Enrolled nurse title revived

1 February 2010

WORKFORCE/FIONA CASSIE

After a decade of debate and division a stepped-up enrolled nurse role is officially back. The Nursing Council in December voted to create a single generic scope for all second-level nurses and for the scope to be called enrolled nurse.

The decision has been warmly welcomed as a Christmas present by existing enrolled nurses and the New Zealand Nurses Organisation, viewed as a workable resolution to the issue by many others, but mourned by some.

Still awaited with interest are details of how current second-level nurses will be transitioned into the scope and the education standards.

Council chief executive Carolyn Reed said the council was pleased to make a decision backed by the majority of submitters. She said it would enable enrolled nurses to have a greater role in assessment and work as part of a team with registered nurses in a variety of settings including acute.

It would also enable enrolled nurses to lead unregulated workers in aged care settings, though still under the direction and delegation of a registered nurse.

The council received 460 submissions on the ongoing and contentious issue, including 79 from organisations and 311 individual submissions on NZNO forms.

Just over 60 per cent of non-NZNO organisation submitters supported the title enrolled nurse for the new generic scope but this swelled to 82 per cent when all submissions were considered.

Chief nurse Mark Jones said the council had made a “bold and pragmatic step” to resolve how second-level nurses were used “once and for all”. “I’m clear that we now have a robust future for the enrolled nurse in the New Zealand health care system.”

Among the third of organisations not supportive of the enrolled nurse title or wider scope were the College of Nurses with executive director Dr Jenny Carryer severely disappointed by the decision.

“It will take us back to the very reasons that we abandoned this journey in the early 1990s,” said Carryer. And she added that the adage “those who cannot remember the past are condemned to repeat it” was apt.

Gary Lees, chair of the nurse executive group NENZ, was pleased to see a single, wider scope and said the role of the new ENs would become more obvious when the education standards and competencies were released next year.

He said with ENs required to work in teams with RNs in acute settings, the ability of RNs to “appropriately” direct and delegate would also be important in how the new EN role evolved in the workplace.

Jim Green, District Health Boards New Zealand nursing and midwifery workforce strategy group spokesman, said the decision met the boards’ desire for more flexibility and greater clarity about the EN role and its relationship as a support role to the RN workforce.

He said DHBs currently had a variety of models of care and while some would utilise the new EN scope it was “very early days” and still unknown whether every board would want to change their model of care to include the revised role.

Health Minister Tony Ryall said patients would be the big winners from the revised scope as enrolled nurses could now be more involved in the care of patients.

A delighted Robyn Hewlett, chair of NZNO’s enrolled nurse section, said the decision was “a good Christmas present” and after five years fighting to get back the EN title she hoped the issue was now settled.

She said the new generic scope was only slightly altered from the one proposed by the section and members were positive that the move would be good for the health workforce.

NZNO professional nursing advisor Suzanne Rolls said the organisation welcomed the expanded single scope and title and said the council decision removed uncertainty for second-level nurses, reflected the reality of health service provision and provided clarity to the public.

Hewlett said how existing ENs and nurses assistants (NAs) would transition to the new scope was still unknown but the council had indicated that it would not be too difficult for ENs and she hoped that NAs would also make the move.

 

Key points

  • New generic scope for all second level nurses to be called enrolled nurse.
  • 18-month education programme with a third of programme at diploma level.
  • ENs can practice under “direction and delegation” of an RN across all health settings but must work in a team with an RN in acute settings.
  • Nurses in existing enrolled nurse and nurse assistant scopes to have option to transition into new scope of practice.

 

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 and agrees on EN title.