Have you thought of employing an enrolled nurse?
We’re encouraging employers and other health professionals to better understand the scope of practice, education and potential roles of enrolled nurses because:
- enrolled nurses can work with registered nurses to provide quality nursing care that improves health outcomes for New Zealanders
- enrolled nurses can provide leadership for others in the health care team.
This factsheet (PDF, 85 KB) explains the role enrolled nurses can play in the delivery of health care in New Zealand.
There are three levels of nurses in New Zealand. They are nurse practitioners, registered nurses and enrolled nurses. Each level of nurse must meet a set of competencies that describes the skills, knowledge and activities in their scope of practice (a scope of practice sets out the health services a nurse can provide).
In 2010 a new scope of practice for enrolled nurses was put in place and a new education programme was implemented to prepare them for their role. The Ministry of Health and national nursing organisations are committed to supporting enrolled nurses to work to the full extent of their scope of practice.
Enrolled nurse scope of practice
Enrolled nurses can work in a team of health care professionals under the direction of registered nurses to deliver nursing care and health education in home, community, residential care and hospital settings. Their competencies require enrolled nurses to comply with professional standards and codes to safely provide quality care.
Enrolled nurses are regulated health professionals with the knowledge and skills to:
- 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[i] (in some settings) under the supervision of a registered nurse
- undertake other nursing responsibilities (eg, observe changes in patients’ conditions and report to the registered nurse; administer medicines and assist patients with activities of daily living).
To read the full scope of practice for enrolled nurses, visit the Nursing Council website.
Enrolled nurse education
The enrolled nurse education programme is an 18-month diploma course. There are five learning modules at Level 4 of the New Zealand Qualifications Authority (NZQA), which are:
- 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
and a further three modules at NZQA Level 5:
- Rehabilitation (rehabilitation/long-term care/disability – includes community and care of people who have dementia)
- Acute Care (medical/surgical/peri-operative)
- Mental Health (including community and addiction).
To view the enrolled nurse curriculum, see the Diploma of Enrolled Nursing on the Christchurch Polytech Institute of Technology website. To view a list of institutions providing the Diploma of Enrolled Nursing go to the Nurse Educators in the Tertiary Sector website.
To view the standards for enrolled nurse education, see Appendix 5: Education programme standards for the enrolled nurse scope of practice of the Nursing Council Schools Handbook.
Enrolled nurse practice in health settings
An individual enrolled nurse’s practice is determined by four conditions in the care setting.
1. The enrolled nurses’ 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[ii].
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 health patient/person receiving care
In all situations the registered nurse is responsible for undertaking a comprehensive nursing assessment and developing a care plan to meet the health consumer’s health needs. Enrolled nurses provide another level of nursing support, in a team with the registered nurse. They contribute to nursing assessments, care planning and evaluation of care. They observe changes in the health consumer’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).
For more on direction and delegation, read the Guideline: responsibilities for direction and delegation of care to enrolled nurses (PDF, 641 KB) on the Nursing Council website.
Roles for enrolled nurses
When the skill mix in the health care team includes enrolled nurses working with registered nurses, health care assistants, or other clinicians, we expect to see safe, high-quality nursing care, and improved workforce productivity.
Current employment practice, models of care, and variable local policies can result in barriers to ENs contributing to their potential. It is important that nurse leaders and others develop models of care, orientation programmes, and policies and guidelines to make the most of enrolled nurses’ skills and knowledge.
For more information, read the Guideline on the Place of Enrolled Nurses in the New Zealand Health Care System (PDF, 495 KB) on the New Zealand Nurses Organisation website.
Case study – the Nurse Maude Complex Restorative Care Service
In Canterbury the Nurse Maude Complex Restorative Care Service (TotalCare) is recognised as a successful model of care where enrolled nurses are supported to deliver care using all of their knowledge and skills. The TotalCare service offers hospital and rest home level care to complex and dependent people in the community. The service currently has three registered nurses and four enrolled nurses who oversee 22 FTE support workers. The enrolled nurses provide day and evening cover over seven days per week. There is a registered nurse on call for them to consult with.
In 2011 Nurse Maude employed enrolled nurses graduating from the CPIT programme into the Total Care Service. Initially the new graduates had intensive support and teaching from the registered nurses, and mentoring from experienced enrolled nurses within the organisation. As a result the group have quickly reached a level of confidence and skill to practice at their full scope.
Enrolled Nurses working in the Total Care team have become very capable in:
- overseeing and supporting non-regulated support workers
- wound care (non-complex)
- ‘troubleshooting’ queries from support workers about a patient (eg, blocked catheter)
- assessment of patients including deciding to call an ambulance.
Evaluation shows the TotalCare service has achieved the following outcomes:
- reduced attendance at emergency departments
- reduced hospital admissions
- reduced length of hospital stay
- improved efficiency (eg,effective use of staff time and better management of a person’s medicine)
- high patient and family satisfaction with the quality of care.
The enrolled nurses have become valuable members of the team enabling registered nurses to work at the top end of their scope of practice with more complex patients.
[i] A health care assistant is an unregulated health worker. Other names for health care assistant may include support worker, nurse aide, caregiver or nurse assistant.
[ii] Enrolled nurses who have not completed the education and practice requirements to transition to the current scope of practice will have a condition in their scope of practice restricting them to working with health consumers who have stable and predictable health outcomes, or they may have a condition restricting their practice to a specific focused area of practice (eg, long-term care and rehabilitation).