Nursing For Australian Community: Roles And Responsibilities Of Enrolled Nurses And RNs

The Profession of Nursing in Australia

Discuss about the Nursing for Australian Community.

The profession of nursing is vital for the Australian community and incorporates a challenging career. The career of nursing is rewarding as well since the job involves the serving of the sick to make them healthy again. The nurses in Australia work in several health areas that include schools and hospitals in the departments of emergency, oncology, intensive care and pediatrics (Lane et al. 2016, p.6). The Nursing and Midwifery Board of Australia regulates the nursing profession in the country and classifies the nurses in the categories of assistant in nursing, enrolled nurses, registered nurses and nurse practitioners (Nursingmidwiferyboard.gov.au 2016). There have been arguments about the differences in work between a registered nurse and enrolled nurse and based on this core statement, this assignment will further respond to this statement by the enrolled nurses from the perspectives of a future registered nurse. The implications for patient care of the enrolled or registered nurses that are not working to their scope of practice will also be discussed.

An enrolled nurse (EN) is a pertinent and valued member of the Australian healthcare workforce and they have a retention rate that is higher than the registered nurses (RN). The hierarchy level that the profession of nursing follows in Australia goes from being an EN to become and RN (Jacob, McKenna and D’Amore 2014, p. 208). This raises the debate regarding the work responsibilities of the two different nursing professionals. The EN are expected to work along with the RN that lies within the patient care context for the demonstration of the care delivery process that is person-centered and goes in accordance with the framework of decision making based on competence. Following the hierarchy levels, the EN are required to work under the supervision of the RN, either direct or indirect and they are responsible and accountable for their own actions and providing patient care that is delegated as per the care context.

The work of the EN includes the retention of responsibility for their actions and is accountable for providing the delegated care of nursing. The roles of the EN in the hospitals depends on in their area of clinical employment that includes maintenance of the healthcare of the patients by recording, measuring and observing the blood sugar levels, blood pressure levels, respiration, pulse and temperature and report the changes observed to the physicians. They are also responsible for bed making, dressing, showering and bathing for ensuring comfort and hygiene of the patients. They also feed the patients as required and support them during the process of rehabilitation with programs and exercises (Jacob, McKenna and D’Amore 2014, p. 435). Assist the patients on the emergency and first aid situations that help to educate the patients on the lifestyle and health issues. EN helps to minimize the injuries and help in the maintenance of a safe environment. ENs are also responsible for the care planning process however, they are not allowed to act independently with the overall responsibility (Talbot, Dorrian and Chapman 2015, p. 1055). Re-delegation of the activities to other nursing employees is not possible by the ENs when they accept a delegation. From the legal perspectives, the responsibility and accountability of the scope of practice of the ENs have been set out by the Nursing and Midwifery Board (NMBA) of Australia. According to NMBA, the ENs is allowed to administer medications once they complete the education of medication administration during their career. They should be familiar with the ‘State and Territory Drugs and Poisons Legislation,’ the relevant workplace protocols, procedures and policies and the requirements of healthcare service policy prior to administration of the medications by them.

The Roles and Responsibilities of ENs in the Australian Healthcare System

On the other side of the argument, the work of the RN can be summed up as a reflection of their educational competence and preparation for practice as they are licensed and registered under the nursing practice acts of Australia. Their higher level of responsibility and accountability are regulated by the Nursing and Midwifery Board of Australia and their primary responsibility includes the duties of unit manager, team leader, medical administration, management and assessment of the patients requiring complex and specialized nursing care and research activities (Birks et al. 2013, p. 29). They have more autonomy in their responsibilities and practice decisions compared to the other nursing professionals. They ensure the quality of their work with their involvement in the process of the evaluation of the outcomes of the client, competence assistance, supervision and involvement in the process of teaching. From the legal perspectives, the NMBA has designed the national framework of decision making that has been developed in association with the context of the strategies of national workforce that promotes responsiveness, flexibility and diversity in the workforce (Evans, Duggan and Boldy 2014, p. 229). The RNs along with the midwives are expected to follow the two set of principles of the national framework for decision making that deals with the evaluation and development of the tools for decision making and the templates for those tools.

Considering both the aspects of the argument regarding the work responsibility of both the EN and RN, the core statement made by the EN can be easily refuted by the RNs since the work of an RN requires much more of leadership and administrative in addition to the nursing skills when compared with the exclusive nursing abilities of the EN. In addition, the legal requirements of NMBA also permit a superior working framework for the RNs with the national framework for decision making however, there is no such framework for the ENs to permit them with superiority. Considering the hierarchy levels of nursing, the work of the RN is never similar to that of the EN and autonomous work profile with higher competency standards sets them on a much higher level over the EN (Hegney et al. 2014, pp. 506-507). Apart from the core functionalities of the RN, they are also required to implement reflective and critical thinking skills while contributing to the process of decision making whereas the ENs are only required to follow the commands issued by the RNs and report them accordingly. Since the ENs work under the indirect or direct supervision of the RNs, it is evident that their work profiles are completely different and that of the RN includes more of management and leadership traits.

The Roles and Responsibilities of RNs in the Australian Healthcare System

If the RNs and ENs do not work to their scope of practice, it can have severe implications on the health of the community. Even the regulatory standards and codes of the country require the RNs and the ENs to work in coordination to the maximum extent of their scope of practice to maintain the health and well-being of Australia. Considering this argument from the perspectives of the ENs and RNs, they have to be investigated separately to understand the impact of nurses and the consequences of their lack of work to their scope of practice.

There is an acute shortage of ENs throughout the world and in Australia, the country is finding it difficult to recruit and retain the experienced and skilled nurses in the private and public sectors. In addition, the shortage of ENs in the country is also due to inadequate and incomplete data that is associated with the greater amounts of extra working hours. Under such a bottleneck situation, if the ENs decide not to work to their scope of practice, the implications can be horrific for the community (Ruth Jacob et al. 2013, pp. 156-157). The quality of care will have an adverse impact which will be followed by serious reduction in the ability of the Australian community to access the entire range of residential aged care and hospital services. The process of patient care will also be compromised under such circumstances. It will be difficult for the RNs as well to distribute the responsibilities and ensure quality patient care without the ENs working to their maximum potential (Lubbe and Roets 2014, p. 59). The field of healthcare is undergoing drastic changes with increasing complexities and the need for highly specialized nursing workforce has been in demand. These specialty divisions might not be operating effortlessly with the nurses not cooperating with their complete range of skills and services (Lubbe and Roets 2014, p. 63). There have been changes in the aged care sector as well since the care system has been transferred from being custodial care to a more intensive and complex care. For this, the nurses need to provide both the post-operative and palliative care which is not possible if the ENs do not work to the scope of their practice. The ENs working in the community care services deal with a wide range of patients ranging from drug problems, depression and mental illness to elder and child violence and abuse. This has made the environment of working in the community sector more complex and therefore, a generalist workforce is required who are highly skilled (Scanlon et al. 2016, pp. 129-130). Under such circumstances, if the nurses do not work to the scope of their work, the process of care delivery will be extensively hampered and this will be exemplified in the remote and rural areas to the worst. Therefore, NMBA has made it mandatory that the ENs are required to meet its registration standards and they are required to practice to the maximum of their scope within the frameworks of decision making as provided by the RNs.

Implications of Nurses Not Working to Their Scope of Practice

On a similar note, the complications in patient care will continue if the RNs refuse to work to their scope of practice. Patient care delivery is a complex process that requires the professional skills of an RN for problem solving, teamwork, communication and problem recognition. If the RNs do not work to their maximum potential, it will be difficult to implicate the operations efficiently and mange the changing stressors effectively (Cowen and Moorhead 2014). RNs are rarely involved in direct patient care activities however, they instruct the ENs who are directly involved in the patient care activities. If the RNs do not act accordingly, it will affect the services of the EN as well which will eventually risk the patient care and safety. The hospitals will face the critical stressor which will increase the labor and operating costs, decrease the effectiveness and efficiency of provided care and quantity of patient care (Brewer et al. 2012, p. 522). This will also hamper the teamwork and effective communication between the nursing and other professionals which will lead to the development of a poor management and administrative team. They might not be aware of the stressors encountered by the ENs during their bedside shifts and they might not take effective steps to reduce them and make the work easy for their subordinates. This might, in turn, reduce the quality of patient care delivered by the ENs for which the RNs are responsible who are not working to their scope of practice. The NMBA has laid down several professional standards in the form of ‘code of ethics’ and the ‘professional conduct’ for the RNs and they are required to strictly adhere to the existing legal requirements so that they do not work less than their scope of practice. With the changes in the methods of hospital care, the average length of stay has declined and the arrival of newer medical technologies has increased the requirement of care by the patients during their stay in the hospital (Parahoo 2014). Under such circumstances, if the RNs decide not to work to their fullest capacity, the overall concentration of sick people in the hospital will increase exponentially. Due to this negative approach towards their work by the RNs, the ENs will also get de-motivated and eventually the quality of patient will decrease radically (Flinkman, Isopahkala-Bouret and Salanterä 2013). Lower the extent of work to the scope of practice by the RN, higher is the rate of adverse outcomes which can, in turn, aggravate some of the medical conditions like upper gastrointestinal bleeding, shock, pneumonia and urinary tract infections causing longer hospital stay.

Conclusion

On a concluding note, it can be stated that provision of safe and patient-centered care requires a clear articulation of the scope of practice for the ENs and the RNs and it is also essential that both the category of nurses work in harmony towards achieving their common goal. The job of nursing is professionally and personally rewarding as they represent the patient needs as they serve a wide range of health problems, injuries and illness. For intrinsic and extrinsic care plan of the patients in the hospital, working of the RNs and ENs in their respective domains and within their scope of practice is mandatory as stated by NMBA.

References

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Nursingmidwiferyboard.gov.au. 2016. Nursing and Midwifery Board of Australia – Home. [online] Available at: https://www.nursingmidwiferyboard.gov.au/ [Accessed 28 Dec. 2016].

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Talbot, A.L., Dorrian, J. & Chapman, J., 2015. Using the Theory of Planned Behaviour to examine enrolled nursing students’ intention to care for patients with alcohol dependence: A survey study. Nurse education today, 35(11), pp.1054-1061.