Enrolled Nurse Education
- 9. Post basic education
- 10. Higher education and Enrolled Nursing
- 11. General findings regarding the education of Enrolled Nurses
- 12. Summary
9 Post basic education
9.1 Post basic modules
Post basic modules are short modules offered for Enrolled Nurses generally with the intention of further development or enhancement of existing skills and knowledge. Coordinators of Enrolled Nurse courses were asked about the availability of post basic modules, costs involved for participants, and perceptions of demand for post basic module offerings.
The extent to which post basic modules for Enrolled Nurses are offered varies considerably around Australia. In some States and Territories, no post basic modules are offered. Furthermore, a number of respondents observed that the demand for post basic modules varies significantly. In the Northern Territory, palliative care and operating theatre are offered, whilst a psychiatric nursing module is being offered in South Australia. In Victoria, a number of interviewees reported that their institutions had attempted to offer modules, such as acute care, infection control, diabetes management, palliative care, at different stages with generally poor attendance. Some have persisted and continue to offer modules, whilst others have not continued to offer them. Two individuals noted that in Victoria, the Australian Nursing Federation does successfully offer a number of these modules. Whilst not offering any modules at present, interviewees in the Australian Capital Territory reported demand for parentcraft and anaesthetic modules.
Medications packages are available in some areas to provide skills and knowledge for Enrolled Nurses within those States and Territories to administer medications. Such packages are available in Tasmania, Queensland and Western Australia. They have been designed to provide necessary skills and knowledge for Enrolled Nurses who had received their basic education prior to introduction of medications into Enrolled Nursing curricula, or who have moved from States or Territories where medication administration by Enrolled Nurses is non-existent or more limited.
9.2 Other educational opportunities for Enrolled Nurses
One part of the study sought to ascertain the scope of options for Enrolled Nurses for ongoing education, and subsequent career advancement. The findings of the study highlight that opportunities for education beyond post basic modules for Enrolled Nurses are extremely limited. In New South Wales, a number of Certificate IV level courses have been developed in a range of clinical specialties including perioperative nursing, rehabilitation nursing, developmental disability, wound management and community nursing. These courses are available for both Enrolled and Registered Nurses. However, such types of courses are not available outside that State. In other States and Territories, educational opportunities are limited solely to inconsistent offering of post basic modules.
Overall, little opportunities are available for Enrolled Nurses to undertake ongoing education, other than those outlined above, or moving into degree courses in nursing leading to becoming Registered Nurses. This situation limits opportunities for Enrolled Nurses to develop their careers.
The next chapter explores the pathways available for Enrolled Nurses to enter degree courses that will allow them to become Registered Nurses.
10 Higher education and Enrolled Nursing
10.1 Introduction
On-going skills development requires opportunities for articulation between courses. A survey of admission officers and course coordinators of university-based degree courses in nursing was conducted as part of this study. It explored the pathway from Enrolled Nurse to Registered Nurse. This chapter presents some results from that survey, together with related results from the survey of coordinators of courses in Enrolled Nursing.
10.2 Articulation processes
Articulation processes provide pathways for graduates of one educational program to enter into another program. Two aspects of the articulation of Enrolled Nurse education have been investigated in this study. These relate to the following two scenarios:
- Enrolled Nurses moving into Bachelor of Nursing (or equivalent) programs to convert to Registered Nurses
- Registered Nurse students who have discontinued their degree program and seek to enter an Enrolled Nurse course.
10.2.1 Moving into degree programs
As highlighted previously, significant numbers of Enrolled Nurses each year seek to move into degree programs with the intention of becoming Registered Nurses. The second part of this study addresses issues surrounding articulation arrangements for Enrolled Nurses moving into degree programs in nursing. One interviewee reported that two groups of Enrolled Nurses seek to undertake degree studies. One group seeks greater responsibility than the Enrolled Nurse role can offer, whilst the other is disgruntled and frustrated with the role of the Enrolled Nurse and want to move away from it.
On the whole, Enrolled Nurses applying for entry into degree programs are treated similarly to other applicants. A small number of universities reported examining grades obtained in TAFE studies in the selection process, whilst one other expressed evaluating the individual's commitment to the course. Generally, courses did not allocate set numbers of places for Enrolled Nurses in their intakes each year, so there is a degree of variation in Enrolled Nurse numbers from year to year.
All individuals from selected universities interviewed here reported some credit being given for Enrolled Nurses entering their programs. However, this recognition generally only applies for graduates from TAFE or equivalent programs such as those from recognised private education providers. University representatives interviewed reported the existence of blanket credit arrangements for those individuals with TAFE or equivalent qualifications. This credit is offered anywhere between 50 and 100 per cent of first year programs, with the majority offering between 50 and 75 per cent of the first year. A small number of universities also provide credit for one or two subjects in second year studies. Only one university reported that credit given for being an Enrolled Nurse was applied based upon clinical practice experience. In this case, less than two years of clinical practice results in credit being given equal to one and a half semesters, whilst more than two years of clinical experience results in three full semesters worth of credit being awarded. No difference is applied regarding whether the student has undertaken their Enrolled Nurse course in a hospital or TAFE program.
Generally, credit provided for hospital trained Enrolled Nurses displays less consistency among universities. A number of interviewees reported that this group is not offered any credit within their degree courses. Others offered one clinical subject only, whilst some reported taking work experience into account when considering credit applications. One university reported giving the same credit for hospital trained Enrolled Nurses as TAFE graduates, whilst a few others reported that they were examining the possibility of introducing similar arrangements in future.
Participants were asked whether their courses provided opportunities for Enrolled Nurses to undertake some of their clinical experience within the health care setting where they are employed. This question resulted in mixed responses. Many participants stated that this was not possible and that students are required to take leave from their employment in order to undertake blocks of clinical experience as required in their courses. Some participants claimed that this was necessary to ensure that Enrolled Nurses continued to be seen as students with particular learning needs, not left alone to assume patient care loads. In a few cases, universities reported that they are considering more flexibility in where and how Enrolled Nurses can undertake clinical components of their degree courses, including developing arrangements with employers.
10.2.2 Moving out of degree programs
The first part of this study addresses articulation arrangements for students who seek Recognition of Prior Learning from previous studies. Interviewees were asked about credit and articulation opportunities for individuals moving out of degree programs in nursing.
Each year a small number of students undertaking degree studies in nursing choose to discontinue their courses and seek entry into Enrolled Nurse courses. Reasons for this may vary depending upon individual factors, however, credit issued by providers of Enrolled Nurse education on the whole, may not reflect the amount of study that the applicant may have undertaken within the previous degree studies. Almost all interviewees expressed frustration that such students may obtain little credit, perhaps only for modules such as Communication, for example. The problem arises from the difficulty in equating modules or units from the Enrolled Nurse course with those forming part of degree courses. One interviewee reported instances where individuals have actually returned to initial degree courses after finding that the amount of credit granted in Enrolled Nurse courses would be negligible.
10.3 Entry processes
Interviewees were asked to outline the entry processes in place for Enrolled Nurses wishing to enter the degree program. All interviewees reported similar course entry processes. All Enrolled Nurse applicants enter degree studies through the relevant university admissions centre within the State or Territory, in the same manner as other applicants to the courses. However, one university reported that direct entry applications were accepted for late applications. No course was reported as requiring a special entry test for Enrolled Nurses.
10.3.1 Study patterns
Interviewees were asked whether Enrolled Nurses in their degree programs tended to study full time or part time over the duration of their course. Answers to this question tended towards part time study, however, there were a number of interviewees who reported that Enrolled Nurses preferred full time study. In some cases, full time mode was the only available option for students, however, this is not the case in all instances. Some interviewees were unable to identify any pattern.
The chosen study pattern may depend on the individual program requirements, however, this would require further investigation. Some courses offer options for Enrolled Nurses to study selected subjects by flexible delivery. A number of other courses are moving towards increasing flexible subject delivery. The increased flexibility may influence Enrolled Nurses' choices about whether to study full time or part time.
10.3.2 Degree completion for Enrolled Nurses
Interviewees were asked about completion rates for Enrolled Nurses in their degree courses. None had firm data so the responses are anecdotal. Most reported high completion rates for Enrolled Nurses, estimating between 70 and 100 per cent complete their courses, although some interviewees were completely unsure of the figures. Many believed the rates of course completion for hospital trained Enrolled Nurses were higher than those from TAFE programs, however, all rates were believed to be high.
A number of interviewees suggested that attrition rates among Enrolled Nurses were significantly lower than other groups entering degree studies in nursing. It was suggested by a number of interviewees that this finding was probably due to Enrolled Nurses' previous knowledge and industry experience providing them with a sound understanding of the requirements of nursing.
11 General findings regarding the education of Enrolled Nurses
At the end of the interviews participants were invited to comment on any issues that had not been addressed through the interview questions. Many of the participants took the opportunity to add extra comments. These centred around two main areas:
- The need for greater consistency in the delivery of Enrolled Nurse education across the States and Territories; and,
- The lower status of Enrolled Nursing compared with Registered Nursing, and the need to enhance the status and esteem of Enrolled Nursing.
11.1 Nationwide course standards
The lack of consistent approaches to the education of Enrolled Nurses was raised throughout the study. A number of interviewees expressed frustration at the disparity in courses for Enrolled Nurses offered across the States and Territories.
A few participants compared programs for Registered Nurses with those for Enrolled Nurses. The contrasted the diversity of Enrolled Nurse courses with the greater consistency of Registered Nurse courses. The degree programs leading to registration are similarly constructed with similar lengths, content and outcomes. This uniformity leads to ease of registration across jurisdictions for Registered Nurses. Participants expressed a need for a similar, more consistent approach to the preparation of Enrolled Nurses across Australia. Interviewees highlighted the problems many Enrolled Nurses experience when moving between States or Territories.
The main differences in Enrolled Nurse preparation were attributed to individual State and Territory regulations for the administration of medications by Enrolled Nurses. Potential issues arise when either:
- An Enrolled Nurse from a State that allows significant medication administration moves to a State or Territory where practice is more limited; or
- An Enrolled Nurse from a State or Territory where no medication administration is allowed moves to another where medication administration by Enrolled Nurses is normal practice.
In the first situation, the Enrolled Nurse may find that her/his practice is more constrained, while in the second situation, the Enrolled Nurse may be under-prepared. This leads to pressure being placed on the health care provider to ensure that adequate education is provided.
11.2 Esteem of enrolled nurses
A range of issues and concerns were expressed by participants in this study around the education, training and preparation of Enrolled Nurses. One respondent expressed concern about the esteem of Enrolled Nurses. This is an issue raised previously by Dunn (1998), who suggested that Enrolled Nurse students often felt 'devalued due to a general awareness of their achievements'. Dunn further suggests that Enrolled Nurses often feel that their contribution to patient care was considered much lower than that of other health professionals.
In relation to education, the low valuation of Enrolled Nursing appears to persist through the current study. From interviews conducted in this study, Enrolled Nurse courses often appear to be given second option on available clinical placements. Students in Enrolled Nurse courses can be placed only when the requirements of degree students have been satisfied. Some respondents also suggested that there is a widely-held perception that Enrolled Nurses and PCAs were interchangeable within the health care arena. Concern was expressed about the consequences of such beliefs for decreased quality of patient care as employers choose cheaper staffing options through employment of PCAs rather than Enrolled Nurses.
12 Summary
12.1 Conclusions
A number of conclusions can be drawn from this study relating to the education of Enrolled Nurses. The study highlights a range of opportunities for further research into an area that presently lacks a substantial research literature.
Courses for preparing Enrolled Nurses currently exhibit great disparity in their level of offering and lengths around Australia. In part this can be attributed to differences in the scope of practice in the various States and Territories, particularly concerning medication administration. In addition to course offerings by TAFE institutions, in some States, new models for the delivery of Enrolled Nurse education have emerged, including traineeships and employment-based models. In addition, private providers in some areas have purchased programs for private offering. Curricula for Enrolled Nurse programs are developed at State or Territory level. Significant input into curriculum development often involves the local Nurse Registration Authority, TAFE institutes, and members of the health care industry. Courses undergo ongoing review and evaluation at a number of different levels.
Criteria for entry and selection processes for Enrolled Nurse programs vary. In some areas, bridging programs are available for applicants who do not meet entry requirements. Available courses offer different levels of flexibility for students. Costs incurred by students reflect a significant amount of discrepancy across States and Territories. Course fees incurred by students range from nothing to $4500 for a course, depending on the particular State or Territory, and in some instances whether being provided by a TAFE institute or private education provider.
Clinical practice focuses within Enrolled Nurse preparation courses have changed with greater emphasis being placed on acute care, although aged care continues to remain a prominent focus. In addition, new areas for clinical experience are emerging including mental health, community or domiciliary nursing, and operating theatre. Acquisition of quality clinical placements for Enrolled Nurse students is problematic for institutions in most States and Territories. Staff shortages within health care institutions provide further difficulties in ensuring students are appropriately supervised in clinical practice areas.
Students in Enrolled Nurse courses are predominantly mature-aged, with only small numbers of school leavers entering programs. Many students have previous experience in health care areas, especially aged care. For many, Enrolled Nurse courses offer opportunities to move away from such clinical practice areas and into more acute settings. Many students continue to work in health care areas during their courses.
Enrolled Nurse courses around Australia exhibit high completion rates. The highest completion rates relate to full time students, with part time student completion rates less, and completions from traineeships the lowest. Employment prospects are extremely positive for Enrolled Nurses on completion of their courses. With a shift towards employment in acute care areas, Enrolled Nurses are less likely to take up employment in aged care than was previously the case. Some are entering other clinical areas including mental health, community and operating theatre.
Post-qualification education for Enrolled Nurses is extremely limited. In many instances, the only available option is conversion to become Registered Nurses. Many Enrolled Nurse students express interest in undertaking this (?) on completion of their Enrolled Nurse courses. There are no formal academic awards available for Enrolled Nurses seeking higher qualifications. Post-basic modules are offered in some States and Territories in some clinical areas. One State does offer Certificate IV level courses in specialist clinical practice areas. The lack of availability of post-qualification courses for Enrolled Nurses reflects the lack of available career progression pathways for this group.
Articulation processes are inconsistent and Recognition of Prior Learning (RPL) arrangements are poorly developed with regard to Enrolled Nurse education. This situation relates both to individuals moving from other programs into Enrolled Nurse courses, as well as for Enrolled Nurses seeking to move into university degree programs in nursing. Enrolled Nurses moving into degree programs in nursing may receive anywhere between 50 and 100 per cent credit, while individuals moving into Enrolled Nurse programs may receive little credit. The application of RPL does appear difficult for institutions. For Enrolled Nurses moving into degree programs in nursing, completion rates appear extremely high.
12.2 Key findings
Several important findings emerge from the study:
- There is considerable inconsistency in Enrolled Nurse education around Australia. The difficulties that this creates for graduates, health care providers, and potentially patients, means that consideration needs to be given to creating greater uniformity and consistency among States and Territories in the educational preparation of Enrolled nurses.
- The education of Enrolled Nurses currently occurs at Certificate IV level and Diploma level (in Queensland). Given the growing complexity in the Enrolled Nurse role involving greater knowledge and skill development in acute care, consideration may need to be given to preparing all Enrolled Nurses at diploma level around Australia.
- Post-qualification studies for Enrolled Nurses are limited. More structured and flexible professional pathways could be provided for Enrolled Nurses who wish to enhance their skills but remain as Enrolled Nurses rather than undertake a degree course to become a Registered Nurse.
- Enrolled Nurse courses currently have small school leaver populations. The shorter (and often cheaper) pathway to becoming an Enrolled Nurse might be attractive to some school leavers who do not want to undertake a three-year university course to become a Registered Nurse. Increasing awareness of Enrolled Nurse courses in schools may help attract more school leavers to the profession.
- The capabilities of VET qualified Enrolled Nurses may be undervalued in the workplace.
- Articulation processes from Enrolled Nurse courses into degree programs, and from degree programs into Enrolled Nurse programs, remains poorly developed. Consideration needs to be given to developing clearer and more generous articulation processes.
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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