Ministry and council fail to agree on ENS.

The Ministry of Health and the Nursing Council have been unable to agree on a joint position on the employment of enrolled nurses (EN) in acute care. In June last year, following a forum on nurse assistants (NA), the two organisations agreed to work together on the issue. The need for clarification arose from confusion caused by a 2003 letter to district health boards (DHBs) signed by Nursing Council chief executive Marion Clark and the deputy director of the Ministry's clinical services directorate Colin Feek. That letter affected the employment of ENs, with many removed from acute care as a result.

In October last year, the Ministry's chief nursing adviser Mark Jones said he and Clark were collaborating on the issue and hoped a statement would be issued "in the near future" No position statement materialised around that time.

But late last month a letter on the employment of ENs within acute settings, signed by both Jones and Clark, was sent to DHB directors of nursing (DoNs). This letter was subsequently countermanded by Clark, who sent DoNs a different letter, signed only by Clark. An apparent communications mix-up between the Ministry and the Council had caused the situation.

Explaining the two letters, Jones said he had taken the letter signed by himself and Clark, which he circulated to the DoNs, as an agreed statement from the Council and the Ministry. "Apparently an error in the office of the chief executive of the Council led to a draft being agreed with me which subsequently the CEO determined not to be a reflection of Council policy. As such the letter was withdrawn by the Council CEO and a replacement issued. I have informed the DoNs of this situation, as indeed has the Council CEO," Jones said in a statement to Kai Tiaki Nursing New Zealand.

Jones did not sign the second letter.

The original letter stated that ENs' scope of practice made it clear ENs were competent to work only with people with predictable health outcomes in situations that did not call for complex nursing judgement. "This may restrict the number of acute settings in which ENs are competent to practise," the letter stated. It also stated that in acute settings, nursing care was most appropriately provided by a nursing team under the direct supervision of registered nurses (RNs). It said it was the responsibility of employers to determine "the extent patient care environments present patients with stable and predictable care outcomes prior to deploying ENs to meet their needs. Employers should pay due attention to the skill mix and specific competencies of their nursing workforce and to ensure processes for effective delegation of work and supervision are in place," the letter said. The second letter, sent on January 30 and signed only by Clark, has significant differences. It states that ENs' scope of practice does restrict the number of acute settings in which ENs are competent to practise; it makes no reference to a nursing team, stating rather that in acute settings nursing care is most appropriately provided by RNs; and makes no reference to employers' responsibilities. This was "the only letter sent out by Nursing Council", Clark said.

NZNO chief executive Geoff Annals described the situation as an "appalling debacle. The Council and the Ministry have had more than six months to prepare a letter to clarify the situation, only to produce a letter signed by both parties but disowned by the Council, and a second letter from the Council clear in only one detail--that the Council and the Ministry do not agree.

"It makes a mockery of nursing regulation and does nothing for the thousands of RN and ENs actually required to translate the Council's scope of practice into safe care. Nurses throughout New Zealand, whether they be ENs, RNs or DoNs, will be exasperated by this latest absurd chapter in the long-running farce entitled The creation of a registered-only nursing worforce, scripted by the Council but played out in the lives of nurses and those they care for," Annals said.