Enrolled Nurse Education
Executive summary
Background
This report contains information on courses accredited as leading to registration as an Enrolled Nurse. The Monash University-ACER Centre for the Economics of Education and Training (CEET) was commissioned by the Department of Education, Training and Youth Affairs (DETYA) to produce this report to provide research support for the National Review of Nursing Education.
There are two levels of nurse recognised in Australia, the Registered Nurse and the Enrolled Nurse. Enrolled Nurses function as second level nurses, providing nursing care under the supervision of Registered Nurses. There are, however, some important differences in the scope of this role among the States and Territories.
Just as the education of Registered Nurses shifted from hospitals to the higher education sector during the 1980s, so too the preparation of Enrolled Nurses moved from hospitals to the Vocational Education and Training (VET) sector during the 1990s.
Registered Nurses undertake three year degree level courses within universities. Enrolled Nurses, on the other hand, undertake one year or 18 month Certificate IV or Diploma courses within the VET sector.
In 2000, there were 5 834 students in courses designated as for Enrolled Nursing. Between 1997-98 and 1999-2000 commencements in Enrolled Nurse courses increased by 25 per cent. Much of the increase occurred in New South Wales.
In 2001, Enrolled Nurses made up 9.1% of the nursing workforce. Their total numbers, both absolutely and as a percentage of the nursing workforce, have declined over the last 15 years.
Relatively little research has been undertaken on Enrolled Nurses in Australia or on their equivalents internationally. The United Kingdom closed education programs for second level nurses in the early 1990s. New Zealand followed a similar path, but is currently considering reintroducing education programs for second level nurses in response to a shortage of nurses and the need for a more diverse skills mix in the nursing workforce. The United States has an active program for the education of second level nurses who obtain employment in a variety of clinical settings.
This study
The results presented in this study are based on:
- Interviews with coordinators of 27 Enrolled Nursing courses.
- Interviews with admissions officers or coordinators of 19 Registered Nurse courses.
- Selected consultations with other relevant bodies.
The interviews with the coordinators of Enrolled Nursing courses were wide ranging. The report is mainly based on these interviews. The interviews with admissions officers and coordinators of Registered Nursing courses focus on pathways for Enrolled Nurses into Registered Nursing courses.
State differences
The preparation of Enrolled Nurses seems largely to have escaped the reforms that have led to nationally accepted competencies in many fields of skill formation in the VET sector in the last decade. Curricula for Enrolled Nursing often differ between States and Territories. Some of these differences are associated with differences in the scope of practice of Enrolled Nurses - principally the extent to which Enrolled Nurses are able to administer medicines independently of the supervision of a Registered Nurse. Other differences appear mere happenstance. The development and administration of courses in eight separate jurisdictions provides the potential for inefficiency.
The differences among States and Territories in the curricula of Enrolled Nurse courses raise important questions about the movement of Enrolled Nurses to jurisdictions that permit Enrolled Nurses broader scope of practice. Enrolled Nurses educated in States and Territories that place greater restrictions on their practice may not have the skills required by more liberal jurisdictions. Similarly, movement of Enrolled Nurses to States and Territories in which their practices are more circumscribed results in the loss of skills through an inability to use them. Such concerns would be allayed by greater uniformity among States and Territories in the preparation of Enrolled Nurses and in the agreed scope of their practice.
Courses in Enrolled Nursing differ among States and Territories in their nomenclature, duration (one year or 18 months equivalent full-time study), award (Certificate IV or Diploma), content and required contact hours.
Course structure
The structure of most Enrolled Nursing courses consists of periods of classroom instruction and clinical placement. Clinical placements can be interleaved with classroom instruction or arranged in discrete blocks.
There are two alternative models. In New South Wales Enrolled Nurse students are employed for 12 months by the State Government's Area Health Service. Their course is undertaken in concentrated blocks of full-time classroom instruction and clinical placement. This is supplemented by on-the-job learning through their employment with the Area Health Service.
Traineeships in Enrolled Nursing are available in Victoria and Tasmania. They are offered only part time, over two years. Trainees are required to be in approved, course-relevant employment for at least 16 hours per week. Where required clinical experience is not available with the employer, the course provider facilitates suitable placements.
Students
Students in Enrolled Nurse courses are, with some exceptions, typically mature age, female and already employed in the nursing workforce. Given the possible attractions of a shorter and often cheaper course with good employment outcomes, it is surprising that these courses do not attract greater interest from school leavers.
Between 25 per cent and 75 per cent of students in Enrolled Nurse courses (other than in traineeships) are employed in related areas (especially in aged care in hostels or nursing homes as Assistants in Nursing or as Personal Care Assistants) while they are studying. It appears difficult for providers to grant Recognition of Prior Learning (RPL) for this experience.
Clinical practice
Clinical practice within Enrolled Nurse preparation now places greater emphasis on acute care, although the traditional staple of aged care continues to remain a prominent focus. Additional areas for clinical experience are emerging including mental health, community or domiciliary nursing, and operating theatre. Provision of quality clinical placements for Enrolled Nurse students is problematic, and made more difficult by competition for placements with higher education providers of courses for Registered Nurses. Opportunities for varied clinical placements may be restricted in rural areas. Staff shortages within health care institutions make it difficult to ensure that students are appropriately supervised in clinical practice areas.
Flexible delivery
In most States and Territories Enrolled Nurse courses can be undertaken both full and part time. The employment model used in New South Wales means that all students undertake their course full time. Western Australia also offers only full time program.
Some institutes in South Australia and Queensland offer many modules by distance education. Teaching and learning is supported through the use of video conferencing facilities in outlying areas reducing the need for students to travel long distances.
Course completion
Coordinators of Enrolled Nurse courses reported high completion rates. In Victoria, where full time, part time and traineeship programs coexist, several interviewees reported large differences in completion rates. Completion rates for full time students were 75-100%, for part time students 50-60%, and 50% for traineeships.
Estimates from official statistics suggest substantially lower completion rates. The discrepancy may be because completions are under-reported in VET.
Graduate employment
Employment opportunities for Enrolled Nurses are favourable - most graduates are employed soon after graduation. In some cases, agencies and health care venues approach providers seeking to employ graduates as soon as they complete their courses. The areas of employment have shifted away from aged care to a range of clinical practice areas. Most graduates entered either aged care or acute care in hospitals following graduation. Other graduates obtain employment in less traditional areas for Enrolled Nurses such as mental health, community or developmental disability areas.
Pathways
Enrolled Nursing is commonly seen as a pathway for individuals working in aged care to move into more acute practice areas. The Recognition of Prior Learning (RPL), however, appears difficult for providers of Enrolled Nurse courses. Career progression for Enrolled Nurses as Enrolled Nurses is limited. A significant proportion-perhaps as high as a third-of Enrolled Nurses enter degree courses to become Registered Nurses.
The academic credit granted to VET-trained Enrolled Nurses entering nursing degree courses to become Registered Nurses is highly variable between universities. Some universities provide no credit at all. In others, Enrolled Nurses moving into degree programs in nursing may receive anywhere between 50 and 100 per cent credit. Some universities also grant separate credit for clinical placement based on years of practice as an Enrolled Nurse. Completion rates appear high for Enrolled Nurses moving into degree programs in nursing.
Any comments or queries should be sent to: highered@dest.gov.au
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last updated on Tuesday, 04 December 2001
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