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Enrolled Nurse Education

• 5. Course enrolments and selection
  • 5.1 Regularity of intakes
  • 5.2 Application and selection processes
  • 5.3 Recognition of prior learning (RPL)
• 6. Course outcomes
  • 6.1 Introduction
  • 6.2 Completion/graduation
  • 6.3 Employment
    • 6.3.1 Employment following graduation
  • 6.4 Further study options
• 7. Course quality mechanisms
  • 7.1 Introduction
  • 7.2 Curriculum development processes
  • 7.3 Course review and evaluation
  • 7.4 Course constraints
• 8. Financial factors
  • 8.1 Introduction
  • 8.2 Student costs
  • 8.3 Other funding issues

5 Course enrolments and selection

5.1 Regularity of intakes

Courses vary with regard to the regularity of intakes of Enrolled Nurse students, although there is some consistency within States and Territories. Some States and Territories reported that the number of intakes each year was variable. This occurs primarily where non-recurrent government funding is provided for extra intakes and was reported by respondents in Victoria and the Australian Capital Territory.

Most courses have intakes in February or March each year, with a variety of part time (known as half time in SA) and full time groups scattered across the year. New South Wales interviewees also reported having intakes in May and October each year. However, in this State along with Western Australia and Queensland, courses are offered by full time mode only. Other States and Territories reported offering students choice over whether they study by full time or part time mode.

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5.2 Application and selection processes

The processes employed by Enrolled Nurse education programs for dealing with both student applications and the selection of prospective students vary considerably among States and Territories and among providers. In some instances, students apply directly to the institution they wish to enter (Victoria, South Australia, Australian Capital Territory, Northern Territory, Tasmania), while in others, applications are directed to the relevant tertiary admissions centre (Queensland, Western Australia). In New South Wales, area health services advertise positions once annually. Students apply directly to the area health service and are offered a place in the TAFE course only after a position is obtained with the area health service.

Admission prerequisites differ in their expectations of prospective students. Completion of Year 12 studies is recommended by all courses, however, some specify particular subjects at this level, predominantly English and Mathematics (New South Wales, Western Australia). Where applicants do not have Year 12 qualifications, Certificate III studies in health related areas are often accepted in combination with relevant work experience. In Queensland, such applicants are required to have three years full time (or part time equivalent) experience in the past five years, whilst other courses do not specify length of related experience. In New South Wales, individuals with relevant Certificate II studies and proof of work in health care are considered. Other selection criteria highlighted by interviewees include bridging studies such as the Certificate III Bridging Program (Western Australia) and the Tertiary Enabling Program (Northern Territory).

Institutions have varying input into the overall selection of students. In those States where students apply directly to the tertiary admissions centre, institutes play little or no role in the selection of students. In others, extensive selection procedures take place. Interviewees in Victoria, South Australia and Tasmania described scoring procedures where students were rated on such aspects as qualifications, numeracy and literacy tests, and interviews in some cases. It was noted that in the Australian Capital Territory and Victoria, selection procedures commence early, around September. With the early commencement of selection processes, school leavers may have reduced chances of entering these courses.

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5.3 Recognition of prior learning (RPL)

The issue of Recognition of Prior Learning (RPL) in Enrolled Nurse courses is problematic around Australia with similar concerns presenting across the various States and Territories. Although the TAFE sector offers RPL within courses, many course coordinators had experienced difficulties with granting RPL within their Enrolled Nurse programs. A range of significant issues emerged from the study in relation to this area.

A number of individuals interviewed in the study expressed difficulty in recognising studies completed outside of the Enrolled Nurse courses, particularly matching previous studies with modules in their courses. This problem is even present where individuals have undertaken Certificate III courses in apparently related areas such as Aged Care and Disability studies. In some institutions, RPL may be awarded for competencies such as communication or first aid. Often, however, little else can be given recognition. A number of interviewees expressed concern with the level at which these courses are taught, particularly the depth of the material covered when compared with the Enrolled Nurse course, whether Certificate IV or Diploma level. Other interviewees noted that there were particular inconsistencies between students who had undertaken their Certificate III program in TAFE and those who had attended private providers to obtain their award. In a number of cases, TAFE institutes had implemented challenge tests for individuals seeking RPL for Certificate III studies, in order to assess the depth of knowledge and skill possessed, and to determine whether to grant RPL.

A small number of students entering Enrolled Nurse programs are from Bachelor of Nursing programs, having decided to leave the course at some stage and move to Enrolled Nurse studies. A number of interviewees expressed frustration at the difficulty in aligning programs in order to provide RPL for partially completed Bachelor of Nursing programs. Often only minimal RPL could be granted. This issue is explored further in Section 10.1.2 in relation to articulation processes.

Several interviewees reported that RPL is an area under current examination and development within their institutions. Some institutes have established RPL committees to evaluate individual applications for RPL. These committees are also examining ways to increase the RPL being awarded in future.

However, overall across Australia it seems that only a small number of individuals seek RPL in Enrolled Nurse programs. In some areas, RPL is not being offered at all as a result of the difficulties in aligning previous study with course modules.

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6 Course outcomes

6.1 Introduction

This chapter summarises responses to questions about student outcomes: course completion; employment; and further study.

6.2 Completion/graduation

Nationwide Enrolled Nurse courses have high completion rates. In many cases, institutes report that almost 100 per cent of students reach graduation with a high degree of stability from year to year. In some cases, the figures were reported as increasing. No institute reported that completion rates were declining.

A variety of reasons for student discontinuation were reported including personal reasons and failure in only a small number of cases. One Victorian participant suggested that the gradual improvements in completion rates could be attributed to increasing efficiency within institutions in assisting students with study skills, student support and counselling services.

A noteworthy discrepancy in completion rates was identified within Victoria where full time, part time and traineeship programs coexist. A number of interviewees within that State reported significant differences in completion rates between full time and part time students, and traineeship students. For full time students, completion rates were estimated at between 75-100 per cent across institutes. However, for part time students estimates were approximately 50-60 per cent completion. Traineeship completions were estimated in the area of 50 per cent. These findings appeared consistent across both rural and metropolitan areas. One interviewee suggested that it was often difficult to maintain student motivation in the course over the more extended period of time. In addition, this problem is exacerbated as traineeship students are already working in clinical areas and often see little benefit to completing the course.

The responses of course coordinators about completion rates are in marked contrast to official data on completions. Table 6.1 shows the number of students completing Enrolled Nurse courses by State and Territory for 1998-2000. These are converted to completion rates by dividing them by commencements in the preceding year (see Table 1.2). This approach is at best an approximation because there is no guarantee that there is a one-to-one correspondence between students commencing in say 1999 and students completing in 2000. Some students complete in the year they commence and others may not complete until several years later. In Table 6.1, for instance, such problems produce the impossible completion rate of 125 per cent for the ACT in the year 2000. Nevertheless, these values may serve as a rough guide to the level of completion in Enrolled Nurse courses.

Table 6.1 Course Completions and Completion Rates in Enrolled Nurse Courses by State and Territory 1998-2000

Source: Unpublished data supplied by NCVER.

Note: Courses defined by ASCO code 341; Completion rate is completions in Year n divided by commencements in Year n-1 multiplied by 100. Commencements are taken from Table 1.2.

Table 6.1 shows that completion rates are in the range of 30 to 40 per cent Australia-wide. There are some problems with this estimate in addition to those already mentioned. Western Australia, for instance, has commencements of 149 in 1998 and 153 in 1999. Given that the course for Enrolled Nurses in Western Australia is 18 months full-time, it is reasonable to expect that some students would have completed by 2000. No doubt some have - they are just not recorded as having done so.

There is a suspicion that completions are poorly recorded in the VET system. Hence the values in Table 6.1 may substantially underestimate actual completions. Accordingly the responses of our interviewees should be granted some credence.

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6.3 Employment

6.3.1 Employment following graduation

Employment opportunities for Enrolled Nurses around Australia are generally favourable and, on the whole, most graduates would be employed soon after graduation. However, the nature of employment has shifted significantly away from the traditional area of aged care to a range of clinical practice areas. Generally, most graduates entered either aged care or acute care in hospitals following graduation. Despite being employed in aged care, many Enrolled Nurses were not being employed in nursing homes. In South Australia, it was reported that more than ninety per cent of graduates were working in acute care within three months of graduation.

Most States and Territories reported high demand for graduates of Enrolled Nurse programs. In some cases, agencies and health care venues were approaching institutes seeking to employ graduates as soon as they complete their courses. In some places, graduates were obtaining employment in less traditional areas for Enrolled Nurses such as mental health, community or developmental disability areas. However, one interviewee from a rural institute in Victoria reported that within rural areas acute hospital places are often not available for students completing Enrolled Nurse courses. In such areas, Enrolled Nurses are only able to obtain employment in aged care, predominantly nursing homes.

The pattern of employment for Enrolled Nurses in the ACT appears different from that in other States and Territories. In the ACT, the availability of positions for Enrolled Nurses frequently fluctuates. Many graduates return to AIN positions (where they started) until Enrolled Nurse vacancies arise. Many graduates in the ACT seek employment in acute care areas, and take up employment with agencies to access the acute care work.

Graduate programs for Enrolled Nurses are beginning to emerge to help new graduates make the transition from student, especially in acute hospital areas. Western Australia appears to be at the forefront of this development. Two regional institutions in Western Australia reported that many Enrolled Nurse graduates from their programs enter one of a number of graduate programs being offered in Perth (including Fremantle). The introduction of graduate programs within other States and Territories is being considered at present.

Overall, the shift in employment from aged care to other areas, predominantly acute hospital areas, may influence the skills mix within the aged care sector and warrant consideration.

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6.4 Further study options

One of the problematic issues for Enrolled Nurse education is the lack of further study options. Usually the only option available for formal ongoing study is to enter a degree program and to become a Registered Nurse, rather than further development for enhanced Enrolled Nursing practice. Although some students enter Enrolled Nurse studies as a pathway to subsequent degree studies, many also decide during their course to continue onto degree studies.

Most course coordinators interviewed during this study reported a high level of student interest, at some stage in their course, in moving onto degree programs for registration. Generally, the numbers of Enrolled Nurses reported as actually commencing these studies consistently ranged between one third and one half of graduates across Australia. However, it was noted that in a small number of rural areas this was not the case. In these areas, interest in degree programs was not strong and few individuals actually went on to commence these studies.

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7 Course quality mechanisms

7.1 Introduction

Ensuring quality of education and training provision is an important role for government in the training market. The quality control mechanisms for Enrolled Nursing courses centre on the State and Territory nurse registration authorities. These bodies accredit courses of instruction. In most States and Territories these authorities conduct regular audits. The providers themselves usually maintain course committees with external representatives to oversee the quality of provision. Obtaining suitable clinical placements for students was an on-going concern for most course coordinators.

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7.2 Curriculum development processes

Nurse registration authorities within each of the States and Territories play roles in the curriculum development process for nursing programs leading to registration and enrolment. However, there is variation in the degree of course regulation involved. In some cases, the relevant registering authority sets prescribed hours for course and clinical contact, whilst in other areas this is not perceived to be the role of the authority. In New South Wales, for example, courses are required to be of twelve months in duration, with fourteen weeks dedicated to the delivery of theoretical content in two blocks, one of eight weeks and the other of six weeks duration (Nurses Registration Board of New South Wales 1998).

With courses for Enrolled Nurses, TAFE institutes, too, play major roles in course development. In some instances, States and Territories have chosen to adapt programs offered in other areas to their own environments. The Certificate IV in Health (Nursing) offered in Victoria was developed by one TAFE institution for statewide implementation in 1995, including through private providers. This program was also adapted for use in the Australian Capital Territory and South Australia. In addition, a private provider in Tasmania is currently using that program. The modified program being offered in South Australia is currently being used in the TAFE sector in Tasmania. The Training Product being used in Queensland was developed through TAFE Queensland, with each institute having input into its implementation. In Western Australia, TAFE and the Nurses Board of Western Australia developed the course. Nurse registration authorities in each State and Territory ultimately accredit educational programs and agree to register graduates.

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7.3 Course review and evaluation

Interviewees were asked about course review and evaluation processes around their Enrolled Nurse courses. Most interviewees reported these processes occurring at a range of different levels, including subject or module, teaching, clinical, course, institute and industry. These appeared to be relatively consistent across the States and Territories. Most interviewees reported ongoing subject or unit evaluations being undertaken by students on their completion. Most reported institute evaluations occurred including graduate surveys. Industry opinions are significant with a number of individuals reporting the existence of industry reference or advisory groups informing program delivery. This occurs with ongoing informal feedback following student clinical placements.

The relevant nurse registering authorities in New South Wales, Tasmania, Victoria and Western Australia undertake formal program audits at various time intervals.

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7.4 Course constraints

Study participants in this area were asked about the types of constraints, either resource or institutional, that affects the quality of the training provided for students. Overall, interviewees reported being well resourced for their programs. Undoubtedly, however, the greatest constraint that effects Enrolled Nurse programs relates to the acquisition of suitable clinical placements for students. In some instances, this constraint was related more to specialist clinical environments such as operating theatre or mental health. However, for other courses there is increasing competition for clinical placements from other Enrolled Nurse courses as well as from higher education providers.

Further in relation to clinical areas, ensuring quality of clinical teaching was reported as problematic. One interviewee expressed frustration in not being able to ensure quality of preceptored clinical experience for students. In those areas where institutes are required to provide sessional staff for the clinical teaching of students on placements, the cost of providing additional staff was also raised as a concern.

Constraints relating to classroom teaching relate to difficulties in accessing suitably qualified teaching staff. This situation appears worse in rural areas where accessing specialist staff is even more difficult. In addition, through the model offered in New South Wales, one individual expressed concern that the crowded theoretical blocks limited students' ability to undertake any individual research or study that may not be as significant in other models.

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8 Financial factors

8.1 Introduction

This chapter discusses aspects of the finances of Enrolled Nurse courses. Costs to students are the most directly measured and vary substantially between States and among providers. Other costs of provision are more difficult to assess.

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8.2 Student costs

The costs for students in undertaking Enrolled Nurse courses vary immensely among States and Territories. In most States and Territories, students are required to pay course fees, the exception being New South Wales where the Area Health Service meets these costs. In contrast, some Tasmanian students pay course fees up to $4500. Table 8.1 demonstrates the discrepancies in students' costs in undertaking Enrolled Nurse programs. These are identified according to course fees, and other identified costs. Nationwide, some fee reductions apply for students who are holders of health care cards or eligible for Youth Allowance or Austudy. Such concessions may reduce student fees considerably. From Table 8.1, it is evident that

Table 8.1 Costs incurred by enrolled nurse students

apart from course fees, other costs are relatively similar across Australia. Non course fee costs include such acquisitions as textbooks, uniform, travel to and from clinical venues, accommodation as needed during clinical placements and student association fees.

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8.3 Other funding issues

Funding for Enrolled Nurse courses appears to be a complicated issue. Interviewees were asked about how funds are allocated to their courses within their particular institution. Many individuals were unsure as to how this occurred. In most cases, it became evident that the funding is a combination of TAFE and health department funding in most States and Territories. Most interviewees were able to identify that actual dollar values were placed on hours of student curriculum contact and this was significant in the funding for the course. Formulas based upon student contact hours ranged from $1.00 per hour per student to $1.45 per hour.

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