Enhancing scope of practice for the second level nurse: A change process to meet growing demand for rural health services

Abstract

This article reports on Australian research, funded by the Victorian Department of Human Services Nurse Policy Branch and conducted in two rural Victorian health services. Predicted workforce shortages in the health professions and accompanying growth in demand for services have set the scene for exploring new ways of working. Focused on Victoria's second level nurse, the division two registered or enrolled nurse, this research explored opportunities to enhance scope of practice as one mechanism to meet anticipated workforce demand and expectations. The study revealed a lack of collective wisdom as to how scope of practice may be enhanced, and an accompanying lack of organisational readiness to facilitate the broad changes needed to implement a different practice role. In response to these findings, the SCOPED model was developed as a tool to assist health services explore and implement an enhanced scope of practice for the second level nurse.

Educators' expectations of roles, employability and career pathways of registered and enrolled nurses in Australia

“…However, participants felt organisations were unprepared for increased scope of practice of diploma ENs. This is supported by Nankervis et al (2008) and Bellchambers and McMillan (2007) confusion and ambiguity around scope of practice for ENs is seen as both limiting their practice and encouraging them to practise at levels for which they are unprepared. For ENs to be utilised to their practice scope and provide safe nursing care, practising nurses need education regarding ENs' graduate skills and knowledge to enable appropriate care delegation.…”

“…Despite limited opportunities for EN career progression, many health services are increasingly employing ENs to deliver care in acute medical and surgical wards, and even high acuity areas such as emergency, anaesthetics and operating theatre Nankervis et al 2008). However, participants felt organisations were unprepared for increased scope of practice of diploma ENs.…”

“…Increased scope of practice has seen ENs employed in positions previously reserved for RNs, such as emergency departments, operating theatres, and acute medical and surgical wards Nankervis et al 2008). One large metropolitan health service reported increased EN employment from 6.5% of nursing staff in 2002 to 18.3% in 2012 (Bull & Hickey 2012).…”

“…This was in response to economic and workforce pressures (Conway 2007;Nankervis et al 2008) and resulted in increased opportunities for ENs to practise in broader clinical areas. Prior to the scope of practice change, ENs were M A N U S C R I P T…”

Australian registered and enrolled nurses: Is there a difference?

“…This is supported by Durdin 15 who suggested that the EN curriculum was made similar to that of the RN in the 1970s in Australia in order to raise the standard of patient care. Additional changes to the educational requirements for ENs with the introduction of the National Health Training Package in 2007 17,23 to increase the consistency and depth of training across Australia further narrowed any discernable difference in education between the two categories of nurse.…”