Enrolled nurses in New Zealand

The Ministry of Health encourages employers and services to ensure the nursing skill mix is planned to match the level of health need in the population. Enrolled nurses are part of the solution as we seek to provide cost-effective, high-quality care in a range of settings.

Enrolled nurses work in teams under the direction of registered nurses. They provide health care and education in home, community, residential and hospital settings. As regulated health practitioners, enrolled nurses are required to comply with professional standards and codes of practice.

The enrolled nurse scope of practice means they can:

• contribute to nursing assessments and patient care planning
• provide nursing care and evaluate the outcomes of care for patients and their families
• coordinate teams of health care assistants (in some settings) under the supervision of a registered nurse
• undertake other nursing responsibilities (eg, monitoring change to patient conditions, administering medicines, health education, wound management and assisting patients with daily activities).

Guidance for employers

An individual enrolled nurse’s practice is determined by four conditions in the care setting.

1. The enrolled nurse’s own knowledge, skill and experience

This is not the generic knowledge of any enrolled nurse but the specific knowledge, skill and experience of the enrolled nurse concerned.

2. The knowledge, skill and experience of the practitioner providing direction or delegation

The registered nurse must be competent in the nursing care of the patients they direct the enrolled nurse to care for, and in direction and delegation. Another registered health practitioner (eg, midwife or doctor) may also give direction to an enrolled nurse when there is a supervising registered nurse available.

3. Needs of the patient receiving care

In all situations, the registered nurse is responsible for undertaking a comprehensive nursing assessment and developing a care plan to meet the patient’s health needs. Enrolled nurses provide another level of nursing support, working in a team with the registered nurse. They contribute to nursing assessments, care planning and evaluation of care. They observe changes in the patient’s condition and report to the registered nurse.

4. Working environment

The environment will determine the type of duties an enrolled nurse can carry out.

• In acute settings (eg, a surgical ward), enrolled nurses must work in a team with a registered nurse to plan and deliver nursing care.
• In some settings (eg, an aged-care facility), the enrolled nurse might coordinate a team of health care assistants under the direction of a registered nurse.
• In some settings, enrolled nurses may work under the direction of another registered health practitioner (eg, a doctor) to deliver delegated care (in these situations, the enrolled nurse must have registered nurse supervision and must not assume overall responsibility for nursing assessment or care planning).

Find out more

Go to www.nursingcouncil.org.nz to find out more about the enrolled nurse scope of practice and to access Guidelines for Direction and Delegation to Enrolled Nurses.

Go to the New Zealand Nurses Organisation to read the Guidelines on the Place of Enrolled Nurses in the NZ Health System.

Enrolled nurses at work

All around New Zealand, enrolled nurses are demonstrating how much they can improve the quality of health care.

Southern DHB employs six enrolled nurses in Dunedin’s renal dialysis unit to provide care and support for people in the home haemodialysis programme. These enrolled nurses are supported by rigorous training, ongoing professional development, and a clear direction and delegation process.

Canterbury DHB employs 75 enrolled nurses to support registered nurses in the mental health service. Enrolled nurses make up 20 percent of the mental health nursing workforce in acute, rehabilitation and chronic care settings. New graduate enrolled nurses are offered a structured orientation programme. Feedback from other staff, patients and their families shows that enrolled nurses are providing effective and efficient care.

Waikanae Health (a general practice in Capital & Coast DHB) employs an enrolled nurse to provide wound care dressings and advice in the clinic and in local rest homes. Although she works under the direction of a registered nurse, her level of expertise means that she provides guidance to less experienced registered nurses and sometimes to the doctors. You can read more about her work on the nurses.org.nz website.

Waikanae Health also has another enrolled nurse working in a mobile practice team. This team supports aging people with deteriorating mental and physical health to live well in their homes. The enrolled nurse works with a registered nurse, remaining in touch with the general practice team and other services in the community. Advanced care planning is just one aspect of the role which requires a comprehensive range of nursing and relationship skills.

Waikato DHB employs an enrolled nurse at Hamilton’s Atawhai Assisi Home and Hospital. This enrolled nurse is the team leader on afternoon shifts, working under the direction of a registered nurse to supervise health care assistants providing care to residents. She also provides orientation for new staff and manages the assessment and education in the Aged Care Education (ACE) programme for caregivers. Assessment information gathered by the enrolled nurse helps in developing individualised care plans with the registered nurse. As the infection control coordinator, her role includes managing infection control policies and procedures, staff education, audits and monthly reporting. She is a member of the national expert advisory group on pressure injuries.

Northland DHB employs an enrolled nurse in a clinic that treats babies from across the district who are born with congenital talipes equino varus (CTEV). She works in a team of orthopaedic surgeons and nurses to care for infants and support their families through the treatment process. This enrolled nurse builds trusting relationships with families, using interpersonal skills and her technical knowledge of casting and skin care.

Becoming an enrolled nurse

The enrolled nurse education programme is an 18-month diploma course with eight learning modules on levels 4 and 5 of the New Zealand Qualifications Authority (NZQA).

NZQA Level 4 modules:

• Clinical Skills for Enrolled Nurses
• Structure and Function of the Human Body
• Social Science for Enrolled Nurses
• Foundations for Enrolled Nurse Practice
• The Discipline of Nursing

NZQA Level 5 modules:

• Rehabilitation (rehabilitation/long-term care/disability – includes community and dementia care)
• Acute Care (medical/surgical/peri-operative)
• Mental Health (including community and addiction).

Find out more

Go to the Ara Institute of Canterbury for information about the Diploma in Enrolled Nursing curriculum.

The Nursing Council website provides:

• a list of institutions that offer the Diploma in Enrolled Nursing
• the Schools of Nursing Handbook that has the standards for enrolled nurse education.