Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Administration of Medications by Enrolled Nurses: Perceptions of Metropolitan and Non-Metropolitan Registered Nurses and Nursing Unit Managers

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Administration of Medications by Enrolled Nurses: Perceptions of Metropolitan and Non-Metropolitan Registered Nurses and Nursing Unit Managers

Article excerpt

BACKGROUND

The professional level and scope of practice of Enrolled Nurses (ENs) in Australia has significantly evolved in response to the acute nursing shortage in both metropolitan and non-metropolitan areas, increasingly complex health needs of the community and advancing medical technology and treatment (Gibson & Heartfield 2003). Innovative models of care, role expansion and changes to the nursing skill mix to include increased number of ENs, Assistants in Nursing (AIN) and unregulated health workers in some areas, have been introduced to keep pace with the developments in the health care system and to ameliorate the impact of nursing workforce issues (Commonwealth of Australia 2001).

The implications of recent health care trends are mirrored in the increased breadth and depth of the ENs' educational preparation and the expansion of their scope of practice (Kenny & Duckett 2005) which now includes roles traditionally undertaken by Registered Nurses (RNs). Following completion of intensive preparatory courses, ENs can now assume advanced roles in rehabilitation, gerontology, peri-operative nursing and wound care (Commonwealth of Australia 2001). However, in Australia the EN is still viewed as an associate nurse and is therefore accountable to the RN (Kenny & Duckett 2005).

The contemporary roles undertaken by Australian ENs are varied, and are influenced by several factors namely geographical location, population density and needs of the community (Hegney 1996). For example, rural settings have been associated with shortages of RNs and therefore roles such as medication administration traditionally undertaken by RNs are delegated to ENs. Advanced practice relating to medication administration is one area challenging RNs and ENs from the perspectives of the education, knowledge and skills required to prepare ENs for this role. There exists diverging opinions among nurses regarding the implications for practice and impact on consumer outcomes of ENs administering medications (Milson-Hawke & Higgins 2003).

Kimberly et al. (2004) investigated the effect of an initiative undertaken to enhance the professional development of ENs to allow them to administer medications without the direct supervision of RNs. The findings indicated that allocation of this task traditionally held by RNs to appropriately qualified ENs will result in benefits for patients dirough increased continuity of care and improved clinical practice (Kimberley et al. 2004).They also reported that expanding the EN role to include administration of medications has been linked to greater job satisfaction and improved morale for ENs. While some RNs welcomed the opportunities to focus on other important nursing activities such as patient education and the lower stress levels that followed the reallocation of tasks to the EN, others reported an increased supervisory responsibility to oversee the medication administration role for ENs. Other concerns reported include inadequate educational preparation for ENs to undertake the responsibility of medication administration (Kimberley et al. 2004).

In Australia, medications are currently administered by RNs and assistants in nursing (AIN) who are the third level of nurses in NSW. Assistants in nursing are authorised to administer medications if they have achieved the recognised competencies in Aged Care. This practice has generated extensive debate within the nursing profession about the associated safety and professional implications of AINs administering medications. Given that ENs are the second level of nurses with an expanded role in medication administration, precedence in providing them with skills and knowledge to safely administer medications was recognised by the nursing sector of the health care industry(McKenna et al. 2001; Working Group on Aged Care Worker Qualifications of the National Aged Care Forum 2001). In addition, providing legislative support to administer medications within specified limits (Holmes 2002) was also identified as a priority by the same body. …

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