Enrolled nurses: where do they go from here?

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.

The changing skill mix in nursing: considerations for and against different levels of nurse

AIM

To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs.

BACKGROUND

Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care.

EVALUATION

Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs.

KEY ISSUE

The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity.

CONCLUSION

Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality.

IMPLICATIONS FOR NURSING MANAGEMENT

When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.

Knowing nursing and finding the professional voice: a study of enrolled nurses converting to first level registration

This study explored the experiences of a group of second level registered nurses converting to first level registration in a two-year, part-time open learning programme. It aimed to examine the relationship between the mode of course delivery and the personal and professional development experienced by the learners. Data were collected by semi-structured interviews, conducted at five points over the two-year period and analyzed by constant comparative analysis. A theoretical model was developed to demonstrate the stages of knowing nursing, experienced by the students as they made the transition from passive to autonomous professional practice. In their 'Women's Ways of Knowing' [Belenky M.F., Clinchy B.A., Goldberger N.R., Tarule J.M., 1986. Women's Ways of Knowing. Basic Books, New York] identified a progression through different stages of thinking about the nature of knowledge and evidence. This progression was evident in the nurses in this study. It was applied and developed to reflect the progression through ways of knowing nursing. This process consisted of three positions of development, each underpinned by their associated ways of knowing [Belenky M.F., Clinchy B.A., Goldberger N.R., Tarule J.M., 1986. Women's Ways of Knowing. Basic Books, New York] and characterized by a specific approach to professional nursing practice. The changing ways of knowing nursing, described in this paper, are likely to be observed in registered nurses and health care assistants who are now entering Higher Education (HE) to undertake higher awards for the first time. A clearer understanding of this process of personal and professional change, and factors that impact upon it, will be a useful guide for those supporting learners both in the clinical and academic arenas.

Contemporary enrolled nursing practice: Opportunities and issues

Over the last decade, Australia, as with the rest of the developed world, has experienced a widespread labour market decline in the numbers of nurses in the health workforce. Concurrent with this nursing shortage, the second level nurse has, in many countries, ceased to be recognised as a legitimate nursing role. In Australia, recent research indicates that the enrolled nurse role, though contentious, is consolidating as a core component of the health care workforce. This paper reports on national research that examined the role and function of the enrolled nurse in Australia and reviewed the Australian Nursing Council Inc (ANCI) National Competency Standards for Enrolled Nurses. Specific issues related to the contemporary role and function of enrolled nurses, namely supervision, scope of practice and education, are also discussed.

The perceived benefits of the enrolled nurse conversion course on professional and academic advancement

A study by Seccombe et al. (1997) for the United Kingdom Central Council (UKCC) found that seven in ten nurses who responded to their study perceived that there was no future for enrolled nurses (ENs). Conversion to first level registration is seen as a means by which ENs can progress in their career and there are an estimated 36 000 nurses who may still seek to convert. There is little evidence in the literature to indicate the value of conversion courses for ENs, yet Health Minister Alan Milburn plans to increase the number of places on conversion courses including funding 2700 places (Watson 1998). Evidence of the value of conversion would be helpful to individuals, teachers and managers rather than relying on anecdotal evidence of progress on which to judge its success or otherwise. The aims of conversion courses include the development of nursing knowledge, clinical skills and attitudes. In this study, a questionnaire is used to determine the perceived benefits to the individual who has undertaken a conversion course and the impact it has on career advancement, both professional and academic. The statements used are developed from a small exploratory study carried out by the authors (Allan & McLafferty 1999) in which it became clear that there were indeed positive changes in knowledge, skills and attitudes with as many as 90% of respondents having commenced or considering further study. The authors have broadened the study to include all Schools of Nursing and Midwifery who offer an EN conversion course in Scotland.

The road to conversion for enrolled nurses: a literature review

The literature concerning the plight of the enrolled nurse (EN) is extensive. This article examines published material from the last 10-12 years to consider the problems that ENs experience in relation to professional development and career advancement. For many ENs, conversion to first-level registration is seen as the only means of progress and possibly the only means of retaining a career. However, does conversion actually achieve progress? The literature on this subject is scarce but reports suggest that converted ENs do go on to achieve promotion and make use of educational opportunities (Crotty, 1990; MacGregor and Hill, 1996). Nevertheless, there is a substantial number of ENs who have no desire to convert to first-level registration and their role should be valued.