
C Monash University, School of Rural Health, PO Box 1497, Bairnsdale, Vic. 3875, Australia. Email: angelo.d’amore@monash.edu
D Corresponding author. Email: elisabeth.jacob@federation.edu.au
Australian Health Review 38(4) 432-439 https://doi.org/10.1071/AH13216
Submitted: 7 November 2013 Accepted: 8 April 2014 Published: 8 July 2014
Abstract
Objective This paper reports on a project to examine the expectations of senior nurses regarding graduate roles of registered and enrolled nurses educated in Victoria, Australia.
Methods Participants completed an online survey to indicate whether predetermined competencies were in the roles of graduate enrolled or registered nurses or not in the role of either nurse. Chi-squared analysis was used to identify differences between participant groups.
Results Participants expressed variations in role expectations for the different level of graduate nurse. Although basic nursing care was undertaken by both graduate enrolled and registered nurses, no specific role was identified for enrolled nurses. Differences were found in the opinions of senior nurses over the roles of graduate nurses, demonstrating considerable variation in expectations. Management, education and research roles were not identified as the role of either nurse on graduation. Differences were found in the expectations of the different senior nurse groups regarding the roles of the enrolled nurse, particularly in the new skills taught in the enrolled nurse diploma program.
Conclusions Confusion exists regarding the roles of both types of nurse on graduation. Further research across Australia is required to clarify the roles of the different level of nurse in different practice contexts.
What is known about the topic? Australia, like many other countries, prepares two levels of nurse for entry to practice: the degree-prepared registered nurse and the diploma-prepared enrolled nurse. Role confusion and ambiguity have been reported in the literature by many countries, including Australia, that employ two levels of nurse.
What does this paper add? Great variation exists between expectations of senior nursing staff as to the role of both levels of graduate nurse. Role confusion and ambiguity exists for nurses in Australia. Role confusion and ambiguity around the scope of practice for enrolled nurses is seen as both limiting their practice and encouraging them to work at levels for which they have not been prepared. Graduate registered nurses were seen as more prepared for required graduate attributes than enrolled nurses. Care of acute, complex or deteriorating patients remains the role of registered nurses.
What are the implications for practitioners? Practising nurses need to be educated as to the skills and knowledge that diploma enrolled nurses are graduating with in order to enable them to use their full range of abilities. To provide safe, quality care, registered nurses must fully understand the roles and abilities of the enrolled nurses to whom they delegate care. Organisational health policies and procedures need to be reviewed to accommodate the increased skills and knowledge of diploma-prepared enrolled nurses and enable best utilisation of their skills. Practising nurses need to be aware that enrolled nurses are not educationally prepared to care for complex or deteriorating patients. Although they are able to undertake basic nursing care, the role of caring for complex, highly acute and deteriorating patients remains in the domain of registered nurses. The increasing acuity of patients admitted to health services requires a higher skill mix of registered nurses to safely care for them.
References
[1] Jacob E, Sellick K, McKenna L. Australian registered and enrolled nurses: is there a difference? Int J Nurs Pract 2012; 18 303–7.| Australian registered and enrolled nurses: is there a difference?Crossref | GoogleScholarGoogle Scholar | 22621302PubMed |
[2] Heartfield M, Gibson T. Australian enrolled nurses have their say. Part 1: teamwork and recognition. Contemp Nurse 2005; 19 115–25.
| Australian enrolled nurses have their say. Part 1: teamwork and recognition.Crossref | GoogleScholarGoogle Scholar | 16167441PubMed |
[3] Milson-Hawke S, Higgins I. The scope of enrolled nurse practice: a review of the literature. Contemp Nurse 2003; 14 129–37.
| The scope of enrolled nurse practice: a review of the literature.Crossref | GoogleScholarGoogle Scholar | 12785603PubMed |
[4] Australian Nursing and Midwifery Council. Report of the national framework for the development of decision-making tools for nursing and midwifery practice. Dickson, ACT: Australian Nursing and Midwifery Council; 2007.
[5] Chaboyer W, Wallis M, Duffield C, Courtney M, Seaton P, Holzhauser K, Schuluter J, Bost N. A comparison of activities undertaken by enrolled and registered nurses on medical wards in Australia: An observational study. Int J Nurs Stud 2008; 45 1274–84.
| A comparison of activities undertaken by enrolled and registered nurses on medical wards in Australia: An observational study.Crossref | GoogleScholarGoogle Scholar | 18243206PubMed |
[6] Gibson T, Heartfield M. Contemporary enrolled nursing practice: Opportunities and issues. Collegian 2003; 10 22–6.
| Contemporary enrolled nursing practice: Opportunities and issues.Crossref | GoogleScholarGoogle Scholar | 15481507PubMed |
[7] Milson-Hawke S, Higgins I. The scope of enrolled nurse practice: a grounded theory study. Contemp Nurse 2004; 17 44–62.
| The scope of enrolled nurse practice: a grounded theory study.Crossref | GoogleScholarGoogle Scholar | 17929735PubMed |
[8] Conway J. The changing skill mix and scope of practice of health care workers in New South Wales: implications of education and training reforms for registered nurse practice, performance and education. Contemp Nurse 2007; 26 221–4.
| The changing skill mix and scope of practice of health care workers in New South Wales: implications of education and training reforms for registered nurse practice, performance and education.Crossref | GoogleScholarGoogle Scholar | 18041973PubMed |
[9] Nursing and Midwifery Board of Australia. National competency standards for the registered nurse. Dickson, ACT: Australian Nursing and Midwifery Council; 2006.
[10] Lu H, While A, Barriball K. Role perceptions and reported actual role content of hospital nurses in mainland China. J Clin Nurs 2008; 17 1011–22.
| Role perceptions and reported actual role content of hospital nurses in mainland China.Crossref | GoogleScholarGoogle Scholar | 18093121PubMed |
[11] Barnett T, Sellick K, Cross M, Walker L, James A, Henderson S. Preparing student nurses for healthcare reform. Focus on Health Professional Education 2012; 14 23–34.
[12] Streeton R, Cooke M, Campbell J. Researching the researchers: using a snowballing technique. Nurse Res 2004; 12 35–46.
| Researching the researchers: using a snowballing technique.Crossref | GoogleScholarGoogle Scholar | 15493213PubMed |
[13] Duffield CM, Gardner G, Chang AM, Fry M, Stasa H. National regulation in Australia: a time for standardisation in roles and titles. Collegian 2011; 18 45–9.
| National regulation in Australia: a time for standardisation in roles and titles.Crossref | GoogleScholarGoogle Scholar | 21706990PubMed |
[14] Wells E. ANCI competencies: an investigation of uniqueness and importance. Nathan, Qld: Griffith University; 2002.
[15] Bellchambers H, McMillan M. The critical elements within a journey towards the achievement of quality use of medications. Collegian 2007; 14 31–6.
| The critical elements within a journey towards the achievement of quality use of medications.Crossref | GoogleScholarGoogle Scholar | 17294684PubMed |
[16] Fitzgerald M, Pearson A, Walsh K, Long L, Heinrich N. Patterns of nursing: a review of nursing in a large metropolitan hospital. J Clin Nurs 2003; 12 326–32.
| Patterns of nursing: a review of nursing in a large metropolitan hospital.Crossref | GoogleScholarGoogle Scholar | 12709106PubMed |
[17] Australian Nursing and Midwifery Accreditation Council. Application pack for education providers seeking accreditaion of nursing and midwifery programs leading to registration or endorsement, enrolled nurses version #112011. Dickson, ACT: Australian Nursing and Midwifery Accreditation Council; 2011.
[18] Australian Institute of Health and Welfare (AIHW). Nursing and midwifery labour force 2004. Canberra: AIHW; 2006.
[19] Newton J, Cross W, White K, Ockerby C, Billett S. Outcomes of a clinical partnership model for undergraduate nursing students. Contemp Nurse 2011; 39 119–128.
| Outcomes of a clinical partnership model for undergraduate nursing students.Crossref | GoogleScholarGoogle Scholar | 21955272PubMed |
