Enrolled nurses!

Bringonthenight · Feb 2, 2012

The bachelor isnt a waste of time. although the scope is similar in terms of skills performed, RNs are more autonomous and can make decisions without consulting another nurse or physician as well as carrying more responsibility overall especially in emergency situations. There are no limitations to their scope like ENs can experience eg: ENs cannot administer certain meds if a patients condition suddenly deteriorates etc. There's also more career opportunities as an RN, there is a clinical ladder that you can climb in terms of responsibility and wages where as ENs have a 5 year salary cap and can not advance in skills or responsibility (cannot be in charge). Also there are areas of nursing that ENs are rarely seen in such as critical care areas. I would recommend definitely doing your diploma first then bridge to RN. your EN training will give you excellent practical skills that RN students will be envious of if you choose to bridge. And thats the thing you might not want to bridge, there are a lot of ENs that choose to remain as ENs so that they can stay in their job they love without pressure from management to become a charge nurse etc.

Bringonthenight · Feb 2, 2012

Also your correct, State enrolled nurses were erradicated in the 90s in the UK (such a shame!) so if those are your plans the RN route would be essential. I would check out the international forum for more advice on that subject :).

BeeJaye · Feb 3, 2012

Thanks for that, it's helpful to know. I always intended to do the bridging course and this just cements that decision :)

MatthewKeating · Jun 15, 2013

the RN has a greater level of responsibility and accountability in the OR because it's our role to supervise and delegate to EN's. For example, if the surgical count is wrong then the greater proportion of blame will be given to the senior RN even if the EN was the scrub nurse. This is the same for anything that can go wrong, specimen mishandled, incorrect consent, injury to the patient etc.

I am an EEN and I think this is rediculous. I understand as the more knowledgeable nurse you need to take responsibility for the actions of those under you, but if an E/EN screws up something they should take at the minimum, 60% blame (I'd say 90%) unless the mistake was due to misinformation provided by the RN, insufficient training/assessment on the RNs part, or lack or supervision. But even then the EEN should be knowledgeable enough to tell if their instructions arent quite right and question it, should understand the consequences their actions could have on their patient and not do something they havent been trained properly in, and should be competent enough to be able to work without an RN looking over their shoulder the whole time.

When I make a mistake I expect to take the blame. First of all I studied hard to gain my skills and knowledge and to get registered, and I continue to study so as to provide best care and expand my knowledge base. To alow someone else to take the blame for my mistake, even if they are in a position of responsibility, is paramount to saying, "no, I am in fact neither skilled nor knowledgeable enough to perform my duties at an acceptable standard." And although I understand WHY we work under the supervision of RNs, I also understand that we are delegated our duties under the supervising RNs faith in our competence. Turning around after you have made a mistake and saying that the RN shouldn't have trusted you with said responsibility in the first place just makes no sence to me!

I have worked with EENs (and PCAs) who have done that. They made a mistake (big ones) claimed they werent trained properly and/or didnt understand their training and then one of our RNs responsible for training new staff gets in heaps of trouble. But they get a mild scolding, retrained and continued on like nothing happened... no one seemed to wonder why, if they didnt understand what they were being told, and then obviously knew they werent properly trained, they went ahead and did it anyway. No one seemed to ask why, when what they were doing wasnt working, they didnt stop and ask for help. Instead a good RN (or EEN in the case of PCAs) gets their backside handed to them.

Sorry for rambling on but it enrages me... and it is one of the reasons I've delayed my bachelors because I know many EENs rely on the fact that there is an RN responsible for quite a bit of stuff that they are required to do and they take liberties that they probably wouldnt if they were 100% responsible for it. So I'm not sure I want to spend a lot of money, three years studying my butt off, living of baked beans, coffee and 8 hours of sleep a week, so that I can not only take on increased responsibility for my patients, but also be responsible for a bunch of EENs who don't respect the potential risk I am taking on by supervising their clinical practice. I am not saying we EENs have an annual turn the RNs hair grey early summit... but over the years you work with a lot of people and a few (or quite a few in my case) who are ethically and/or professionally questionable. I'm just not sure I want to put myself in the position where I may be in anyway responsible for the actions of people like that. I know I wouldnt likely be slapped in handcuffs and thrown in the slammer because an EEN made a booboo. But even small things can damage careers, professional reputations and future oportunities.

But in conclusion the SOP for the EN has grown very quickly and the legislation hasn't kept up, allowing ENs to administer medications, perform more technical procedures, and make assessments and judgement calls without there being an equal growth in our legislated responsibility. I have a great respect for RNs as not only do they provid a more complex level of nursing care to their patients but they allow an EEN to participate and develop professionally in ways they wouldnt be able to under their own merit by taking on the risk (regardless how small it is) of taking responsibility for the competency of the EEN. So, I really do hate that RNs get so much of the blame for a mistake made by a person who (according to APRAH) is trained and certified to perform these tasks or has been trained and assessed on site as competent (ie procedure supervised so many times)...

anyway Id better stop ranting before I start hating myself for being such a pain in the orifice for RNs haha.

DavidFR, BSN, MSN, RN · Aug 16, 2013

This conflictual situation seems to exist in every country where there is a two tier system of nurse education. It produces more problems and frustrations than it solves. Usually, it's perfectly competent second level nurses that end up being used and abused and the target of discrimination. Are there no moves in Australia towards a single level of nurse?

I lived through EN/RN wars in the UK. The best thing the UK did was make the move to a single level RN training. I now work in a country (France) where there is one level of nurse (the IDE) and we're all equal, each taking total responsibility for their own patients and their own workload, with the help of care assistants (aide soignants) who despite a one year training are NOT considered to be nurses but aides. One level of trained nurse only - it's the way to go!

Bringonthenight · Aug 16, 2013

This conflictual situation seems to exist in every country where there is a two tier system of nurse education. It produces more problems and frustrations than it solves. Usually, it's perfectly competent second level nurses that end up being used and abused and the target of discrimination. Are there no moves in Australia towards a single level of nurse?
I lived through EN/RN wars in the UK. The best thing the UK did was make the move to a single level RN training. I now work in a country (France) where there is one level of nurse (the IDE) and we're all equal, each taking total responsibility for their own patients and their own workload, with the help of care assistants (aide soignants) who despite a one year training are NOT considered to be nurses but aides. One level of trained nurse only - it's the way to go!

I do agree that the 2 level nursing model creates a lot more drama that what it appears to be worth. However, Australia seems to only be increasing the use of EEN/ENs- this is evident by the continual increase in SOP. EENs are cheaper, so it makes sense that employers are hiring more IV endorsed ENs over an experienced RN in some cases.

That being said I have worked with many well experienced and graduate EENs who are fantastic at what they do! The new national diploma course seems to prepare them very well for practice from what I've seen.

From what I can understand from the AHPRA SOP a EEN is responsible for their INDIVIDUAL actions. However, an RN is responsible for the OVERALL patient care. Therefore if a EEN makes a mistake ie: giving insulin to the wrong patient even if the RN told them to, the EEN is the one who is ACCOUNTABLE for their actions- they have a license and have been educated.

Sometimes I wonder what it would be like if Australia moved towards the UK single level model- there would certainly be less arguments/ hierarchy attitudes. But then again I've worked with so many great ENs I don't want that to happen! Haha.