Intraprofessional collaboration between enrolled and registered nurses in the care of clinically deteriorating ward patients: A qualitative study.

BACKGROUND: Nurses' role in vital signs monitoring places them in an ideal position to recognise and respond to clinical deterioration in general wards. However, enrolled nurses (ENs) and registered nurses (RNs) do not always work collaboratively, and this can lead to delays in recognition and escalation of clinical deterioration in general wards. OBJECTIVES: The aim of the study was to explore the collaboration experiences between ENs and RNs in recognising and responding to clinical deterioration in general ward settings. METHODS: A qualitative descriptive study involving 12 ENs and 11 RNs was conducted in a 1250-bed tertiary hospital in Singapore using semistructured interviews. Interviews were transcribed and thematically analysed. FINDINGS: Three main themes emerged from the data analysis. The first, "reaching a collective understanding of patients' conditions', identifies nursing shift handover as the primary method of obtaining patient information essential for ENs and RNs to work collaboratively to deliver safe patient care. However, the dissociation of ENs during the handover process created information gaps on patients at risk of clinical deterioration. The second, "role expectations of each other", describes expectations that both groups of nurses had for each other's functions and responsibilities and the importance of mutual support in the nursing teamwork process. The third, "lacking in shared decision-making", depicts a top-down approach in decision-making, wherein ENs were often not engaged in the decision-making process related to patient care. CONCLUSIONS: A less-than-optimal collaborative EN-RN relationship was observed in this study, which sometimes caused delays in recognising and responding to deteriorating ward patients. This study illuminates the need for intraprofessional learning opportunities in prelicensure nursing programmes and the workplace to foster effective EN-RN collaborative practice. Nurse managers and educators are instrumental in fostering EN-RN collaboration and providing ongoing education on nursing teamwork skills and competencies.

Enrolled nurses' experiences of caring for patients living with HIV in a South African rural hospital.

BACKGROUND: Most public hospitals in African countries are overpopulated with patients suffering from conditions related to HIV and AIDS. These patients increase the burden on healthcare providers, among which are enrolled nurses. AIM: To explore enrolled nurses' experiences of caring for patients living with HIV and AIDS at a public rural community hospital in the Vhembe district of Limpopo Province, South Africa. DESIGN: The study was underpinned by the interpretative phenomenological design. PARTICIPANTS: A total of 11 purposively selected enrolled nurses who met the inclusion criteria participated in the study. The sample size was based on data saturation. METHOD: Data were collected through semi-structured individual face-to-face interviews guided by an interview guide. Interviews were audio-recorded; and field notes were also taken. Data were analysed thematically following a framework for interpretative phenomenological analysis. RESULTS: The study revealed that enrolled nurses are working without adequate resources. They also experience minimal support despite the negative circumstances they are exposed to in the process of caring for patients admitted with HIV-related illnesses. CONCLUSIONS: A lack of resources, limited support and inadequate skills have a negative impact on the health care that enrolled nurses provide to patients admitted in hospital with HIV-related ailments. Researchers recommend the importance of supporting and equipping enrolled nurses to provide quality care to patients living with HIV. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The findings have highlighted the challenges faced by enrolled nurses while caring for patients with HIV. The identified gaps will assist the Department of Health in developing policies to enhance the support offered to enrolled nurses and improve the care provided to patients with HIV-related conditions that are admitted to rural hospitals.

Meanings of troubled conscience and how to deal with it: expressions of Persian-speaking enrolled nurses in Sweden.

INTRODUCTION: A feature of the healthcare system in Sweden, particularly in the care of older people, is its cultural diversity in terms of having considerable numbers of both caregivers and care recipients with an immigrant background. Considering the influence of culture in ethical decision-making processes, the idea of conscience and the adverse effects of a troubled conscience, it is important to study the concepts of conscience and troubled conscience in culturally diverse populations. There is no published study regarding troubled conscience among immigrant populations that includes enrolled nurses. AIM: To illuminate the meanings of troubled conscience and how to deal with it among enrolled nurses with Iranian backgrounds working in Swedish residential care for Persian-speaking people with dementia who have emigrated from Iran. METHOD: The study was conducted with a phenomenological hermeneutic design. Ten enrolled nurses with an Iranian background, with at least one year's experience of taking care of older people with dementia, were interviewed. The study was reviewed by the Regional Ethical Review Board for ethical vetting of research involving humans. Appropriate measures were taken to ensure confidentiality and voluntary participation. RESULTS: The meanings of having a troubled conscience for the participants comprise not being a good person, including being an uncaring person, not acting according to one's values and living in a state of unease. Dealing with a troubled conscience involves trying to compensate for the harm one has caused and trying to prevent similar situations by being a responsible caregiver. CONCLUSIONS: The enrolled nurses understood themselves as caring people and not only caregivers. They knew that they should hear their conscience and respond to it by trying to be a caring person and acting according to their values. The findings should be interpreted in the given specific context.

EN2RN - transitioning to a new scope of practice.

BACKGROUND: In Australia, newly graduated registered nurses enter the workforce and a number of these have previous experience as enrolled nurses. For all newly graduated registered nurses, transitioning to the new role can be challenging. AIM: The aim of this study was to explore the experiences of enrolled nurses transitioning to the role of registered nurses to support the development of effective transition programs. DESIGN: An exploratory qualitative design. METHODS: In-depth interviews with a purposive sample from one health service in South East Queensland, Australia. Data were analysed thematically. FINDINGS: The three main themes emerging from analysis: a new scope of practice, perceptions of capability, building on experience and knowledge. CONCLUSIONS: We recommend assessment of individual learning needs and support during the transition period which acknowledges previous experience and recognises learning required to effectively transition to the role of a registered nurse.

Similarities and differences in educational preparation of registered and enrolled nurses in Australia: An examination of curricula content.

UNLABELLED: Abstract Background: Variations exist internationally in the types and numbers of nurses registered to practice. Whilst the United Kingdom has phased out second level nurses, countries such as Australia, New Zealand, Singapore and the United States have maintained a two level system. In Australia, the two levels of nurse authorised to practice are the registered nurse whom complete an undergraduate nursing degree, and enrolled nurse (EN) whom complete either a certificate or diploma programme. Recent changes to educational preparation and resulting scope of practice for ENs have resulted in increased confusion between roles and expectations of the different levels. AIM: This paper reports on findings of a study aimed at identifying differences in educational preparation of the different levels of nurse in Australia. METHOD: Course coordinators from nine organisations offering pre-registration nursing programmes completed self-reporting questionnaires designed to obtain information on types and lengths of courses, and details of curricula including course objectives, teaching and assessment methods and content areas. RESULTS: Comparative analysis of survey responses identified similarities and differences between registered and EN programmes. Common areas included teaching and assessment methods, core theoretical units and general nursing skills. The diploma and degree programmes appear aligned in most theory and clinical skills. The main difference identified existed between skills taught in the two EN programmes. CONCLUSIONS: Findings further add to confusion regarding registered and ENs in Australia. Further research is required to determine expectations of employers and other major stakeholders with regard to the differences.

Senior nurse role expectations of graduate registered and enrolled nurses in Australia: Content analysis of open-ended survey questions.

Abstract Changes to educational preparation and scope of practice for enrolled nurses (ENs) in Australia have impacted on role expectations. This paper reports results of a survey of senior nurses in Victoria, Australia, regarding opinions of the differences in role expectation and scope of practice for graduate registered and ENs. Content analysis of open-ended survey questions was used to identify themes in the written data. Results identified education, skill level and responsibility as differences between the levels of graduate nurses despite many respondents perceiving there to be no or little difference in graduate roles.

The voice of the second-level regulated nursing role: a qualitative approach.

BACKGROUND: With an international nursing shortage, there is a need to navigate towards an improved nursing workforce structure where each nursing role is valued and recognised for the work they contribute. The second-level regulated nursing role is seen as integral; however, there is role confusion, especially with the registered nurse, and high attrition. To implement strategies to retain an integral nursing workforce, there is a need to better understand the role from the experiences and expectations of the second-level regulated nursing role. AIM: To gain a better understanding of the second-level regulated nursing role in the Australian nursing workforce. DESIGN: Qualitative descriptive study from a larger mixed methods study. METHOD: Five focus groups in 2018. The findings were analysed through the lens of organisational behaviour. RESULTS: The findings identified that enrolled nurses' intrinsic and extrinsic motivators influenced levels of job satisfaction and sense of feeling valued. The findings also identified key determinants that influence job satisfaction and occupational stress: enrolled nurses' understanding of their role and scope of practice; the registered nurses' understanding of the enrolled nurses' role and their role when working with the enrolled nurse; and the organisation's understanding and recognition of their role. When these determinants align, there is job satisfaction, less occupational stress and enrolled nurses feel valued. At a professional level, the title does not reflect the role, and there are no career pathways. CONCLUSION: This study explained why recurrent challenges impact the role and what contributes to those in the role feeling valued. Challenges that affect job satisfaction and occupational stress for the second-level (enrolled) nurse are related to the working environment and with whom the nurse works. From a professional level, there are limited career opportunities that recognise and retain the enrolled nurse in their role.

Experiences and challenges of enrolled nurses undertaking a Bachelor of Nursing Science programme in Namibia.

BACKGROUND:  Globally, enrolled nurses (ENs) are embarking on an educational journey to become registered nurses (RNs) in order to enhance their knowledge and career opportunities. However, their aspiration is not without challenges. In Namibia, the experiences of these nurses have not been extensively researched. OBJECTIVES:  This study aims to explore and describe the experiences and challenges of ENs undertaking a Bachelor of Nursing Science at the University of Namibia. METHOD:  A qualitative, exploratory, descriptive and contextual research strategy was followed as the basis of conducting the study. A sample of 15 nursing students was purposively selected from the target population of 73 nursing students. This sample size was determined by the saturation of data as reflected in repeating themes. The collected data were analysed thematically using an inductive approach. RESULTS:  Three main themes subsequently emerged from the study: ENs' positive experiences advancing in the Bachelor of Nursing Science (BNSc) programme; nurses' negative experiences advancing in the BNSc programme; and recommendations to ensure effective advancement in the BNSc programmeConclusion: The findings of this study revealed that ENs positively experience becoming a RN when it comes to self-development; however, they have negative experiences such as not receiving exemptions for prior learning and having to learn a new curriculum.Contribution: These findings may be used by the Faculty of Health Sciences, School of Nursing and Public Health management in order to develop targeted interventions and ongoing strategies during their curriculum review cycles to ensure positive student experiences and success within the programme.

Transition and pathway programs from second to first level nursing: A scoping review.

BACKGROUND: Second-level nurses comprise a large proportion of the nursing workforce in many countries. Despite differences in nomenclature, these nurses work under the supervision of first-level registered nurses and possess a more restricted scope of practice. Transition programs facilitate second-level nurses upgrading their qualifications to become first-level nurses. Globally, the impetus for transition of nurses to higher levels of registration has been to increase the skill mix demands in health care settings. However, no review has sought to explore these programs internationally and experiences of those making the transition. OBJECTIVES: To explore what is known about transition and pathway programs from second to first level nursing. DESIGN: Scoping review informed by the work of Arksey and O'Malley. DATA SOURCES: Four databases were searched, CINAHL, ERIC, Proquest Nursing and Allied Health and DOAJ, using defined search strategy. REVIEW METHODS: Titles and abstracts were uploaded into the online program Covidence for screening, followed by full-text screening. Two members of the research team screened all entries at both stages. Quality appraisal was performed to assess overall quality of research. RESULTS: Transition programs are often undertaken to open up career pathways, job and financial advancement. These programs can be challenging as students seek to maintain dual identities, grapple with academic requirements and juggle work, study and personal demands. Despite their prior experience, there is a need for students to receive support as they adjust to their new role and scope of practice. CONCLUSION: Much of the existing research around second to first-level nurse transition programs is dated. There is a need for longitudinal research to examine students' experiences as they transition across the roles.

Graduate enrolled nurse readiness to practice: A scoping review.

BACKGROUND: In some countries, enrolled nurses (also known as Licensed Practical Nurses) have become essential members of the healthcare team, supporting registered nurses to address patient care needs. Registered nurses' readiness to practice is well documented in the literature, however, less is known about the preparedness of enrolled nurses for practice. OBJECTIVE: To explore and synthesize the available evidence on the graduate enrolled nurse practice readiness upon completion of their nursing qualification and at the time of entering the nursing workforce. DESIGN: A scoping review was conducted. DATA SOURCES: Databases such as CINAHL Complete, Directory of access journal, Cochrane Library, Medline, PubMed, Scopus, Web of Science, ProQuest and Google scholar were searched. REVIEW METHOD: The review was conducted using The Joanna Briggs Institute Methodology for Scoping reviews. RESULTS: Seven studies were identified for inclusion and two themes were constructed as 'ambiguous roles and expectations' and 'lack of educational preparation'. Findings from the selected studies showed a lack of clarity on the role of an enrolled nurse. In some healthcare settings, enrolled nurses were expected to undertake the same role as registered nurses. Furthermore, it was expected that enrolled nurses would be educationally prepared to work in specialty areas such as mental health, acute care and aged care upon completion of their studies. Though, none of these studies provided any conclusive evidence of whether enrolled nurses were ready to transition to practice. CONCLUSION: In line with the limited evidence, there is a need to undertake further studies to understand the graduate enrolled nurse practice readiness from graduates' and industry stakeholders' perspectives. The findings will assist the education providers to strengthen their curriculum and health industry to support enrolled nurse transition to practice.

Exploring the role of the second-level regulated nurse in the Australian nursing workforce: an integrative review.

BACKGROUND: The enrolled nurse is the second-level regulated nursing role in Australia and internationally. Reports and research indicate that the nursing profession requires greater understanding of the role, so it can be utilised to its potential. AIM: To explore issues that may impact the EN role in the Australian nursing workforce. DESIGN: An integrative review. METHODS: A seven-step framework was used to review scholarly papers, government documents, and grey literature. RESULTS: Three themes from 24 documents were identified: understanding the EN's scope of practice, standardised practice, and career development. DISCUSSION: A lack of understanding of their scope of practice creates role confusion and a lack of standardised practice, with an expected progression to become a registered nurse. These factors contribute to ENs' not feeling valued. CONCLUSION: The nursing profession do not understand the enrolled nurse role, and further work is required to value its place in the Australian nursing workforce.

Understanding the enrolled nurse to registered nurse journey through a model adapted from Schlossberg's transition theory.

BACKGROUND: Substantial numbers of Enrolled Nurses (ENs) enrol in higher education programs to undergo the transition to Registered Nurse (RN) with the experience described as containing numerous challenges. OBJECTIVES: This paper reports on a synthesis of the literature that explores the experiences of ENs undertaking a program of study to convert to RN. Consequently, a model is developed to identify educational interventions and resources to enable a successful transition for these students. DESIGN: A narrative review was completed with thematic synthesis of the literature guided by Schlossberg's Transition Theory, and Thomas and Harden's framework for systematic analysis of qualitative studies. DATA SOURCES: CINAHL, Scopus, ProQuest Central and Health Collection were searched. REVIEW METHODS: The databases were searched for English language journal articles, theses and grey literature published from 1987 to 2016 from Australia, New Zealand, the United Kingdom, Canada and the USA. The key search words included truncations of: "enrolled nurse", 'licensed practical nurse', "transition", "conversion" and "experience". This resulted in the identification of 33 related articles for review. RESULTS: Themes and sub-themes developed from the literature synthesis were integrated into an 'EN to RN Transition model.' The four stages of the model reflect the experiences of the ENs as they overcame the various challenges they encountered during their transition to RN. The model was used to develop recommendations that may improve their transition experience and decrease attrition. CONCLUSION: This paper reports on a synthesis of the literature, and presents a four stage model, that reflects the experiences of ENs in their transition to RN. Recognising the elements within each stage can assist educators develop strategies and provide educational resources to enhance the EN journey.

Back to the future: A practice led transition program from Assistant in Nursing to Enrolled Nurse.

Continuing professional development is an essential element in professional nursing practice. In our Hospital and Health service, a gap in existing nursing pathways was identified for Assistants in Nursing (AINs), who wished to further their career in nursing and progress to Enrolled Nurse (EN). There is also little in the literature that addresses Assistants in Nursing wishing to progress their career to Enrolled Nurses. This article describes a quality improvement project designed to address this gap. The project was a collaborative venture between a Queensland Hospital and Health Service and an Institute of Tertiary and Further Education (TAFE). The focus was on creating a flexible career path for Assistants in Nursing, wishing to become Enrolled Nurses. The project resulted in the Diploma of Nursing program (theory and practice) being delivered within the hospital setting by nurse educators and clinical nurse consultants. This is unusual in that the program is normally delivered in the tertiary setting, by academic staff from the Institute of Further Education. Program implementation is described along with the challenges encountered. Outcomes from the project were: 78% completion rate; 100% employment on completion of their course of study; and 18% progressing to further their education such as Advance Enrolled Nurse or Registered Nurse. Student satisfaction regarding the program was also positive. The initiative established a local career path for Assistants in Nursing wishing to progress to Enrolled Nurse. This quality project demonstrates that collaborative ventures between the tertiary sector and hospital and health services, can create innovative flexible solutions for staff wishing to further their career in nursing.

Educators' expectations of roles, employability and career pathways of registered and enrolled nurses in Australia.

In Australia, like other countries, two levels of nurse are registered for entry to practice. Educational changes for second level nurses in Australia have led to questions regarding roles and career options. This paper reports on interviews with nursing course coordinators to examine educator expectations of roles and career pathways of registered and enrolled nurses. Coordinators of eight degree (registered) and diploma (enrolled) nursing programs were interviewed to determine their opinions on roles and careers that students were prepared for. Transcripts were thematically analysed. Educators reported similar graduate roles, although high acuity care was primarily the role of registered nurses. Career expectations differed with enrolled nurses having limited advancement opportunity, and registered nurses greater career options. Health organisations were unprepared to accommodate increased practice scope of enrolled nurses and limited work practice through policies stipulating who could perform procedures. Organisational health policies need to accommodate increased enrolled nurse skill base. Education of practising nurses is necessary regarding increased scope of enrolled nurse practice to ensure they are used to their full potential. Increasing patient acuity requires more registered nurses, as enrolled nurses are unprepared to care for complex or deteriorating patients.

Senior nurse role expectations of graduate registered and enrolled nurses in Australia: Content analysis of open-ended survey questions.

Abstract Changes to educational preparation and scope of practice for enrolled nurses in Australia have impacted on role expectations. This paper reports results of a survey of senior nurses in Victoria, Australia, regarding opinions of the differences in role expectation and scope of practice for graduate registered and enrolled nurses. Content analysis of open-ended survey questions was used to identify themes in the written data. Results identified education, skill level and responsibility as differences between the levels of graduate nurses despite many respondents perceiving there to be no or little difference in graduate roles.

Similarities and differences in educational preparation of registered and enrolled nurses in Australia: An examination of curricula content.

Abstract Background: Variations exist internationally in the types and numbers of nurses registered to practice. Whilst the United Kingdom has phased out second level nurses, countries such as Australia, New Zealand, Singapore and the United States have maintained a two level system. In Australia, the two levels of nurse authorised to practice are the registered nurse whom complete an undergraduate nursing degree, and enrolled nurse whom complete either a certificate or diploma program. Recent changes to educational preparation and resulting scope of practice for enrolled nurses have resulted in increased confusion between roles and expectations of the different levels. Aim: This paper reports on findings of a study aimed at identifying differences in educational preparation of the different levels of nurse in Australia. Method: Course coordinators from nine organisations offering pre-registration nursing programs completed self-reporting questionnaires designed to obtain information on types and lengths of courses, and details of curricula including course objectives, teaching and assessment methods and content areas. Results: Comparative analysis of survey responses identified similarities and differences between registered and enrolled nurse programs. Common areas included teaching and assessment methods, core theoretical units and general nursing skills. The diploma and degree programs appear aligned in most theory and clinical skills. The main difference identified existed between skills taught in the two enrolled nurse programs. Conclusions: Findings further add to confusion regarding registered and enrolled nurses in Australia. Further research is required to determine expectations of employers and other major stakeholders with regard to the differences.

Comparisons of the educational preparation of registered and enrolled nurses in Australia: the educators' perspectives.

Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the degree or postgraduate entry prepared registered nurse and diploma or certificate-prepared enrolled nurse. Over the past decade, significant changes have occurred in educational preparation of enrolled nurses. This has resulted in enrolled nurses undertaking many roles and responsibilities previously undertaken only by registered nurses. An exploratory qualitative research study using interviews with educators of both registered and enrolled nurses was undertaken to investigate differences in educational preparation of registered and enrolled nurses in Australia. This paper describes perceptions around how participants viewed educational approaches and different cohorts, types and levels of students. Similarities included topics covered and the majority skills taught, although high acuity skills remain a difference between the levels of nurse. Differences were also found in type of student, educational background and teaching methods.