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Enrolled Nurse Education

• 4. Enrolled Nursing courses
  • 4.1 Introduction
  • 4.2 Nomenclature and level of offerings
  • 4.3 Structure of Enrolled Nurse courses
    • 4.3.1 Program models
    • 4.3.2 Course flexibility
    • 4.3.3 Course contact
    • 4.3.4 Clinical practice experience
    • 4.3.5 Issues surrounding clinical experience
    • 4.3.6 Profiles of teaching staff
  • 4.4 Enrolled Nurse students
    • 4.4.1 General profile
    • 4.4.2 Related employment
    • 4.4.3 Other courses related to Enrolled Nurse education

4 Enrolled Nursing courses

4.1 Introduction

This chapter documents the structure of Enrolled Nurse courses, staffing and the types of students who enrol in those courses. There is considerable variation among States and Territories in the duration of courses, the awards associated with courses, modes of delivery, required hours of education and training, arrangements for clinical experience and teaching staff. Across States and Territories there is often greater consistency in the background of students who enter courses in Enrolled Nursing - they are, with some exceptions, mature age female already employed in the nursing workforce.

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4.2 Nomenclature and level of offerings

Regulatory authorities at the State or Territory level accredit courses leading to registration as an Enrolled Nurse. In most cases, course offerings are determined through the agreements of VET institutes and nurse registration authorities. Nurse registration authorities agree to recognise graduates on completion of courses. The development of courses within the various States and Territories has often resulted in considerable variation in the educational programs. Most Enrolled Nurse courses across Australia developed as Certificate IV courses within the Australian Qualifications Framework (AQF). Table 4.1 summarises the courses offered within states and territories, including titles, duration and AQF qualification.

Table 4.1 Enrolled Nurse course offerings by State or Territory

Clearly, course names vary among the States and Territories and the duration of courses ranges from 12 to 18 months full time equivalent study. Table 4.1 also shows the inconsistency across the States and Territories in the awards for courses for enrolled nurses. Although most courses result in a Certificate IV, in Queensland Enrolled Nursing leads to a higher level of qualification, that is, a Diploma. The Certificate IV courses are predominantly offered over 12 months equivalent full time study, except in Western Australia. In Queensland and Western Australia the courses are 18 months full-time equivalent, but they result in different AQF qualifications.

In addition to the TAFE providers, one hospital in South Australia is currently undergoing approval processes for introducing a hospital based certificate program. Approval by the Nurses Board of South Australia is pending. This program would be offered in traditional, apprenticeship format, and may not lead to a recognised award within the AQF. Additionally there are private providers of Enrolled Nursing courses in Victoria and Tasmania.

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4.3 Structure of Enrolled Nurse courses

4.3.1 Program models

A range of programs exists for preparing Enrolled Nurses. The types of courses existing for the preparation of Enrolled Nurses predominantly involve learners assuming student roles. These focus on classroom learning supplemented with supernumerary status on clinical placements. However, other models exist. The structure for Enrolled Nurse programs in New South Wales involve employment models, while traineeships have been introduced in Victoria and Tasmania running

Table 4.2 Program models and providers

alongside traditional courses. TAFE is the predominant provider of Enrolled Nurse education. Other providers, however, are entering the domain. In Victoria, Tasmania and South Australia private education providers have purchased programs from the TAFE sector and offer them privately.

In 1997 Dr David Kemp, the Commonwealth Minister for Education, launched the introduction of two-year traineeships for Enrolled Nurses in Victoria. According to a parliamentary press release at the time, traineeships were designed to alleviate a shortage of nurses by allowing health care agencies to employ trainees (Kemp 1997). In Victoria, most TAFE colleges are currently offering traineeships alongside traditional full time and part time offerings. Generally, traineeships are offered only part time, over four semesters. Participants in traineeships are required to be employed for a minimum of 16 hours per week. In general, employed time is considered as course time. However, where clinical experience is required by the course, but not available within the employing institution, the course provider facilitates suitable clinical placements. In addition, the student's place of employment needs to be approved by the Nurses Board of Victoria before a student's enrolment can be confirmed.

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4.3.2 Course flexibility

The flexibility available to students within courses varies considerably around Australia. Within New South Wales programs, all students undertake an employment model and complete their course full time. There is currently no option available for part time studies in that State. Western Australia also offers only full time programs with no part time option available. According to one participant, this requirement has been determined by the Nurses Board of Western Australia (NBWA). In a hospital-based program proposed to be offered in South Australia in 2002, students will undertake an employment-based program, available by full time mode only. Within the other States and Territories, there is greater flexibility for students to study either full or part time (known as half time in South Australia).

Many TAFE institutes are considering means for improving flexibility of program delivery. In rural institutes in particular, many students travel long distances to and from scheduled classes. 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. Spencer Institute in South Australia offers a Certificate IV program across State borders for students in other States including Tasmania and Queensland. Some Queensland students undertaking the program travel to South Australia to undertake clinical experience. TAFE Tasmania organise clinical placement experience for students in that State whilst utilising the South Australian program.

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4.3.3 Course contact

Hours of course contact are determined within the curricula set at State and Territory levels. Some variation in contact hours exists between States and Territories. Total course contact hours vary between 756 hours (Northern Territory) and 1200 hours (Western Australia). A new curriculum is being

Table 4.3 Course contact hours by State and Territory

introduced in the Northern Territory from 2002 that consists of a significant increase in classroom and clinical hours. In Victoria and the ACT total course hours are set at 850 hours generally with 610 hours allocated to classroom teaching. Within the majority of courses students spend four full days per week on campus engaged in classroom learning.

In New South Wales, classroom hours are set at 420 hours for the duration of the course. These hours are delivered in two blocks, one of eight weeks on commencement of the course, and another of six weeks later in the course. During blocks, clinical visits to specialised clinical areas are undertaken. However, additional general clinical hours are difficult to determine. Students undertake clinical nursing practice within their employing area health service for the remaining thirty-eight weeks of the fifty-two week contract as full time employees. One interviewee in New South Wales suggested that the immense amount of content to be delivered within theoretical blocks means that students are in the classroom for four full days (the other in clinical visits). This situation potentially provides students with little time for independent research or study during blocks, and with full time employment for the remainder, does present some difficulties for students. Table 4.3 summarises the general course and clinical hours across Enrolled Nurse courses.

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4.3.4 Clinical practice experience

Enrolled Nurse students usually undertake block placements in health and community settings throughout their courses. Focuses for clinical practice experience provided within courses vary from State and Territory. Interviewees were asked to provide information about the clinical components of their programs, including the:

• Amount of clinical experience;
• Type of clinical experience available for students;
• Structure of clinical experience;

Table 4.4 Clinical focuses within Enrolled Nurse courses

• Arrangements for the provision of clinical teaching and supervision; and,
• Factors influencing the amounts and type of clinical experience offered.

In a number of States and Territories (ACT, Victoria, Queensland, SA, Tasmania, WA) students undertake clinical placements structured in blocks around theoretical content delivered on campus. Currently, this is also the case in the Northern Territory. However, with the introduction of a new curriculum in 2002, students will undertake clinical experiences for two days per week over seventeen weeks.

In New South Wales, employed time is considered clinical experience time. Students generally rotate through a number of clinical areas including aged care, acute care, mental health, developmental disability and mental health. This time is supplemented with one day per week of specialised clinical visits during theoretical (on campus) blocks in TAFE. These specialised visits include such areas as operating theatre, maternity, and paediatrics.

Arrangements for students during clinical placements vary considerably. In some areas, preceptors provide clinical supervision for students, including the ACT and Tasmania. In Tasmania, preceptors need to be approved by the Nurses Board of Tasmania in order to undertake these roles. In the ACT, preceptors do not undertake clinical assessment of students, this role being carried out by institute staff. In WA and NT students are 'buddied' with other nurses in the clinical setting. In NT, 'buddies' sign off on students' clinical skills. In Victoria, either sessional clinical teachers are employed or, if possible, staff from the health care venue are seconded. In some instances, preceptorships are also utilised.

In NSW students are employed in an area health service. Each area health service has an Enrolled Nurse coordinator. This person provides clinical supervision and teaching for students during their clinical experience time within the hospital where students are employed. Generally, TAFE institutes have little direct input in students' clinical experiences. The exception relates to the single days during theoretical blocks when students undertake visits to specialised clinical areas facilitated by institute staff.

Clinical focuses provided within Enrolled Nurse courses differ between institutions with no identifiable consistency within States and Territories. All courses expose students to significant amounts of aged care and rehabilitation as has been traditional for these courses. Furthermore, all the courses included in our study provide students with exposure to acute care areas, mainly medical surgical nursing. From the interviews it appears that more attention is being placed on acute care nationally than was previously the case. For some courses these are the only clinical practice environments to which enrolled nurse students will be exposed.

Table 4.4 summarises the general findings in relation to clinical focuses provided within Enrolled Nurse courses on a State and Territory basis. There exists, however, some individual variation between institutes in particular States and Territories and the clinical experience offered. In some instances, the type of clinical experience available depends on health care agencies and what they are actually able to offer.

Increasingly, however, courses are reducing their emphasis on aged care and rehabilitation with many introducing other clinical areas. Many courses have introduced placements within mental health and community placements, including such areas as outpatient clinics and maternal child health. Within a smaller number of institutions, students are also being exposed to clinical areas such as maternity, paediatrics, operating theatre, and in one case, even emergency. Many courses are offering Enrolled Nurse students exposure to a broader range of clinical practice areas than previously. This exposure is opening new practice possibilities for Enrolled Nurses on completion of their courses.

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4.3.5 Issues surrounding clinical experience

Clinical experience is often a problematic area for nursing courses. This section sought to examine issues surrounding the provision of clinical experience for Enrolled Nurse students. The findings of the interviews suggest that clinical components of Enrolled Nurse courses are areas of difficulty in many States and Territories. However, there are degrees of similarity between them. The issues effecting the clinical components of Enrolled Nurse courses centre predominantly on general staff shortages within the health care sector as well as increasing competition for clinical places.

The lack of availability of clinical placements is significant for many Enrolled Nurse courses. Many institutes nationwide expressed concern that availability of clinical placements was an increasing problem because of growing competition between universities and TAFE institutes. Many interviewees felt that students from degree courses (for registration) were given priority in the allocation of clinical places, with Enrolled Nurse programs receiving the remainder of available places. Furthermore, interviewees expressed greatest difficulty in accessing specialised places such as in mental health. Whilst least affected with problems in accessing suitable clinical placement, this was also an issue within NSW when attempting to secure visits to specialty clinical areas.

Staff shortages are highlighted as affecting clinical experience for students. Interviewees in Queensland, NT and WA all claim that it is becoming increasingly difficult to maintain 'buddy' or preceptor models for clinical supervision. This has been attributed to fewer nurses seeking to work as full time, permanent staff members, leading to fewer nurses being able to assume responsibility for providing continuous student support and supervision. In areas where the nursing population was transient, this problem appears to be further compounded.

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4.3.6 Profiles of teaching staff

In this section participants were asked to outline numbers of staff undertaking teaching within the Enrolled Nurse programs, along with the qualifications required to teach in the courses. The results of the study indicate that around Australia there is general consistency in the profiles of staff engaged in teaching within Enrolled Nurse programs. In a majority of cases, the teaching profiles in nursing departments consist of a few full time employed teaching staff, with a large number of either part time or sessional staff assuming responsibility for large areas of content.

In all but one of the institutes in the study, teaching staff are required to be Registered Nurses. Enrolled nurses are not involved in the direct teaching of Enrolled Nurse students in the majority of institutes. In some States, Registered Nurses involved in teaching are required to have a bachelor degree preferably in nursing or education. Many institutes report, however, that a number of staff are seeking higher qualifications at Graduate Diploma or Masters level, often in education areas.

All States and Territories expect that staff teaching within Enrolled Nurse programs possess at least a Certificate IV in Assessment and Workplace Training. In some areas, time frames have been placed on expectations that staff will obtain this qualification. Many interviewees in the study reported that their staff were currently working towards this qualification.

However, the expectations held about the qualifications possessed by teaching staff may not be enforceable in all cases. One interviewee located in a regional institute commented on the difficulty in accessing and employing suitably qualified teaching staff within rural areas. It was suggested that teachers within regional areas might have fewer formal qualifications than in metropolitan areas. However, whether this situation affects overall learning outcomes for students in rural areas is not known.

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4.4 Enrolled Nurse students

4.4.1 General profile

The description of the 'typical' student in Enrolled Nurse courses is fairly consistent. In all but one TAFE institute included in our survey, the respondent

Table 4.5 Course Enrolments in Enrolled Nurse Courses by Age and Sex, 2000

Source: Unpublished data supplied by NCVER.

Note: Courses defined by ASCO code 341; Numbers may not sum to totals because some totals include cases missing on one or more variables; See discussion of the data in Sections 1.3 and 6.2 of this report.

reported that the majority of students fall into the mature-age entry group. Many had minimal prior educational preparation. The exception was at one Victorian university where 50 per cent of students were reported as being school leavers. In most institutes, there were only one or two school leavers per intake. One participant in Victoria suggested that this could be in part because entry procedures commenced each September or October and that final year high school students were more focussed on entering university courses. There was the possibility that school leavers did not consider TAFE to be their first port of call.

Student profiles were predominantly female, with one or two males within each intake. Several interviewees noted that a majority of students had previous experience in aged care settings, either as carers, Assistants in Nursing (AINs) or Personal Care Attendants (PCAs). Many students entering the program had undertaken Certificate III studies in related areas such as aged care or community health. A number of students use their Enrolled Nurse course as a stepping stone to entering degree programs.

Table 4.5 shows the age and sex distribution of students in Enrolled Nurse courses in 2000. The values are consistent with the descriptions of course coordinators - 85.1 per cent of enrolments are female and nearly 60 per cent of students are 30 years or older.

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4.4.2 Related employment

For students in Enrolled Nurse courses, it is not uncommon to undertake related employment through the duration of the course. Significantly, where institute-based courses exist, a large proportion of students work in areas related to nursing, especially aged care in hostels or nursing homes. In some cases, employment may be community based or in disability areas.

In New South Wales, all students are employed by the Area Health Service as part of their program and therefore do not have outside employment. These students are paid by the Area Health Service throughout their course based on the employed time, and according to award rates determined in that State. Similarly, students in Victoria and Tasmania in traineeship programs are employed part time as part of their programs.

TAFE institutes across States and Territories (excluding New South Wales) reported that between 25 and 75 per cent of Enrolled Nurse students were employed in areas related to nursing. Consistently from interviews, some full time students are engaged in nursing-related work whilst a large number of part time students work in such areas. In most cases, the employment was as AINs or PCAs. Notably, in South Australia Enrolled Nurse students often work as carers or paramedical aids. The latter role is community based, providing personal care on a case management basis.

The high numbers of students working in nursing-related areas throughout their Enrolled Nurse course can be attributed to the fact that many enter the course having already obtained a Certificate III in aged care or other related area. Many have worked in these areas for extensive periods of time before commencing Enrolled Nurse studies. Some interviewees in this study actually suggested that many Enrolled Nurse students had worked in aged care areas for many years and were seeking to move out of that particular area into another such as acute care. Undertaking Enrolled Nurse courses were seen as a vehicle for allowing this move to occur.

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4.4.3 Other courses related to Enrolled Nurse education

Within the TAFE sector, a few other courses exist that are relevant to the education of Enrolled Nurses. In all States and Territories, Certificate III studies in Aged Care and Disability can provide a pathway for individuals to enter Enrolled Nurse programs. From our interviews, it appears that a number of Enrolled Nurse students do enter their studies through this pathway.

In some States, bridging courses to enter Enrolled Nurse programs are offered for individuals who either do not meet entry requirements, or who choose to undertake preliminary studies before commencing their courses. In Western Australia, a Bridging Course to Enrolled Nursing is offered as a Certificate III. This course covers a range of topic areas including mathematics, sciences (biology, chemistry, physics), social, cultural and communication studies. A similar course is offered in Victoria, although not at Certificate III level. The course covers such areas as study skills and biology. In the Northern Territory, a Tertiary Enabling Program exists with similar aims.

A few courses are available that specifically allow hospital trained Enrolled Nurses to upgrade their qualifications to an equivalent to those of TAFE-prepared Enrolled Nurses. In Queensland, a post-enrolment diploma course is available, whilst in New South Wales, a Certificate IV conversion course is available for hospital trained Enrolled Nurses.

Deficiencies in medication knowledge may present where Enrolled Nurses move from a State or Territory where medication administration by Enrolled Nurses is limited, to another with greater scope of practice. In addition, Enrolled Nurses may have undertaken studies before the move into the VET sector, or be returning to practice. In order to 'up-skill' Enrolled Nurses with limited medication knowledge, a medication course is available in Queensland. Similarly, in Tasmania a medication endorsement package is also available. In other areas, such as Western Australia, hospitals assume responsibility for providing up-skilling of individuals from other States and Territories, or whose medication knowledge is inadequate.

Post-basic modules are offered to extend the education of Enrolled Nurses in particular areas. These are discussed in Section 9.1.

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