The role of the enrolled nurse in the Australian nursing workforce: A mixed methods study

Background The enrolled nurse (EN) is the second-level regulated nursing role in Australia. It was designed to support and assist the registered nurse (RN) role by providing more hands-on, practical bedside nursing care. Despite many reports and research papers indicating that this role is integral to the nursing workforce, persistent challenges have been identified. Exploring the role of the EN will provide a greater understanding through the perspective of the EN as an individual, as a member of the nursing team and within the hospital or facility and the nursing profession. This will inform the development of strategies to address the continuing challenges and ensure the role is effective and valued. Aim This study aims to gain a better understanding of the role of the EN in the Australian nursing workforce. Methods A sequential multiphase exploratory mixed methods research design was used. It commenced with 10 focus groups in 2019, followed by the development and administration of a self-administered questionnaire in 2020. This resulted in 400 completed questionnaires. The results were analysed through the lens of the philosophical assumptions of pragmatism and the transformative approach, and the conceptual framework of organisational behaviour. Findings The qualitative data captured three themes: the EN as an individual, the EN in the workplace and the EN in the profession. These themes aligned with the three analysis levels of the conceptual framework of organisational behaviour: the individual, the team and the organisation. The results from the questionnaire reinforced these themes. The findings identified significantly different perspectives and expectations between the nursing roles. At an individual level, ENs were driven by intrinsic and extrinsic motivators, with the primary motivator being a nurse. Extrinsic motivators were influenced by the behaviours, attitudes and feedback provided by others in the nursing and wider healthcare workforce. These influenced levels of job satisfaction, occupational stress in the team and organisational culture in the working environment. At a professional level, the title does not reflect the role, and there are no career pathways. Discussion The success and value of ENs are influenced by their intrinsic and extrinsic motivators and three key determinants: that the EN understands their role, that the RN understands their role when working with an EN and that the organisation provides opportunities for the EN and understands how the nursing team needs to work to ensure all nursing roles can work within their respective scope and standards of practice. When these three determinants align, there is job satisfaction, minimal occupational stress and the EN feels valued. Collectively, these create an environment with pull factors. Conversely, in environments where any one of the three determinants is absent, there is a lack of job satisfaction, increased occupational stress, the potential for the nursing roles to work outside their scope and standards of practice, and poor organisational culture, where the EN does not feel valued in their role. Collectively, these create an environment with push factors. At the professional level, there is a need for the nursing profession to better recognise the EN within the structure of the nursing team, as the perception is that it is a transitional role to becoming an RN. This requires greater clarity on how the nursing roles collaborate in the practice of nursing. Once that is established, for the nursing profession to construct a career pathway with accompanying qualifications, financial remuneration and titles that reflect the qualification and experience required for the EN role. Conclusion This research identifies why there are recurrent challenges surrounding the EN role. It demonstrates that there is a need to examine the nursing roles and how they work together in the practice of nursing to create effective and sustained change. Changes at the professional level that create a structure recognising the role and enabling ENs to create a career as ENs are also needed