The ‘return’ of the enrolled nurse is a mixed success, with many of the first graduate cohort struggling to find work and others heading across the Tasman, a Nursing Review survey has found.
The first graduates of the new 18-month diploma sat the state final exam in July and three months later the six nursing schools involved are reporting one-third to 92 per cent of their graduates working as ENs – the majority in residential aged care. Four schools from Whangarei to Invercargill have also reported graduates finding work as ENs in Australia.
Nationwide, at least 43 per cent of the new EN graduates were still job hunting or working as unregulated health care assistants.
The schools report high demand from potential students for the diploma but a number are delaying or reducing intakes because of concerns about clinical placements and the employment market.
Chief Nurse Jane O’Malley said one of her advisors was currently working with an advisory group on an information sheet to inform and remind employers, including acute hospitals, about the new broader EN scope and potential models of care using ENs. “This is what was asked for (return of EN) and its now time that they start demonstrating their support of the role”.
Jane Anderson, nursing programme leader at NorthTec, said it was of concern that half of its first cohort of 21 diploma students were still seeking jobs as ENs, including six currently working as unregulated health care assistants. Of the graduates that had found EN work, two had gone to Australia and only three were employed by district health boards.
“The push was from the Minister to bring back the EN programme and to what purpose if the graduates can’t get employment?” asked Anderson. She is on the chief nurse advisory group and hoped employers would come to realise the role that a regulated EN workforce could fill in acute care wards.
Job availability has been a “bone of contention” also for many graduates of Whitireia Community Polytechnic’s first EN diploma cohort, said programme co-coordinator Ros Leahy.
She said a survey of its 24 graduates from July found that currently just nine had jobs has ENs. Only three of those had jobs within DHBs, with the rest working in residential aged care hospitals.
Whitireia had already decided to delay taking on its third diploma cohort until July next year after experiencing a “little bit of resistance” from DHBs in finding clinical placements for its second cohort of EN diploma students earlier this year.
Leahy said boards were aware of the Minister’s desire to rebuild the EN level workforce but were reporting a catch-22 situation because to employ ENs they needed to restructure their nursing teams but there wasn’t the critical mass of ENs to fill EN positions if they did create a new nursing team model that included ENs. Also, the economic situation meant there was low nurse turnover and boards were not in a position to create new positions.
“The new ENs looking for jobs are frustrated that there are not the jobs to apply for,” said Leahy. “I’m hoping its (EN job shortages) is just a time bubble and it will catch up with itself and jobs will come.” She said the DHBs that had taken on graduates were providing good packages of support to the new nurses.
Ngaira Harker-Wilcox, director of Waiariki Institute of Technology’s nursing school, said 14 of its 27 Rotorua and Whakatane intakes had found EN jobs in New Zealand and a further two had found work across the Tasman.
She said the majority had found work in rest home settings but one had found work in Tokoroa Hospital and one was working in mental health. Harker-Wilcox said Waiariki's next intake wasn’t until March next year and it would probably reduce the number of places as it had experienced difficulties getting acute hospital clinical placements for the last intake and wanted to ensure quality placements
Sandra Wilkinson, an associate dean of Manukau Institute of Technology’s nursing school, said it surveyed 14 of its 17 midyear EN graduates and found just six had EN jobs – including two across the Tasman. Another two had interviews pending and the rest were without work. She said it still had an “excessive” number of applications for its second diploma intake that got underway in July.
Lucy Prinsloo, EN programme manager for Southland’s SIT, said it had been really lucky with all but two of its 25 graduates finding work as ENs, and that included one graduate working in a specialist dental surgery.
One graduate had crossed the Tasman to work in an acute hospital, but SIT had good numbers finding working in local acute hospitals, including seven at Dunedin Hospital, one at Gore Hospital, and the first EN to be employed at Southland Hospital in a decade. Prinsloo said it had taken some time for local hospitals to accept ENs back into acute care. "But I think the rest of the country will follow the same way … once the recognise how effective they (ENs) are."
SIT has just started its second diploma cohort in October, but despite high numbers of applications, the institute had cut back numbers to 21 ensure it could offer quality placements without affecting placements for its bachelor of nursing students.
Cathy Andrew, head of nursing at Christchurch’s CPIT school, also reported higher number of graduates working as ENs than the North Island schools. She said 14 of its 19 graduates were working as ENs, six in acute settings (medical, mental health inpatient, and rehabilitation), six in residential aged care, and one for an agency. Of the remain graduates, two were not looking for work, one was still job hunting, and two were working as health care assistants.
Meanwhile, Leahy said graduates working as health care assistants (HCAs) while waiting for EN positions had been advised that despite being employed in an unregulated role that they still remain accountable as ENs for the care they provide.
Background to return of EN
Politicians on both sides of the house called for the ‘return’ of the enrolled nurse during the 2008 election campaign.
The push followed a decade of debate about the title, scope, and qualification for second level nurses, including a controversial one-year certificate programme introduced in 2002 – the first second level nursing programme since hospital-based EN training ended in 1993.
In 2009, the incoming Health Minister Tony Ryall requested the Nursing Council and district health boards to work together to bring back a broader EN scope and qualification as “modern nursing and healthcare teams need another level of nursing expertise”.
That call lead to the Nursing Council developing a new scope allowing ENs to work in acute settings and for nursing schools to develop a new 18-month enrolled nurse diploma that got underway in early 2011.
