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Enrolled Nurse Education

• 2. Legislative environment of Enrolled Nurses
• 3. The study
  • 3.1 Overview
  • 3.2 Survey of providers of Enrolled Nurse education
  • 3.3 Survey of providers of Registered Nurse education
  • 3.4 Other activities

2 Legislative environment of Enrolled Nurses

This chapter summarises the legislative environment governing the education and registration of Enrolled Nurses.

In order to undertake nursing activities as an Enrolled Nurse, the candidate must obtain registration with the relevant State or Territory Nursing Board. To secure registration the candidate must produce, amongst other things, evidence that they have completed a recognised course of education and training.

The education of Enrolled Nurses, and indeed that of Registered Nurses, is not controlled by legislation. The educational requirements necessary to achieve registration are fixed by the state nursing regulatory authority, typically the State Nurses Board.

The Enrolled Nurse is a second level nurse who provides nursing care within the limits specified by education and the registering authority's licence to practice. The relevant Nurses Act provides for the State or Territory Board to determine the educational requirements for various types of nurses including Enrolled Nurses.

Historically, nurses' registration legislation provided for registration of Registered Nurses. Subsequently, there was provision for the regulation of assistants who were then titled 'Assistants in Nursing' (later called Nursing Aides, Enrolled Nursing Aides and now Enrolled Nurses or Division 2 Nurses). The second level nurse, however titled, has always undertaken a shorter program of education than Registered Nurses and has always been required to work under the supervision¹ and direction of a first level nurse. [Is this true?]

The relevant nursing legislation in each jurisdiction is essentially similar. The various Nurses Acts require the Boards to maintain a Register divided by Divisions. Those nurses entered as Division 1 Nurses are required to meet certain educational and other qualifications. A typical statutory arrangement for Enrolled or Division 2 Nurses is as provided by the West Australian Nurses Act 1982 WA. It identifies six divisions in the register of nurses maintained by the Board. Section 34, typical of other State and Territory Acts, states

(1)The information to be recorded in the register under section 33 shall be divided into 6 divisions as follows --

(a) division 1 shall contain the names and other particulars of those persons whose qualifications and experience have been approved in writing by the Board as rendering them capable of practicing independently as professional nurses;

(b) division 2 shall contain the names and other particulars of those persons whose qualifications and experience have been approved in writing by the Board as rendering them capable of practicing nursing only --

(i) under the professional direction of a nurse registered in division 1;or

(ii) in a particular prescribed nursing speciality;

......

The relevant controlling legislation is:

Nurses Act 1991 NSW

Nurses Act 1982 WA

Nurses Act 1995 Tas

Nursing Act 1992 Qld

Nurses Act 1999 SA

Nurses Act 1993 Vic

Nurses Act 1988 ACT

Nursing Act 1999 NT

There are typically no by-laws or other subordinate instruments dealing specifically with enrolled nurses.

While the particular provisions of the Acts are different, they essentially regulate Enrolled Nurses by a generic process. That is, they create of a number of divisions of nurses within the Register of Nurses and vest authority in the Board to allow it to establish educational and other qualifications to determine a person's entitlement to be registered within a particular division. The Boards therefore set educational requirements for Enrolled Nurses that entitle them to achieve registration into Division 2 of the Register.

The various States and Territories also have codes of conduct, commonly adapted from the Australian Nursing Council Incorporated (ANCI) Code, which sets out the broad parameters of a code of acceptable practice including administration of medications by an Enrolled Nurse. These Codes of Conduct are consistent with the poisons legislation in each State that places prohibitions on the administration of certain medications.

ANCI is a peak national nursing body concerned with national standards and processes for the regulation of nursing. The purpose of ANCI is directly related to its relationship with the Australian nurse regulatory authorities whose role and function is the regulation of nursing in the public interest. The respective state laws regulate each of the Australian nurse regulatory authorities. Although ANCI does not have legislative authority to enforce or define the responsibilities of Enrolled Nurses, it has produced the ANCI National Competency Standards for the Enrolled Nurse and the ANCI Code of Professional Conduct for Nurses in Australia. These are endorsed by the State and Territory nurse regulatory authorities and are used in policy development and as a guide for Code of Conduct Issues.

Alterations to the educational requirements of Enrolled Nurses do not require amendment to any existing legislation.

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3 The study

3.1 Overview

This chapter reviews the methodology of the study. The study consists of three processes:

1. A survey of coordinators of courses leading to registration as an Enrolled Nurse;
2. A survey of coordinators or admission officers of courses leading to registration as a Registered Nurse; and
3. Consultations with a range of other bodies to provide a broader understanding of issues relating to the education of Enrolled Nurses.

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3.2 Survey of providers of Enrolled Nurse education

The first part of the investigation involves conducting a survey of providers of education and training for Enrolled Nurses. Given the timeframe for the entire

Table 3.1 VET providers of courses leading to qualification as an Enrolled Nurse by State and Territory

Note:

Numbers represent providers. Many providers offer courses on more than one campus.
Numbers include one hospital in Adelaide that intends to offer courses in 2002.
One provider in Adelaide also has a rural campus.
The Tasmanian regional provider is a private provider.
One Melbourne provider is a private provider, was selected, but not interviewed.

study, it was considered that a representative sample be chosen to participate in telephone interviews. The sample was selected to reflect both metropolitan and rural institutes, as well as public and private providers, across all states and territories.

Table 3.1 shows the number of providers of Enrolled Nursing courses by State and Territory and location. It also shows the number of institutes within each category selected for the study and the number of institutes in which interviews were actually achieved.

The coverage of the courses is quite high - interviews were conducted at half of the institutes that offer courses in Enrolled Nursing. Response rates were also high - interviews were conducted with 90 per cent of the selected institutes.

The sample was stratified by State and location because these factors were expected to influence course delivery. Numbers were not selected proportionally within these strata. Strata with fewer courses are over-represented, in some cases just to ensure their inclusion (such as the ACT or NT) and in others to allow for variation within strata.

Selection of institutes within strata was not random. Instead it was based on some knowledge of the programs offered by institutes. For instance, institutes that offer traineeship programs for Enrolled Nurses were targeted because these programs were a particular interest of the study and relatively few institutes offer traineeships. Similarly providers offering possible alternative arrangements-cross-sector university-TAFE institutions, private providers, distance education providers and a hospital about to introduce a course-were selected.

Within the identified institutes, key individuals (primarily program coordinators) were sent a letter outlining the study and their involvement, as well as an outline of the interview schedule (Appendix A). Providing the interview schedule in advance was expected to allow respondents to make a more considered response to questions as individuals had sufficient time to reflect on the questions before the interview. Soon after despatching the letters, the key individuals were contacted by telephone to arrange a suitable time to conduct the interview. Interviews in this part of the study took from one half to one and a half hours to complete.

Questions asked of participants cover the following areas:

• Courses for preparation of enrolled nurses - offerings, structure, staffing;
• Enrolments - intakes, numbers;
• Selection - criteria, processes;
• Arrangements for Recognition of Prior Learning - availability, access;
• Graduation rates and outcomes;
• Program review processes;
• Costs and fees incurred by students;
• Post-basic course offerings;
• Links to hospitals and employers; and
• General comments on education, training, preparation and employment of enrolled nurses.

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3.3 Survey of providers of Registered Nurse education

The second part of the study was a survey of providers of Registered Nurse education, that is, schools of nursing offering bachelor degree courses for registration. As for the first part of the study, participants in this survey were selected to provide a representative sample covering both metropolitan and rural universities across the States and Territories of Australia.

Table 3.2 shows, for each State and Territory, the number of providers of courses leading to registration as a Registered Nurse. All providers are universities. As with VET providers, many universities offer courses on more than one campus. Because the interviews were briefer, the number of providers smaller, and between-institution variability was expected, a higher proportion of universities was sampled - 61.3 per cent. Interviews were conducted at all selected institutions.

Interview questions in this part of the study focus on the following areas of the pathway from the Enrolled Nurse to Registered Nurse and a university degree qualification:

• Articulation and credit for enrolled nurses in degree programs;
• Entry and selection processes for enrolled nurses in degree programs;
• Study patterns of enrolled nurses in degree programs;
• Completion rates of enrolled nurses in degree programs; and
• General course information.

Within each of the selected providers of Registered Nurse education, key individuals (course coordinators) were sent a letter outlining the aims of the study and their involvement, as well as an outline of the interview schedule (Appendix B).

Table 3.2 Universities offering courses leading to qualification as a Registered Nurse by State and Territory

Note: Numbers represent universities. Several universities offer courses on more than one campus. The Australian Catholic University is counted in each State in which it provides a nursing course.

Individual therefore had time to think about the questions before the interview. Soon after sending the letters, the key individuals were contacted by telephone to arrange a time for the interview.

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3.4 Other activities

The final part of the study involves a range of activities selected to supplement the findings and interpretations of the first two stages of the study. It is envisaged that these activities will provide a deeper understanding of emerging issues in relation to Enrolled Nurse education in Australia. Activities to be undertaken include:

• consultation with a range of nursing and health bodies, including nurse registering authorities, including clarification of issues required deeper understanding;
• requesting input from a range of relevant training bodies, including State and Territory training authorities, and Industry Training Boards; and,
• undertaking extensive literature and document searches.

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