Enrolled Nurses Research Articles

The Registered Nursesʼ experiences of workplace culture and workplace climatic factors as influences on nursing workloads: A systematic review

The Registered Nursesʼ experiences of workplace culture and workplace climatic factors as influences on nursing workloads: A systematic review

The Registered Nurses' experiences of workplace culture and workplace climatic factors as influences on nursing workloads: A systematic review.

Review question/objective: The objective of this review is to identify and synthesise current evidence on workplace cultural and climatic factors that influence the daily work of nurses in an acute health care setting Types of intervention(s)/phenomena of interest: This review will consider the experiences of Registered Nurses in busy acute care facilities, in regard to values, beliefs, attitudes, artefacts, rituals, routines and traditions that impact on nursing workloads. In addition, to this cultural aspect, the experiences of climate factors that include clinical governance, inter-professional relationships, collegiality, workplace support, non-nursing duties, organisational structure and processes, work redesign, work flow, nursing roles and demands on nurses practice context that influence nurses workloads, will be included. Patient clinical care factors will be excluded. Types of outcomes: This review will consider studies that include experiences of Registered Nurses of specific cultural and climatic factors that influence Registered Nurses' daily workloads in an acute care facility.

90 years strong

The law on the registration of nurses is 90 years old this month. But the road for the regulatory bodies has not always been smooth.

Degrees are valuable only if they reflect additional study

The move to an all-graduate profession reminds me of the time enrolled nurse (EN) training was abandoned. At the time, my EN colleagues and I had the choice of retraining to become registered general nurses (RGNs) or remaining as ENs. Many of us went on to complete first and second degrees to enable us to climb the career ladder.

The role of the nurse lecturer in clinical practice in the Republic of Ireland

Undergraduate nurse education in Ireland transferred into the third level sector in 2002. As a result nurse lecturers are expected to develop a model of clinical practice that enables them to be involved in practice and its development while maintaining their own nursing expertise and credibility [An Bord Altranais, 2005. Requirements and Standards for Nurse Registration Education Programmes, third ed. An Bord Altranais, Dublin]. In light of this the researchers set out to explore the perceptions of the nurse lecturers' role in clinical practice among nurse lecturers, preceptors, clinical nurse managers, clinical placement co-ordinators and students. A qualitative research design using focus groups was chosen. A purposive sampling strategy generated the sample for 5 in-depth focus group interviews with the aforementioned key stakeholders and the data was thematically analysed. Five themes emerged which centred on the maintenance of lecturers' clinical credibility, the lecturers' role as a resource to clinical staff, teaching and assessing students in practice, the value of fostering relationships in practice and role duplication. The findings from this study supports the anecdotal evidence that confusion exists around the role but more importantly it gives the nurse lecturer population guidance on how to develop the role in partnership with the various stakeholders in a way that supports the nursing students and clinical staff in practice in an effective manner.

From strategy to implementation - clinical and academic perspectives

From strategy to implementation - clinical and academic perspectives

Is there a case for tailoring graduate programs for nurses who have previously practiced as Enrolled Nurses?

The nursing workforce in Australia, the UK and New Zealand has traditionally comprised two levels of nurse - the Registered Nurse (RN) and the Enrolled Nurse (EN). There is a significant difference in the role and scope of practice between the two levels. This difference is clearly reflected in the education required which, in Australia, is delivered the Vocational Education and Training (VET) sector for ENs and in the tertiary education sector for RNs. In an attempt to redress worldwide shortage of RNs, conversion programs have been developed for ENs to upgrade to the RN qualification. In Australia a variety of such courses are on offer, yet these are not without their critics. There have been issues identified as to the appropriateness of credit awarded by universities for recognised prior learning as well as concerns raised regarding the difficult transfer of knowledge between the VET sector and the tertiary education system. This paper presents a review of published research exploring the development and implementation of EN conversion programs. While ENs have been identified as having 'specific' needs during their first year as Registered Nurses these 'specific' needs have not been articulated. Moreover, there is no evidence to suggest health care organisations address these needs in graduate programs. This paper therefore has highlighted a need to identify what the 'specific' needs are and then to develop a graduate program tailored specifically for the RN graduate who previously practiced as an EN.

Report of increase in NMC fees was pure speculation

I wish to correct the misleading report about Nursing and Midwifery Council (NMC) registration fees (news July 1). The NMC recently held a briefing for journalists on our trustees' report and accounts. Due to careful financial management and prudent investment, the NMC has cleared the historical debt inherited from its predecessor, the UKCC.

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

Editorial: The need for complementary and alternative medicine familiarisation in undergraduate nurse education

A deputation of nurses meets the Prime Minister

The first time that an offi cial deputation of trained nurses met with a Prime Minister to discuss the subject of state registration for nurses, was on the 13 May 1909. Apart from the Prime Minister, several other leading members of parliament were present. The deputation from the Society for the State Registration of Nurses included several supportive medical practitioners, women’s organization representatives and many leading nurses of the time. The BJN devoted several pages of its issue to the important occasion. The following are some interesting snippets.

Nurse registration

Nurse registration

Voices - Nursing and midwifery council chair tony hazell joins the voices columnists

Can regulation become a barrier to innovation and change? Florence Nightingale apparently thought so, given her opposition in the 1880s to the Hospitals Association’s principle of registration for nurses.

An innovative model improving success at university for regional Australians suffering educational and social disadvantage

Regional Australia is critically short of registered nurses (RNs) due to an ageing nursing workforce and difficulty in attracting new staff. It is recognised that rural background is the most influential factor shaping a health professional's decision to practise in regional areas. Because of this, Charles Sturt University (CSU), with campuses throughout regional New South Wales (NSW), Australia, offered a bachelor of nursing by distance education (DE), enabling rural and remote enrolled nurses (ENs) trained by the Department of Technical and Further Education (TAFE) to upgrade their qualifications to RN. However, despite the flexible study mode offered, many rural and remote ENs were reluctant to progress to university study. This article describes an outreach model developed in recognition of the importance of supporting ENs to undertake RNs studies. Theories of social capital informed the model, which assisted understanding of the reluctance of rural and remote ENs to undertake university studies to become RNs. Most of the ENs lived and worked in communities where this was not an expectation; in addition, they were not members of social networks that knew about university study. The model assisted the development of participants by recognising and respecting barriers to their university participation. These barriers included their: self-perception as learners; concept of a university and themselves as university students; understanding of enrolment processes and course progression; understanding of what university study entails and the supports available in both community and university. Central to the model was the provision of face-to-face academic workshops for the ENs in the communities where they lived and worked. This allowed direct contact with university lecturers and support staff, enabling the rural ENs to establish the trustworthiness of 'the messengers'. Once this was achieved they were able to build a personal connection with the university and potential support providers, and to develop their own support networks. The workshops occurred at least 6 months before an intake of bachelor of nursing by DE. Eight academic preparation workshops were conducted between 2003 and 2008 throughout rural and remote NSW with a total of 168 participants. Currently 89 participants (63%) have enrolled in the CSU Bachelor of Nursing course by DE. Successive workshops have built on knowledge acquired in this process. The model was supported by CSU and industry partnerships; since 2005 the academic preparation workshops have been supported by area health services' (AHSs) promotion, participation and funding. The workshops now form part of the AHSs' nursing recruitment strategy and have been endorsed by the Nursing and Midwifery Office, Aboriginal Nursing and Midwifery, NSW Health. The CSU believes the model has potential application beyond prospective nursing.

Nurses in the dock

The BJN, even 100 years ago, published legal cases involving nurses or nursing situations. These were highlighted to illustrate the need for the State Registration of nurses. The following is a sample of some of the main points taken from such cases and helps us to compare some of our common professional issues with those of the past.

A Comprehensive Systematic Review of the Factors that Impact Nurses' Performance in Conscious Level Assessment.

Review Objective: The overall aim of this review is to systematically review the various factors that affect nurses’ performance in conscious level assessment. This review question will focus on three specific areas, namely, ‘knowledge’, ‘attitude’ and ‘demographic factors. More specifically, ‘knowledge’ in the context of this systematic review refers to their understanding of the conscious level assessment and the rationale for its use, as well as neurological and physiological knowledge.5 ‘Attitude’, refers to ‘thoughts and disposition’ towards the conscious level assessment and how it is used in the clinical setting Questions: 1. How does level of knowledge and nurses’ attitude affect their performance of conscious level assessment? 2. What are, and how do demographic factors affect nurses’ performance of conscious level assessment? 3. How accurate are nurses’ skill in performing conscious level assessment? Types of interventions/Phenomena of Interest: Studies that examine factors such as knowledge and attitudes, as well as demographic factors including, but not limited to, such as age, educational history, recency of practice, years of practice and clinical context and how they impact nurses’ performance of the conscious level assessment will be considered for this review. The phenomena of interest will focus on nurses’ assessment of conscious level. Types of participants: The review will include studies with these participants: • Nursing staff in an acute hospital, more specifically Registered Nurses (RN), Nursing Students and Enrolled Nurses (EN) • Working in clinical settings such as Critical Care, Emergency Medicine, Neuroscience or General Ward Types of outcome measures/anticipated outcomes: More specifically, the outcomes of interest in this study will include the following: • The level of accuracy and interrater reliability of nurses’ performance of conscious level assessment • The consistency in nurses’ performance of conscious level assessment • Nurses’ knowledge in conscious level assessment in their clinical setting, e.g. the GCS • The confidence level of nurses in performing conscious level assessment

A Comprehensive Systematic Review of the Factors that Impact Nurses’ Performance in Conscious Level Assessment

Review Objective: The overall aim of this review is to systematically review the various factors that affect nurses’ performance in conscious level assessment. This review question will focus on three specific areas, namely, ‘knowledge’, ‘attitude’ and ‘demographic factors. More specifically, ‘knowledge’ in the context of this systematic review refers to their understanding of the conscious level assessment and the rationale for its use, as well as neurological and physiological knowledge.5 ‘Attitude’, refers to ‘thoughts and disposition’ towards the conscious level assessment and how it is used in the clinical setting Questions: 1. How does level of knowledge and nurses’ attitude affect their performance of conscious level assessment? 2. What are, and how do demographic factors affect nurses’ performance of conscious level assessment? 3. How accurate are nurses’ skill in performing conscious level assessment? Types of interventions/Phenomena of Interest: Studies that examine factors such as knowledge and attitudes, as well as demographic factors including, but not limited to, such as age, educational history, recency of practice, years of practice and clinical context and how they impact nurses’ performance of the conscious level assessment will be considered for this review. The phenomena of interest will focus on nurses’ assessment of conscious level. Types of participants: The review will include studies with these participants: • Nursing staff in an acute hospital, more specifically Registered Nurses (RN), Nursing Students and Enrolled Nurses (EN) • Working in clinical settings such as Critical Care, Emergency Medicine, Neuroscience or General Ward Types of outcome measures/anticipated outcomes: More specifically, the outcomes of interest in this study will include the following: • The level of accuracy and interrater reliability of nurses’ performance of conscious level assessment • The consistency in nurses’ performance of conscious level assessment • Nurses’ knowledge in conscious level assessment in their clinical setting, e.g. the GCS • The confidence level of nurses in performing conscious level assessment

Expanding the scope of practice for enrolled nurses working in an Australian rural health service – Implications for job satisfaction

Career opportunities have been limited for enrolled nurses (ENs) working in small, rural health services. Medication endorsement offers ENs expanded scope of practice which may lead to improved job satisfaction. This small study compared job satisfaction between a group of ENs with recent medication endorsement and a group who elected not to undertake the course in a small, isolated health service. A questionnaire was designed to measure job satisfaction containing the measure of job satisfaction (MJS) scale and other information regarding the course in medication administration. Interviews were also conducted with medication endorsed nurses to gain a greater understanding about the course and their expanded scope of practice. Medication endorsed nurses were newer to nursing and their current job, and reported higher job satisfaction on all five factors. Non-medication endorsed nurses cited lack of confidence and ability as key reasons for not undertaking the course while medication endorsed nurses reported professional and personal reasons for expanding their scope of practice. Most enjoyed the responsibility and reported satisfaction from distributing medications and responding to pain while one viewed it as added work. The findings from this small study suggest that providing local education will improve job satisfaction of ENs.

Proud to finish my training but we pay a high price for the privilege

I completely agree with Mike Wilkie (letters August 27) on the issue of Nursing and Midwifery Council registration fees.

The determinants of nurses’ therapeutic attitude to patients who use illicit drugs and implications for workforce development

To examine the determinants of generalist nurses' therapeutic attitude to patients who use illicit drugs, and to model workforce development initiatives. Individuals who use illicit drugs rely heavily on healthcare in emergency departments and inpatient hospital wards. Little is known about the determinants of generalist nurses' therapeutic attitude to provide care, therefore limiting our understanding of the important issues for workforce development. The study was a cross-sectional survey of registrants on the Australian Capital Territory Nurses Registration Roll 2002 (N = 3241, 50% response rate). The associations between variables and nurses' therapeutic attitude were examined by multi-variable linear regression analysis. Nurses' therapeutic attitude was assessed using a modified version of the Alcohol and Alcohol Problems Perception Questionnaire. Personal characteristics, attitudes to illicit drugs and professional practice variables such as drug and alcohol education, experience with the patient group and role support were examined using a mix of standardised and new questions. Professional practice variables explained 53% of the variation of nurses' therapeutic attitude, the most important being role support. Although a negative attitude to illicit drugs had a statistically significant association with therapeutic attitude, it added less than 1% to the variation explained. Personal characteristics showed no association. Generalist nurses struggle to provide care to this patient group. Role support was found to be the strongest driver of nurses' therapeutic attitude, and workplace illicit drug education was only useful in combination with high role support. Nurses' caring role with patients who use illicit drugs is complex and demanding. Nursing workforce development must focus on increasing nurses' role support, in terms of appropriately skilled staff readily available for consultation and advice. Support for nurses, in the form of evidence-based practice standards and appropriate time allocation, is also important.

From enrolled nurse to registered nurse in the rural setting: the graduate nurse experience

This article reports on the findings of a study into enrolled nurse (EN) to registered nurse (RN) transition in South Australian rural settings. Rural RNs are required to be multi-skilled generalists capable of providing a wide range of nursing services to a diverse range of clients. This frequently occurs in situations without medical or specialist assistance. The objective of this study was to gain an understanding of the EN to RN transition process within this unique context. A hermeneutic phenomenological approach guided the study because this employs the processes of description and interpretation to examine lived experiences. Following ethics approval, four rural hospitals were chosen as suitable sites for the study due to their combined proximity within a rural area. The administrators agreed to support the study and information sheets were distributed. The four participants, one from each hospital, self-selected and took part in an unstructured interview. All participants were ENs who had recently or were currently in the process of transition to RN. Data analysis used van Manen's holistic and selective approaches in conjunction with Hycner's more structured guidelines. Significant phrases or units of meaning were then identified and collated into relevant themes. Three main themes identified were: (1) great expectations--self-expectations; adjusting to the new role; other's expectations; (2) support: sink or swim--peer, managerial and medical staff support; (3) Jacks and Jills of all trades--coping with the scope; proficiency equals specialising; positives of rural transition. The study found that these new graduates had very high expectations of their performance and experienced difficulty in adjusting to their new role. This was far more likely when the new RN had previously worked at the venue as an EN. Other staff and administrators expected these new RNs to be experienced beyond the new graduate level resulting in poor skill match to workload allocation and lack of support. The expectations placed on these new graduates by clinicians and managers far exceeded their level of expertise and resulted in them experiencing high anxiety levels. Ensuring this unique group of graduates are well supported throughout their transition phase is of utmost importance and this has implications for nurse managers, organisational administrators, nurse clinicians and future graduates. Rural ENs are increasingly undertaking nursing degrees and are urgently needed in rural settings. Accordingly it is in the best interests of managers and others to encourage and support them through an effective transition process.