Valuing Enrolled Nurses – A study to better understand the investment education and training have on the retention of Enrolled Nurses

The voice of the second-level regulated nursing role: a qualitative approach

BACKGROUND

With an international nursing shortage, there is a need to navigate towards an improved nursing workforce structure where each nursing role is valued and recognised for the work they contribute. The second-level regulated nursing role is seen as integral; however, there is role confusion, especially with the registered nurse, and high attrition. To implement strategies to retain an integral nursing workforce, there is a need to better understand the role from the experiences and expectations of the second-level regulated nursing role.

AIM

To gain a better understanding of the second-level regulated nursing role in the Australian nursing workforce.

DESIGN

Qualitative descriptive study from a larger mixed methods study.

METHOD

Five focus groups in 2018. The findings were analysed through the lens of organisational behaviour.

RESULTS

The findings identified that enrolled nurses' intrinsic and extrinsic motivators influenced levels of job satisfaction and sense of feeling valued. The findings also identified key determinants that influence job satisfaction and occupational stress: enrolled nurses' understanding of their role and scope of practice; the registered nurses' understanding of the enrolled nurses' role and their role when working with the enrolled nurse; and the organisation's understanding and recognition of their role. When these determinants align, there is job satisfaction, less occupational stress and enrolled nurses feel valued. At a professional level, the title does not reflect the role, and there are no career pathways.

CONCLUSION

This study explained why recurrent challenges impact the role and what contributes to those in the role feeling valued. Challenges that affect job satisfaction and occupational stress for the second-level (enrolled) nurse are related to the working environment and with whom the nurse works. From a professional level, there are limited career opportunities that recognise and retain the enrolled nurse in their role.

A Massive Open Online Course Delivered Just-in-Time: A Cohort Study

BACKGROUND

Just-in-time education enables knowledge improvement during health crises. This study was conducted to determine whether nurses' knowledge improved after participating in an innovative online education intervention designed to upskill subacute nurses to prepare for a health crisis.

METHOD

The intervention was developed by university nursing academics and supported and promoted through a partnership with a government health department and clinical nurses. Quantitative data obtained with a pretest/post-test knowledge survey were analyzed with independent samples and paired t tests.

RESULTS

Statistically significant improvements were seen in nurses' knowledge according to qualification level. The mean difference for knowledge improvement for registered nurses was 1.90, SD = 2.54, and the mean difference for knowledge improvement for enrolled nurses was 2.93, SD = 2.43 (mean difference = 1.03; 95% CI [0.04, 2.03].

CONCLUSION

The intervention was highly effective during the emergent and ongoing phases of the coronavirus disease 2019 pandemic. This study showed that delivering just-in-time education can improve nurses' knowledge. [J Contin Educ Nurs. 2023;54(10):472-479.].

Transition and pathway programs from second to first level nursing: A scoping review

BACKGROUND

Second-level nurses comprise a large proportion of the nursing workforce in many countries. Despite differences in nomenclature, these nurses work under the supervision of first-level registered nurses and possess a more restricted scope of practice. Transition programs facilitate second-level nurses upgrading their qualifications to become first-level nurses. Globally, the impetus for transition of nurses to higher levels of registration has been to increase the skill mix demands in health care settings. However, no review has sought to explore these programs internationally and experiences of those making the transition.

OBJECTIVES

To explore what is known about transition and pathway programs from second to first level nursing.

DESIGN

Scoping review informed by the work of Arksey and O'Malley.

DATA SOURCES

Four databases were searched, CINAHL, ERIC, Proquest Nursing and Allied Health and DOAJ, using defined search strategy.

REVIEW METHODS

Titles and abstracts were uploaded into the online program Covidence for screening, followed by full-text screening. Two members of the research team screened all entries at both stages. Quality appraisal was performed to assess overall quality of research.

RESULTS

Transition programs are often undertaken to open up career pathways, job and financial advancement. These programs can be challenging as students seek to maintain dual identities, grapple with academic requirements and juggle work, study and personal demands. Despite their prior experience, there is a need for students to receive support as they adjust to their new role and scope of practice.

CONCLUSION

Much of the existing research around second to first-level nurse transition programs is dated. There is a need for longitudinal research to examine students' experiences as they transition across the roles.

Exploring the role of the second-level regulated nurse in the Australian nursing workforce: An integrative review

BACKGROUND

The enrolled nurse is the second-level regulated nursing role in Australia, with similar roles in other Organisation for Economic Co-operation and Development countries. A plethora of reports and research papers indicate that this role is seen as integral but under scrutiny by the nursing profession and government bodies. Despite changes such as national accreditation and registration requirements there is a lack of role clarity and delineation, especially between the registered nurse and enrolled nurse roles. As a key nursing role there is the need to ensure it is understood and used to its potential in the nursing workforce.

AIM

To explore key issues that may impact the role of the EN in the Australian nursing workforce.

DESIGN

An integrative review.

METHODS

A seven-step framework was used to review peer-reviewed research papers, scholarly and published government documents, grey literature and government data.

RESULTS

The review identified three themes from 24 documents: understanding the enrolled nurses' scope of practice, standardised practice, and career development.

DISCUSSION

It is posited that a lack of understanding of the enrolled nurses' scope of practice creates confusion between the nursing roles and a lack of standardised practice. There is also an expectation that the enrolled nurses' career progression is to become a registered nurse, which is supported by the high dual registrations. Collectively these factors contribute to the enrolled nurse not feeling valued. Similar challenges to the equivalent role are found internationally.

CONCLUSION

The literature demonstrates a lack of understanding of the enrolled nurse role by the nursing profession. Further work is required to better understand the role and its place in the Australian nursing workforce.

IMPACT STATEMENT

Better understanding of the enrolled nurses' role and its place in the nursing workforce is needed to progress this role.

Healthcare professionals' perspectives on enrolled nurses, practical nurses and other second-level nursing roles: A systematic review and thematic synthesis

BACKGROUND

Significant workforce shortages and economic pressures have led to the expanded scope and reintroduction of new roles for second-level nurses in many Organization for Economic Co-operation and Development countries. Given this, there is a need to understand the emic and etic perspectives of second-level nurses, to ensure collaborative teamwork and safe patient care.

OBJECTIVE

This review aimed to systematically identify, appraise, and synthesize qualitative research evidence on healthcare professionals' perspectives on second-level nursing roles in the healthcare workforce. These findings inform recommendations that would influence the development and implementation of these roles in healthcare organisations.

DESIGN

A systematic review and thematic synthesis of qualitative research was conducted. Six databases were systematically searched and forward and backwards searching completed. Included studies focused on healthcare professionals' perspectives (including views of second-level nurses themselves) on second-level nursing roles. All included articles were from Organization for Economic Co-operation and Development countries. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the evidence quality. The results section of each included article was coded and descriptive themes were developed. An interpretative and iterative process led to the final analytic themes.

FINDINGS

Twenty-six qualitative studies were identified from five countries over 26 years. Four analytic themes were identified: undifferentiated role; efficient but limited; subordinated task-doers; and broadening scope and strengthened identity. The synthesis demonstrated dichotomies wherein some second-level nursing roles were devalued, and others had increasing scope and responsibility. Role and boundary confusion was evident and had not decreased over time. Hierarchies in nursing practice underlined the split between critical thinking and hands-on approaches to care which, in some cases, debased the second-level nursing role because of its association with practical hands-on care.

CONCLUSIONS

The analytic themes in this synthesis suggest that second-level nurses have faced the same issues over decades with little change. Perceptions of second-level nursing roles are primarily influenced by meso (organisational level) factors and micro (individual, behavioural) factors. The synthesis concludes that a cultural shift in valuing the hands-on care provided by second-level nursing is necessary, along with systems-level shift that clarifies the role of second-level nursing within healthcare teams to enhance collaborative practice. Further research should attend to macro-level influences on perceptions of second-level nurses, the work they do, and how this is valued or institutionally embedded. Tweetable abstract: Healthcare professionals' perspectives on second-level nursing roles: a systematic review and thematic synthesis.