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Joyce-McCoach J, Ashworth P, Park SA, Kellerman T, McKenna L. Transition and pathway programs from second to first level nursing: A scoping review. NURSE EDUCATION TODAY 2023; 125:105777. [PMID: 36905747 DOI: 10.1016/j.nedt.2023.105777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/29/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
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.
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Affiliation(s)
| | | | - Seung A Park
- Chisholm Institute Higher Education, Berwick, Australia.
| | | | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, Australia.
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2
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Wiggins D, Downie A, Engel RM, Brown BT. Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:87. [PMID: 36564798 PMCID: PMC9786531 DOI: 10.1186/s12960-022-00783-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION A well-functioning health system delivers quality services to all people when and where they need them. To help navigate the complex realm of patient care, it is essential that health care professions have a thorough understanding of their scope of practice. However, a lack of uniformity regarding scope of practice across the regulated health professions in Australia currently exists. This has led to ambiguity about what comprises scope of practice in some health care professions in the region. OBJECTIVE The objective of this review was to explore the literature on the factors that influence scope of practice of the five largest health care professions in Australia. METHODS This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the five largest health care professions in Australia. The search was conducted using the following databases: AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE (Excerpta Medica Database), MANTIS (Manual, Alternative and Natural Therapy Index System), MEDLINE, PubMed, and SCOPUS. Additional data sources were searched from Google and ProQuest. RESULTS A total of 12 771 publications were identified from the literature search. Twenty-three documents fulfilled the inclusion criteria and were included in the final analysis. Eight factors were identified across three professions (nursing & midwifery, pharmacy and physiotherapy) that influenced scope of practice: education, competency, professional identity, role confusion, legislation and regulatory policies, organisational structures, financial factors, and professional and personal factors. CONCLUSION The results of this study will inform a range of stakeholders including the private and public arms of the healthcare system, educators, employers, funding bodies, policymakers and practitioners about the factors that influence scope of practice of health professions in Australia.
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Affiliation(s)
- Desmond Wiggins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Leon RJ, Moroney OAM, Fields L, Lapkin S. Exploring the role of the second-level regulated nurse in the Australian nursing workforce: An integrative review. Contemp Nurse 2022; 58:285-295. [PMID: 35881073 DOI: 10.1080/10376178.2022.2107040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
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Affiliation(s)
- Rebecca J Leon
- Director People and Culture, South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC 1871, N.S.W., Australia. T: +61 477 744 774, E: , Twitter: @RebeccaLeon01.,Honorary Professor, School of Nursing, Faculty of Science, Medicine & Health, Northfields Avenue, University of Wollongong, N.S.W. 2522, Australia, T: +61 409 396 825, E:
| | - O A M Moroney
- Director People and Culture, South Western Sydney Local Health District, Locked Bag 7279, Liverpool BC 1871, N.S.W., Australia. T: +61 477 744 774, E: , Twitter: @RebeccaLeon01
| | - Lorraine Fields
- Lecturer, School of Nursing, Faculty of Science, Medicine & Health, Northfields Avenue, University of Wollongong, N.S.W. 2522, Australia, T: +61 2 4221 5991, E: , Twitter: @Lane_Fields21
| | - Samuel Lapkin
- Senior Lecturer, School of Nursing, Faculty of Science, Medicine & Health South Western Sydney Campus, University of Wollongong, 33 Moore Street Liverpool N.S.W. 2170 Australia T: +61 2 8763 6227 E: , Twitter: @DrLapkin
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Murray J, Havlis J, Varvounis N. Four-hour swallow screening target for stroke - from guidelines to practice: A mixed methods knowledge translation study. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:519-528. [PMID: 33544000 DOI: 10.1080/17549507.2020.1858157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: To conduct systematic analysis of compliance with swallow screening against a 4-hour target timeframe and determine barriers and facilitators to compliance.Method: Knowledge translation approach using mixed methods. Quantitative data from a medium sized metropolitan hospital was extracted from 12-months of medical records to review timing of swallow screening from stroke admission using descriptive and inferential statistics. Qualitative data involved 14 semi-structured interviews of speech-language pathologists, registered nurses and medical officers and were analysed using the Theoretical Domains Framework.Result: 74% of eligible patients (271/365) received a swallow screen by trained nursing staff; 189 (52%) were within the 4-hour target. Screening was facilitated by quality training of nurses, strong belief in the benefits for patients and availability of the specialist stroke nurse. Quantitative analysis, confirmed through participant interviews as barriers, revealed that the strongest predictors of not meeting the 4-hour target were overnight admissions and not being admitted to the dedicated stroke unit.Conclusion: 52% of swallow screenings were performed within the 4-hour target timeframe recommended as best practice in the Australian and UK stroke guidelines. Barriers identified may assist other institutions improve compliance with the 4-hour timeframe that will likely be adopted internationally.
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Affiliation(s)
- Joanne Murray
- Caring Futures Institute, Flinders University, GPO, Adelaide, Australia
| | - Jana Havlis
- Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale, Australia
| | - Nicolette Varvounis
- Lyell McEwin Hospital, Northern Adelaide Local Health Network, Elizabeth Vale, Australia
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Assaye AM, Wiechula R, Schultz TJ, Feo R. Impact of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries: a systematic review. JBI Evid Synth 2021; 19:751-793. [PMID: 32881732 DOI: 10.11124/jbisrir-d-19-00426] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this review was to determine the effect of nurse staffing on patient and nurse workforce outcomes in acute care settings within low- and middle-income countries. INTRODUCTION Health care systems in low- and middle-income countries experience a high proportion of the global burden of disease, which is aggravated by several health care constraints. The high rates of both communicable and non-communicable diseases, low numbers in the workforce, poor distribution of qualified professionals, and constraints in medical supplies and resources make the provision of quality health care challenging in low- and middle-income countries. Health care systems in low- and middle-income countries, however, are still expected to address universal health care access and provide high-quality health care. Systematic reviews examining nurse staffing and its effect on patient and nurse workforce outcomes are largely from the perspective of high-income countries. There is a need to understand the evidence on nurse staffing and its impact in the context of low- and middle-income countries. INCLUSION CRITERIA Empirical studies that addressed acute care nurse staffing levels, such as nurse-to-patient ratio or nurses' qualifications, experience, and skill mix, and their influence on patient and nurse workforce outcomes were included in the review. Studies conducted in a low- or middle-income country were included. Outcomes must have been measured objectively using validated tools. METHODS Studies published until July 2019 were identified from CINAHL, PubMed, Scopus, Embase, PsycINFO, Cochrane Library, Web of Science, and ProQuest Dissertations and Theses. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. Narrative synthesis was conducted due to high heterogeneity of included studies. The level of evidence was determined using GRADEpro. RESULTS Twenty-seven studies were included in this review and the level of evidence was low, mainly due to the design of included studies. Low nurse-to-patient ratio or high nurse workload was associated with higher rates of in-hospital mortality, hospital-acquired infection, medication errors, falls, and abandonment of treatment. Findings on the effect of nurse staffing on length of hospital stay and incidence of pressure ulcers were inconsistent. Extended work hours, less experience, and working night or weekend shifts all significantly increased medication errors. Higher nurse workload was linked to higher levels of nurses' burnout, needlestick and sharps injuries, intent to leave, and absenteeism. CONCLUSIONS Lower nurse-to-patient ratios and higher nurse workload are linked to in-hospital mortality, hospital-acquired infections, and medication errors among patients, and high levels of burnout, needlestick and sharps injuries, absenteeism, and intention to leave their job among nurses in low- and middle-income countries. The results of this review show similarities with the evidence from high-income countries regarding poor outcomes for patients and nurses. These findings should be considered in light of the lower nurse-to-patient ratios in most low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42018119428.
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Affiliation(s)
| | - Richard Wiechula
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia.,Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia
| | - Timothy J Schultz
- Adelaide Nursing School, The University of Adelaide, Adelaide, SA, Australia.,Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Lucas G, Brook J, Thomas T, Daniel D, Ahmet L, Salmon D. Healthcare professionals' views of a new second-level nursing associate role: A qualitative study exploring early implementation in an acute setting. J Clin Nurs 2021; 30:1312-1324. [PMID: 33497521 DOI: 10.1111/jocn.15675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/14/2020] [Accepted: 01/07/2021] [Indexed: 11/28/2022]
Abstract
AIM The study aimed to establish the views of a range of stakeholders about their experiences of the newly implemented nursing associate role in England and its potential to contribute to patient care. BACKGROUND Second-level nursing roles are increasingly used internationally within the healthcare workforce. In response to registered nurse workforce deficits, a new nursing associate role has been introduced in England to augment care provided by registered nurses and enable career progression of support workers. DESIGN Qualitative descriptive design. METHODS Semi-structured interviews and a focus group were conducted with a range of healthcare professionals in a large inner city acute secondary care healthcare organisation in England. Interviews were guided by the Consolidated Framework for Implementation Research and analysed using Framework Analysis. The study was reported according to COREQ guidelines. RESULTS 33 healthcare professionals were interviewed-directors of nursing, ward managers, nursing associates and multidisciplinary team members. Participants perceived the role was broadly adaptable to different healthcare settings and provided a positive professional development mechanism for healthcare support workers. Managers felt training commitments made implementing the role complex and costly. Participants argued the role had limitations, particularly with intravenous medicine management. Implementation was impeded by rapid pace and consequent lack of clear communication and planning. CONCLUSIONS The nursing associate role was perceived as an inclusive pathway into nursing but with limitations when working with high-acuity patients. Further evaluation is needed to investigate how the role has embedded over time. RELEVANCE TO CLINICAL PRACTICE The role should be seen as both a stepping stone into registered nursing positions and valued as part of the nursing workforce. Consideration must be given to how the role can be safely implemented in different settings. Findings have relevance to healthcare leaders internationally, who continue to work in a climate of economic pressure and staffing shortages.
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Affiliation(s)
| | | | - Tamara Thomas
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Dionne Daniel
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Leyla Ahmet
- City, University of London, London, UK.,Barts Health NHS Trust, The Royal London Hospital, London, UK
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Lucas G, Daniel D, Thomas T, Brook J, Brown J, Salmon D. Healthcare professionals' perspectives on enrolled nurses, practical nurses and other second-level nursing roles: A systematic review and thematic synthesis. Int J Nurs Stud 2020; 115:103844. [PMID: 33383272 DOI: 10.1016/j.ijnurstu.2020.103844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/08/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Grace Lucas
- City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Dionne Daniel
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Rd, London E1 1BB, United Kingdom.
| | - Tamara Thomas
- Barts Health NHS Trust, The Royal London Hospital, Whitechapel Rd, London E1 1BB, United Kingdom.
| | - Judy Brook
- City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Jennie Brown
- City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
| | - Debra Salmon
- City, University of London, Northampton Square, London EC1V 0HB, United Kingdom.
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9
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Chua WL, Legido-Quigley H, Ng PY, McKenna L, Hassan NB, Liaw SY. Seeing the whole picture in enrolled and registered nurses’ experiences in recognizing clinical deterioration in general ward patients: A qualitative study. Int J Nurs Stud 2019; 95:56-64. [DOI: 10.1016/j.ijnurstu.2019.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 11/29/2022]
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10
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Leon RJ, Tredoux JH, Foster SM. Valuing Enrolled Nurses – A study to better understand the investment education and training have on the retention of Enrolled Nurses. Collegian 2019. [DOI: 10.1016/j.colegn.2018.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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McKenna L, Wood P, Williams A, O’Connor M, Moss C, Griffiths D, Della P, Endacott R, Cross W. Scope of practice and workforce issues confronting Australian Enrolled Nurses: A qualitative analysis. Collegian 2019. [DOI: 10.1016/j.colegn.2018.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Assaye AM, Wiechula R, Schultz TJ, Feo RR. Impact of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:2260-2267. [PMID: 30024436 DOI: 10.11124/jbisrir-2017-003707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to demonstrate the effect of nurse staffing on patient and nurse workforce outcomes in acute care settings in low- and middle-income countries.
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Affiliation(s)
- Ashagre Molla Assaye
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Richard Wiechula
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence
| | - Timothy J Schultz
- Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
- The Centre for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Centre of Excellence
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Dalton L, Campbell S, Bull R. Preparing the nursing workforce for the next era: Re-classifying and reframing enrolled nursing knowledge. Collegian 2018. [DOI: 10.1016/j.colegn.2017.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Endacott R, O'Connor M, Williams A, Wood P, McKenna L, Griffiths D, Moss C, Della P, Cross W. Roles and functions of enrolled nurses in Australia: Perspectives of enrolled nurses and registered nurses. J Clin Nurs 2018; 27:e913-e920. [DOI: 10.1111/jocn.13987] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ruth Endacott
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
- School of Nursing & Midwifery; Drake Circus; Plymouth University; Plymouth UK
| | - Margaret O'Connor
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
| | - Allison Williams
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
- School of Health Sciences; University of Melbourne; Carlton Vic. Australia
| | - Pamela Wood
- Eastern Institute of Technology; Napier New Zealand
| | - Lisa McKenna
- School of Nursing and Midwifery; La Trobe University; Bundoora Vic. Australia
| | - Debra Griffiths
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
| | - Cheryle Moss
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
| | - Phillip Della
- School of Nursing, Midwifery and Paramedicine; Curtin University; Bentley WA Australia
| | - Wendy Cross
- School of Nursing and Midwifery; Monash University; Clayton Vic. Australia
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Birks M, Davis J, Smithson J, Cant R. Registered nurse scope of practice in Australia: an integrative review of the literature. Contemp Nurse 2016; 52:522-543. [DOI: 10.1080/10376178.2016.1238773] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Murray-Parahi P, Edgar V, Descallar J, Comino E, Johnson M. ENsCOPE: Scoping the Practice of Enrolled Nurses in an Australian Community Health Setting. Int Nurs Rev 2016; 64:59-68. [PMID: 27652574 DOI: 10.1111/inr.12305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A continuing shift of healthcare delivery from hospital to the community has increased the acuity and complexity of care provided in the home. Global financial crises and nursing shortages have prompted policies supporting two tiers of nursing and expansion of the licensed practical nurse, second level or enrolled nurse role and evoked debate surrounding roles traditionally undertaken by registered nurses. Community nursing offers unique challenges for enrolled nurses wanting to enact their full scope of practice. AIM To compare and describe registered and enrolled nurse opinions of their current and potential enrolled nurse scope of practice in the community health setting. METHODS A cross-sectional survey of 136 nurses (115 registered and 21 enrolled nurses) was undertaken within a large community nursing team in Australia. Participants reported their opinions of enrolled nurse scope of practice based on 27 core community nursing skills. RESULTS Although substantial agreement was evident, there were statistically significant differences between registered nurse and enrolled nurse opinions in core skill areas; 'Patient Education' and 'Clinical Observation'. Registered nurses identified some specialized skills-catheter and gastrostomy care-that could be undertaken by enrolled nurses with further education. CONCLUSION We confirm that registered nurses do agree with extending the skills of enrolled nurses. Education approaches that build shared confidence in enrolled nurse advanced skills are recommended. IMPLICATIONS FOR NURSING AND HEALTH POLICY The future supply of nurses is at risk. There are limited resources and increasing demand for quality health care where people live and work. While there may be opportunities internationally to improve productivity through advanced nursing roles, these policies should prioritize efficiency by firstly promoting the full enactment of nursing skills in these settings.
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Affiliation(s)
- P Murray-Parahi
- Centre of Cardiovascular and Chronic Care, Faculty of Nursing Midwifery and Health, University of Technology Sydney, Sydney, NSW, Australia.,Caroline Chisholm Centre, Liverpool Hospital, Liverpool, NSW, Australia.,Primary & Community Health Nursing, SWSLHD, Liverpool, NSW, Australia
| | - V Edgar
- Primary & Community Health Nursing, SWSLHD, Liverpool, NSW, Australia
| | - J Descallar
- The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,South Western Sydney Clinical School UNSW, Sydney, NSW, Australia
| | - E Comino
- The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Centre for Health Equity Training Research and Evaluation (CHETRE), UNSW Centre for Primary Health Care and Equity, A Unit of Population Health, South Western Sydney and Sydney Local Health Districts, NSW Health, Sydney, NSW, Australia
| | - M Johnson
- The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.,Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia.,Centre for Applied Nursing Research, South Western Sydney Local Health District & University of Western Sydney, Liverpool, NSW, Australia (Affiliated with the Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia)
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Davis J, Morgans A, Birks M, Browning C. The rhetoric and reality of nursing in aged care: views from the inside. Contemp Nurse 2016; 52:191-203. [DOI: 10.1080/10376178.2016.1221326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
BACKGROUND In Australia, newly graduated registered nurses enter the workforce and a number of these have previous experience as enrolled nurses. For all newly graduated registered nurses, transitioning to the new role can be challenging. AIM The aim of this study was to explore the experiences of enrolled nurses transitioning to the role of registered nurses to support the development of effective transition programs. DESIGN An exploratory qualitative design. METHODS In-depth interviews with a purposive sample from one health service in South East Queensland, Australia. Data were analysed thematically. FINDINGS The three main themes emerging from analysis: a new scope of practice, perceptions of capability, building on experience and knowledge. CONCLUSIONS We recommend assessment of individual learning needs and support during the transition period which acknowledges previous experience and recognises learning required to effectively transition to the role of a registered nurse.
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Affiliation(s)
- Canice Brown
- a Nursing and Midwifery Education & Research Unit , Gold Coast Health , Southport , Australia
| | - Mark Baker
- a Nursing and Midwifery Education & Research Unit , Gold Coast Health , Southport , Australia.,b School of Nursing and Midwifery , Griffith University , Gold Coast , Australia
| | - Melanie Jessup
- c School of Nursing and Midwifery , Australian Catholic University , Banyo , Australia.,d Nursing Research & Practice Development Unit , Metro North Hospital and Health Service , Fortitude Valley , Australia
| | - Andrea P Marshall
- a Nursing and Midwifery Education & Research Unit , Gold Coast Health , Southport , Australia.,b School of Nursing and Midwifery , Griffith University , Gold Coast , Australia.,e Griffith Health Institute , Griffith University , Gold Coast , Australia
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Jacob ER, McKenna L, D’Amore A. Senior nurse role expectations of graduate registered and enrolled nurses in Australia: Content analysis of open-ended survey questions. Contemp Nurse 2015. [DOI: 10.1080/10376178.2014.11081943] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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