Enrolled Nurse Education

Glenda Whiting Principal Lecturer TAFE SA North

Introduction
The roles and responsibilities of Enrolled Nurses (ENs) have advanced significantly over the last decade and the education and training has changed accordingly These changes have resulted in different perceptions and beliefs on the scope of practice of the EN

EN education - past
Hospital based training for both RNs & ENs During the 1990s training moved into the vocational & educational training (VET) and the private sector. The first VET qualification being the Certificate IV in Community & Aged Care+ EN Short Course In the mid 1990s the Victorian Enrolled Nurse curriculum was customised for South Australia, the Certificate IV in Health (Nursing) (17 units of competence)

EN education - past
In 2003 the NBSA approved the Queensland Training Product for Enrolled Nurses, the Diploma of Nursing. This document was customised for South Australia and contained units from the Health Training Package (HLT02) The first students commenced this qualification at TAFE SA in Semester 1, 2004 Diploma of Nursing (Pre enrolment) 20 units of competence WA, SA and QLD moved from entry level Certificate IV qualification to a Diploma qualification.

 The deficiencies of the Certificate IV and the perceived role of the EN led to the development and accreditation of a Diploma. Increasingly ENs were being employed in the acute care sector and the acuity of residents in aged care facilities required an increased depth of knowledge and skills.

EN education - present
Health Training Package 2007 (HLT07) Diploma of Nursing
26 units of competence
21 compulsory 5 electives

18 month program or part time equivalent Clinical placements x 3

Aged Care 120 hours Primary Health Care 70 hours Acute Care 210 hours

Diploma of Nursing
Compulsory units include HLTEN401B Work in the nursing profession HLTEN502B Apply effective communication skills in nursing practice HLTIN301C Comply with infection control policies and procedures in health work HLTOHS300B Contribute to OHS processes HLTHIR404D Work effectively with Aboriginal and Torres Strait Islander People HLTHIR403C Work effectively with culturally diverse clients and co-workers

Diploma of Nursing
Compulsory units include HLTEN516B Apply understanding of the Australian health care system HLTEN509B Apply legal and ethical parameters to nursing practice HLTAP401B Confirm physical health status HLTAP501B Analyse health information HLTEN503B Contribute to client assessment and developing nursing care plans HLTEN508A Apply reflective practice, critical thinking and analysis in health

Diploma of Nursing
Compulsory units include HLTEN504B Implement and evaluate a plan of nursing care HLTEN505B Contribute to the complex nursing care of clients HLTEN506B Apply principles of wound management in the clinical environment HLTEN507B Administer and monitor medications in the work environment HLTEN510B Implement and monitor nursing care for consumers with mental health conditions

Diploma of Nursing
Compulsory units include HLTFA301B Apply First Aid HLTEN513A Implement and monitor nursing care for clients with chronic health problems HLTEN515A Implement and monitor nursing care for older clients HLTEN512A Implement and monitor nursing care for clients with acute health problems

Diploma of Nursing
Electives may include HLTEN514B Apply research skills within a contemporary health environment HLTEN511B Provide nursing care for clients requiring palliative care CHCAOD2C Orientation to alcohol and other drugs sector HLTAN510B Use advanced health terminology in a professional context HLTEN610B Practise in the cardiovascular nursing environment HLTEN612A Practise in the perioperative nursing environment

Definitions
The enrolled nurse is an associate to the registered nurse who demonstrates competence in the provision of patient-centred care as specified by the registering authoritys licence to practise, educational preparation and context of care.
ANMC National competency standards for the enrolled nurse

Following is a statement from the Nursing and Midwifery Board of Australia (NMBA) which gives a description of what is expected of the Enrolled Nurse (EN) on entry to practice.

Core enrolled nurse responsibilities the provision of patient-centred nursing care recognition of normal and abnormal in assessment, intervention and evaluation of individual health and functional status monitor the impact of nursing care ongoing communication with RN regarding the health and functional status of individuals.

Core enrolled nurse responsibilities provide support and comfort, assisting with activities of daily living to achieve an optimal level of independence provide for emotional needs of individuals administer prescribed medicines or maintain intravenous fluids, in accordance with educational preparation be information technology literate with specific skills in the application of health care technology

Core enrolled nurse responsibilities demonstrate critical and reflective thinking skills in contributing to decision making which includes reporting changes in health and functional status and individual responses to health care interventions work as a part of the health care team to advocate for and facilitate the involvement of individuals, their families and significant others in planning and evaluating care and progress toward health outcomes

Clinical practices delegated to ENs

Complete fall, cognitive and pressure risk assessments Complete admission using nursing assessment tool Activate units of care on Excel Care Changing care plan in response to assessment of patients observations Change wound dressings Change IV solution/refill burettes without additives Insert & remove IDCs Perform ECGs

Clinical practices delegated to ENs

Check and care for patients with IVs containing additives Administer medications, including: IM & S/C injection, oral, topical, transdermal, rectal, vaginal, ear, eye, nasal and via inhaler or nebuliser Check drugs of dependence Regulate and monitor blood transfusions Provide education to patient & family on pre-existing disease processes, preoperative, procedures, discharge medications

EN Scope of Practice
Determined by legislation and professional standards but also by organisation policy Organisation policy often developed from a consensus opinion of nursing managers/practitioners - not through examination educational preparation & legal and professional standards A review of nursing procedures identified that many were contradictory to, and are out of step with, the current educational preparation of the Enrolled Nurse.
The Repatriation General Hospital, South Australia (Oct 2003)

Areas open to interpretation

The scope of practice of ENs varies between health care organisations, health care organisations own wards/units & between different staff on the same ward/unit, mainly in the areas of: Assessment & care planning Medication & fluid management Invasive clinical interventions Health education and evaluation of outcomes

Understanding RN & EN roles

RNs are responsible for prescribing care and delegating to a competent RN or EN In delegating care RNs must have an understanding of the level of competence and critical thinking required to perform an activity and match this to the appropriate level of the nurse ENs works under the direction and supervision (direct or indirect) of the RN but are responsible for their own actions and are accountable to the RN for all delegated activities

Enrolled Nurse education - future

Educational providers and health care organisations must adhere to the ANMC competency standards that articulate the differences between, and common areas of nursing practice by RNs & ENs Health care organisations should ensure policies reflect the educational preparedness of ENs and these need to be understood at a grass-roots level

Advanced Diploma of Nursing 7 units of competence

2 core
Research Assess and manage client care

5 electives
Mental health Palliative care Paediatrics Orthopaedics Acute care Cardiac care Perioperative Rural and remote Rehabilitation Pathology Disability Aged Care

Conclusion
The view that ENs scope of practice is limited to activities of daily living and basic care needs is out-dated The Diploma of Nursing is reflecting their increased scope of practice Education providers and health care organisations in collaboration with policy makers need to address the varying interpretations of the EN scope of practice

Conclusion EN perspective
A positive and exciting time for ENs in SA
ENs have not had many opportunities in the past to improve their skills and knowledge I have a leadership role in high care, this includes administering medication, liaising with Drs, wound management & supervising staff. The Diploma of Nursing is a positive step for ENs ENs with a Diploma will receive increased pay rates this financial recognition is important to me I have been working in acute care for 20 years, at last there is an opportunity to update to a contemporary qualification