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Report From a National Survey Of Health Service Facilities for the National Review of Nursing Education 20016. Enrolled Nurses
6.1 Demographic DataInstitutions were asked a series of questions about the provision of clinical experience for trainee enrolled nurses (TENs or TRN Division II). Through this discussion the term Enrolled Nurse has been used as this is used by most States. Questions related to the numbers employed and their status on the staffing profile and the supports provided by both health facilities and the TAFE sector. Table 26 - Category of organisation with Trainee Enrolled Nurses (TENs)
In contrast with the findings for undergraduate BN students (90% - see Table 8) only 31.8% of public hospitals have trainee enrolled nurses. Respondents from the private and charitable categories indicate they are more likely to have trainee enrolled nurses (minimum 66.7% in the private for-profit sector). The high response of 'no' may reflect the sample of respondents who may not have met accredited training requirements as specified by regulatory bodies. The poor participation rate from the metropolitan hospitals may impact on the interpretation of these results. Table 27 - Number of TENs provided clinical experience in a year
*The respondent with 200 ENs was an area health service Table 27 provides data on the number of trainee enrolled nurses provided clinical experience throughout the year. As with undergraduate BN students, the public category has more trainee enrolled nurses (see mean and median) while across the other three categories of institution there is little difference. There is a large standard deviation which reflects area/regional responses in the public category. The classification status of trainee enrolled nurses is an important and emerging issue. Institutions were asked to indicate on their staffing profile whether they classified trainee enrolled nurses as full-time equivalents (FTE), 0.5 FTE or whether they were counted as supernumerary. Table 28 - Classification status of TENs on the staffing profile
There is disparity in the ways in which trainee enrolled nurses appear on institutional staffing profiles. The majority in the public category (77.8%) indicated that they are counted as supernumerary while over 20% of respondents count them as full-time staff on their profile. A similar profile also appears in the private for-profit category. Status may affect learning opportunities, particularly if trainee enrolled nurses are expected to take a full service load as part of the ward establishment. 6.2 Support ProvidedAs with undergraduate BN students who are provided clinical placements, respondents were also asked to indicate the supports they are provided by educational facilities and those provided for trainee enrolled nurses by health facilities. Respondents could provide more than one response. Table 29 - Support provided by health facilities to TENs
[Sorted by total responses] Table 29 indicates the support offered by health institutions to trainee enrolled nurses while in their organisations. Partner/buddy system, parking, liaison officer and library access are important, as are flexible shift rosters and paid orientation. There is a substantial array, many of which are provided across all four categories. A greater proportion of public institutions provides subsidised accommodation. All of the charitable organisations having agreements with TAFE (11/11) provide library access and flexible shift rosters, a greater proportion than any other institution. However, it must be remembered that there is a small number of respondents from this category and they accept fewer trainee enrolled nurses (Tables 26 and 27). Table 30 provides data on the support provided by TAFE to health facilities during the provision of clinical experience. Again more than one response was possible. Table 30 - Support provided by TAFE to health facilities withTENs
From Table 30 the most frequently cited support across all categories of institution is the provision of supervisory staff for students. Payment for service and library access are two other tangible supports provided. 6.3 Satisfaction With New Enrolled Nurses' SkillsAppendix II provides data on health facilities' level of satisfaction with new enrolled nurse skills (ENs or RNs Division II). Activities differ slightly from RNs to reflect role differences. Again a four point Likert scale was used and respondents were asked to indicate their level of satisfaction with the skills at three months and then from 3-12 months. 'Never' was a score of '1' while 'always' was '4'. Time management for new enrolled nurses is the skill with one of the lowest mean scores for satisfaction at three months across all categories of institution. This is comparable to the findings for new registered nurses. However, of interest is the low mean score for CPR (2.54 for all categories, 2.69 in the private not-for-profit category) and documentation. Emphasis on documentation in the charitable and not-for-profit categories is significant given the number of aged care facilities in the sample and the fact that their funding depends to a significant degree on the quality of their documentation (Pelletier, Duffield, Gietzelt, and Larkin, 2001). As with new undergraduate registered nurses the skill which employers are most satisfied with is hygiene. At 3-12 months respondents noted improvements in levels of satisfaction for new enrolled nurses across all skills and in all four categories of institution. The mean scores for CPR, time management and documentation are still amongst the lowest. As with new registered nurses the charitable institutions at 3-12 months still recorded a minimum score of '1' (never satisfied) for all skills. There are only two other scores of 'never' during this time frame and that is in the public category for CPR and simple dressings. 6.4 SummaryIn summary, of those who responded, the private (for-profit and not-for-profit) and charitable categories are most likely to have trainee enrolled nurses. While less public institutions indicated they take TENs, those who do take more than in the other categories. As for FTE classification of TENs on the staffing profile, 77.8% in the public category indicate they are classified as supernumerary and there is a similar pattern for the other categories of institution. Health facilities provide a variety of supports for TENs with partner/buddy system the most frequent. The TAFE institutions provide supervisory staff, payment for service and library access most frequently. Satisfaction with enrolled nurses indicates that time management is an issue at three months but the mean scores for CPR and documentation are also low. The mean scores at 3 months are above 2.00 (occasionally satisfied) and by 3-12 months most means rise to 3.00 or above (usually satisfied). At 3-12 months there are improvements in the mean scores for all skills across all categories of institution but CPR, time management and documentation still have lower mean scores than do the other skills. |
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