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

Senior Nurse Role Expectations of Graduate Registered and Enrolled Nurses in Australia: Content Analysis of Open-Ended Survey Questions

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

Senior Nurse Role Expectations of Graduate Registered and Enrolled Nurses in Australia: Content Analysis of Open-Ended Survey Questions

Article excerpt

Nursing roles in Australia have undergone significant changes since clarification of the definition of scope of practice for nurses in Australia (Jacob, Sellick, & McKenna, 2012). The Nursing and Midwifery Board of Australia (2007, p. 2) defines scope of practice as 'that which the individual is educated, authorised and competent to perform.' This enables nurses to undertake roles to the full scope of their abilities. Similar to the USA, Canada, Singapore and New Zealand, two entry levels of nurse are employed in Australia (Heartfield & Gibson, 2005; Jacob et al., 2012), registered nurses (RNs) and enrolled nurses (ENs, known as licenced practical/vocational nurses in the USA) (Australian Nursing and Midwifery Council, 2002; Jacob et al., 2012; Nursing and Midwifery Board of Australia, 2006). Minimum educational requirements for registration in Australia are baccalaureate degrees for RNs and certificates or diplomas for ENs (Ryan, 2009a, 2009b). Since recent broadening of scope of practice, ENs now require a minimum of diploma-level education (Ryan, 2009a) providing higher levels of knowledge and skills, enabling these nurses to undertake higher level roles and responsibilities. The change in educational preparation has opened up expanded practice areas for ENs, enabling them to work in areas previously reserved for RNs. In Australia, EN are currently practicing in settings such as operating theatres, anaesthetics, emergency departments (including triage), mental health, acute medical and surgical wards (Heartfield & Gibson, 2005; Jacob, Barnett, Sellick, & McKenna, 2013; Nankervis, Kenny, & Bish, 2008). There is strong support by employers in Australia to both maintain and extend the EN role as they are cheaper to employ than RNs (Blay & Donoghue, 2006; Francis & Humphreys, 1999). The resulting change in skills, abilities and practice contexts, and increasing overlap in roles, has led to role confusion between ENs and RNs (Jacob et al., 2013; Kerr, Lu, Mill, & McKinlay, 2012; Nankervis et al., 2008).

Since the introduction of diploma qualifications for ENs, few studies have investigated the impact of these changes to nursing roles in clinical practice. Even prior to this increase in EN entry level qualification, Conway (2007) suggested that changes to scope of practice may lead to role confusion and overlap. In the aged care setting, Bellchambers and McMillan (2007, p. 36) found that the changing role of ENs enabling them to administer medications, resulted in 'lack of role clarity for all members of the aged care medication team.' Kerr et al. (2012) examined nurses' opinions of EN medication administration and found that whilst most ENs understood their roles and responsibilities, more than half the RNs surveyed felt they did not have good understanding of ENs' responsibilities and accountability. Whilst these studies examined the addition of medication administration to the EN role, none addressed additional skills which are part of diploma programmes, such as patient assessment, venepuncture and female catheterisation (Department of Education Science and Training, 2007). To the best of the authors' knowledge, no studies have examined opinions of senior nurses regarding the differences in graduate RN and EN roles. Given the paucity of literature, this study sought to address this gap and provide understandings of the perceived role expectations of each level of nurse by senior nurses responsible for daily patient allocations and position description development.

This paper presents results of content analysis performed on open-ended questions from an online survey investigating role expectations of graduate ENs and RNs from the viewpoints of senior RNs. It sought to provide better understanding of role expectations of graduate nurses on commencement of clinical practice. Data were used to ascertain differences in role expectations and scope of practice of the two nursing student groups on graduation. …

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