Work is still needed to change some of the attitudes and myths in health leadership about the enrolled nurse role, says enrolled nurse national leader Leonie Metcalfe.
Metcalfe, chair of the Enrolled Nurse Section of the New Zealand Nurses Organisation, was speaking during a panel discussion on growing the EN workforce at the section’s recent conference in Christchurch. Currently the EN workforce numbers are still falling, and some district health boards are reluctant to employ ENs, despite the 18 month enrolled nurse diploma now being offered by seven nursing schools.
“I think we need our health leaders to champion the role of enrolled nurses as part of the wider health team,” said Metcalfe. “We need to ensure that employers are including enrolled nurses in their workforce planning so they are developing models of care that include the EN role.”
She said currently ENs can work across the whole spectrum so should not be restricted from practising in any setting including primary care and mental health. “We need to dismiss the myths as it is easy to say enrolled nurses can’t and it is harder for them to say enrolled nurses can.”
Suzanne Rolls, NZNO professional advisor for the EN section, set the scene for the panel by saying the enrolled nurse diploma qualification, offered by seven nursing schools across the country, was well-placed to create an enrolled nurse workforce to help meet the future health needs of the ageing population. “And employers need to make the opportunities to make the best use of opportunities now – before health service demands increases any further and there are fewer nurses available.”
She said there had only been 1052 graduates enter the workforce supply since starting re-training enrolled nurses in 2001 which had not been enough to replace ENs retiring in the ageing workforce.
Nursing Council statistics show there were around 6,500 enrolled nurses in 1993 when hospital-based EN training ended. This had dropped to just over 4000 in 2002 when the first EN training programmes re-commenced but controversy over titles, scopes and qualifications continued during the 2000s. The current 18 month diploma was not launched until 2011 by which time EN numbers had fallen to around 3000 and have continued to fall and in 2017 were down to 2,648.
“So we’ve got a long way to go to ensuring that we get back to 2011 levels and actually increase those numbers,” said Rolls.
Also on the panel was Mary Gordon, executive director of nursing for Canterbury District Health Board has been one of the most supportive DHBs of enrolled nurses since training recommenced in 2001.
She told the conference that back in 2001 people were saying ‘what are we going to do with all these people once we train them’. “And I remember thinking at the time – and looking at the age profile of the enrolled nurse workforce we had at the time – and I said we’ll be lucky if we can replace those are due to retire and keep ahead of that.”
Gordon said 7.5 per cent of Canterbury workforce was enrolled nurses but “we could easily do with doubling that, if not more, and there would be employment.” She believed a starting point to building the EN workforce was to make nursing more attractive as a career to prospective nurses across the population and age spectrum.
Dr Cathy Andrew, head of the Ara Institute of Canterbury school of nursing, said one of the barriers to rebuilding the EN workforce was her generation of registered nurses who were lead to believe in the 1980s and 90s that the “only nurse was a registered nurse” and that ENs were being phased out.
She said when the first training programmes were about to be introduced in Northland and Christchurch in 2001-02 she was a very new head of school. “At the time I was a meeting in Wellington and I was bailed up – for want of a better word – by the then chief nurse, the chair of the Nursing Council and the chief executive of the Nursing Council,” recalls Andrew. “I was young, I was new in the job and I was told I had to find a way of stopping enrolled nursing being brought back in by Canterbury DHB and CPIT as it was then.”
Andrew said her generation had been told that patients would do better under a totally RN workforce but she said this was based on actually “quite flawed” research as often it was comparing a total RN workforce to an RN workforce supported by unregulated assistants rather than a regulated enrolled nurse style workforce. She said she was now a convert to the EN role – and with the EN scope of practice now broadened – she believed that now the barrier to employing ENs was the ‘artificial’ barrier of the attitude of her generation of nurse managers rather than regulatory barriers.
Dianne Martin, chief executive officer of the Registered Practical Nurses Association of Ontario, told the conference that unlike New Zealand in Ontario the EN workforce equivalent – the Registered Practical Nurse (RPN) – was actually increasing and was a very young workforce. She said it was the registered nurse workforce in Ontario that was the oldest and the net number of RNs were actually decreasing as a proportion of the nursing workforce so all nursing groups had agreed it needed to work on resolving the RN shortage.
But she said Ontario’s RPNs were also facing a lot of pushback from RNs who saw RPNs as taking their jobs but she said RNs should not feel threatened by an EN/RPN workforce if they are doing a job that only an RN can do.
Metcalfe also told the conference that new graduate ENs, like their registered nurse (RN) colleagues needed support to safely enter into practice so they could fully utilise their nursing skills to meet the needs of health consumers. She said the section was working with the Ministry of Health on a generic orientation programme and also on a living document on addressing the barriers to ENs being employed
Enrolled Nurse Timeline
1993 Hospital-based enrolled nurse programmes end.
2000 Labour government initiates return of EN programmes.
2002 First one-year, narrow-scope EN programmes start.
2004 Title changed to nurse assistant.
2008 Advisory group calls for higher, generic scope EN.
2009 Nursing Council backs call for broader scope and agrees on EN title.
2011 Current 18 month diploma of enrolled nursing begins