Scope of practice for Australian enrolled nurses: Evolution and practice issues

Question 1: Identify which issue is being discussed by the authors in the article “Scope of practice for Australian enrolled nurses: Evolution and practice issues”.

Question 2: What are the two (2) main reasons cited for the issue?

Question 3: The authors provide a number of important reasons in explaining the changes to Enrolled Nurse practice and the current situation. Which two (2) factors/reasons do you think are most significant and why?

Question 4: In the article, identify two (2) of the different considerations, in terms of viewing scope of practice for nurses.

Question 5: In the article, a number of professional and practice issues impacting on nursing are identified as a result of expanding the scope of practice of the Enrolled Nurse. Identify two (2) of these issues.

Answer:

Q1: Jacob et al. (2013) in their article “Scope of practice for Australian enrolled nurses: Evolution and practice issues” have highlighted the issue of significant changes brought about in the scope of practice for enrolled nurses in Australia in the past one decade. The main concern is that enrolled nurses have moved into clinical areas that were previously conventionally the domain of domain of registered nurses in Australia. The responsibilities of an Enrolled nurse have seen drastic expansion in the recent past to include care settings such as anesthetics, operating theaters, and emergency departments acute medical and surgical wards. Earlier, registered nurses used to handle these areas. Further, enrolled nurses at present have taken up enhanced roles including education, bereavement counseling and wound care. The researchers highlighted that the change in the scope of practice for enrolled nurses had the characteristic of accelerating in a rapid pace that has given rise to a number of questions relevant to the quality of care delivered. This is a serious concern since these questions is still unanswered without any precision being achieved. It has been found that due to the changes in the scope of practice there have been changes in the set of activities that enrolled nurses as healthcare practitioners perform within the particular professional domain. The nature of tasks that the nurses of the country are to perform have undergone an evolution, and it is to be mentioned that the scope of practice has been enhanced, expanded and extended. The movement of the role of enrolled nurses into different practice domain has drawn attention since the expansion of the role into diverse domains of practice retained for pharmacists, and most importantly registered nurses have been prominent in the recent past.

Q2: The two primary reasons that have been cited behind the issue of changes brought about in the scope of practice for enrolled nurses in Australia are role confusion and overlap between enrolled nurses and registered nurses in Australia, and education and employment of enrolled nurses. The scope of enrolled nurses initially was focused around providing basic patient care like monitoring of health status of patients and assisting patients with daily activities of living. Since the role of enrolled nurses has expanded, they are at present contributing to the role of registered nurses such as administration of medications. Such role changes, or rather the addition of responsibilities have led to role confusion and role overlap. The majority of issues due to role overlap and confusion have been witnessed in rural settings and aged care sector.

The education and responsibilities that enrolled nurses have shown huge variation from one state of Australia to another. Therefore there has been issues with setting up the appropriate the system of education that can lead to improved career paths for enrolled nurses through the development of standards. The advanced and evolved courses have incorporated advanced skills that are effective in promoting the further enhancement of the scope of practice of enrolled nurses as well as their employment in healthcare service centers (Jacob et al. 2013).

Q3: Jacob et al. (2013) had identified a number of important reasons to explain the changes brought about in the enrolled nurse practice and the current situation. Two factors that are most significant are workforce shortage and economic constraints. As per the author, the changes have largely occurred as a consequence of economic pressure and staff shortage at all levels of the healthcare domain. The percentage of enrolled nurses in the country’s healthcare professional workforce has seen major variations in the past twenty years. Initial peaks in workforce numbers were due to the increased use of enrolled nurses when there had been a shortage of a number of registered nurses. This trend has continued till present times further influenced by the fact that there has been an irregular flow of unregulated healthcare workers. The healthcare departments have been responsible for not increasing provision for adequate funding that can promote professional development of registered nurses. Economic pressure has been felt while bringing changes in the skill mix and stimulating better nursing goals. Due to financial constraints, the recruitment of registered nurses into healthcare settings have not been feasible, compelling the recruitment of enrolled nurses in place of registered nurses. There lies evidence for workforce shortage and economic constraints being the two most significant factors behind changes to Enrolled Nurse practice and the current situation. According to Buerhaus et al. (2017), the clinical staff are the health system’s most crucial inputs and shortage in one nurse professional group needs to be compensated by another group. Further, with economic restrictions in the care settings, advanced care delivery is not possible wherein each healthcare professional has a designated role and distinct set of responsibilities.

Q4: The article has identified different considerations in terms of viewing scope of practice for nurses. The two most important ones are task needs and competency statements. Task lists have been implemented by certain organizations for defining practice. Nevertheless, defining role by a list of tasks instead of involvement in patient care is responsible for demarcating the value of nurses in the healthcare team. Task lists cannot identify management of patient care, differences in clinical reasoning, problem-solving and ethical decision-making skills. The ANMC had developed competency standards which both enrolled and registered nurses are to abide by as national guidelines for practice. These competencies are divided into four domains of practice: critical thinking and analysis; professional practice; provision and coordination of care; and collaborative and therapeutic practice (Jacob et al. 2013).

Q5: The article also highlighted that enrolled nurses might be expressing less enthusiasm for undertaking an expanded scope of practice since such an expanded scope demands advanced skills of reasoning, planning, reflection, and evaluation. Enrolled nurses are pressurized to increase their scope of practice since the healthcare settings consider the strategy as a cost-cutting one. As a consequence enrolled nurses might be feeling overloaded with responsibilities apart from their traditional duties, increasing the chances of attrition or absenteeism. Such risks are of much concern in rural settings where there is lack of clarity regarding extended roles and additional demands in educational preparedness and practice time frame.

References
Buerhaus, P.I., Skinner, L.E., Auerbach, D.I. and Staiger, D.O., 2017. Four challenges facing the nursing workforce in the United States. Journal of Nursing Regulation, 8 (2), pp.40-46.

Ruth Jacob, E., Barnett, A., Sellick, K. and McKenna, L., 2013. The scope of practice for Australian enrolled nurses: Evolution and practice issues. Contemporary Nurse, 45(2), pp.155-163.