What's in a name? The Nursing Council has begun another round of consultation on the title for second-level nurses trained after 2000.

Nurse assistant (NA) or registered assistant nurse (RAN)--they are the two options the Nursing Council is proposing in its second round of consultation on the title for second-level nurses trained after 2000. After its first round of consultation in 2004, the Council, as required under the Health Practitioners' Competence Assurance Act (HPCA Act), finalised scopes of practice. There were two for second-level nurses: enrolled nurse (EN) for those trained before 2000 and NA for those trained post 2000. According to the Council, this was to distinguish between the different training these groups of nurses had received. The NA scope also includes overseas nurses with equivalent qualifications.

But the NA title did not find favour with many--there was a petition by NAs in favour of ENs, support for that from Christchurch MP Lianne Dalziel, action by NZNO and a report from the Health Select Committee in December 2004 calling for the NA title to be reviewed.

Over the last year NZNO chief executive Geoff Annals and former president Jane O'Malley have been negotiating with council chief executive and chair, Marion Clark and Annette Huntington, on alternative titles for those nurses trained after 2000. NZNO agreed to compromise on the title--having favoured EN for all second-level nurses regardless of when they trained--if the Council would took at the "restrictive" scope of practice and the "unsatisfactory" education level, Annals said. The post-2000 training courses have been at level four on the New Zealand Qualifications Authority (NZQA) framework. The Council agreed and two possible titles emerged: associate nurse and RAN. The Council and the NZNO representatives consulted with their respective constituencies on these titles. Nurse assistants overwhelmingly favoured associate nurse but Annals said this title was unacceptable to the Council. The Council has now produced a consultation document with the two title options, NA and RAN. Submissions have to be with the Council by January 28, 2006. NZNO professional nurse adviser Angela Dawbin wants NZNO members making submissions to get them to her before Christmas, so she can collate an NZNO submission before the deadline. The compromise title has not won favour among ENs and NAs. Chair of the national EN committee Robyn Hewlett wants the EN title for all second-level nurses, wants the EN training back and wants that training to be at level five on the NZQA framework.

NZNO's professional services manager, a longtime champion of ENs, Joy Bickley Asher, intends raising the issue with the Ministry of Health's chief nursing adviser Mark Jones and also sees the review of the HPCA Act in July 2006 as another opportunity to debate the issue. She is also very concerned at the "wastage of ENs' nursing skills" in the health sector.

Now you're an EN, now you're not

Caregiver at Marlborough Hospice Lynette King began the EN training at Christchurch Polytechnic Institute of Technology (CPIT) in March 2003, fully expecting to qualify as an EN. She completed the training--"it was a struggle"--in March 2004 and in May received her certificate in enrolled nursing in rehabilitation and long-term care and her EN medal. But in September, as the HPCA came into force, she received a letter from Nursing Council explaining the change. Since then she has lobbied tirelessly to have the NA title scrapped--"it doesn't reflect our training and skills"--and for all second-level nurses to be ENs. But the lobbying has left her feeling "bitter, angry and disillusioned. We were sold a lemon. I didn't go to our graduation because what was going to be given to me was not what I paid for."

She feels particular sympathy for those who came from outside Christchurch to do the training. "It cost me $6000 but it was more expensive for those from away because of bigger expenses and loss of income. They are now paying off their student debt but they are still on caregivers' wages. All of us on that course were sincere people who wanted the best for our patients. We thought we were going to make a difference. I feel so angry because it is so unfair and because of the staffing crisis in aged-care." She said many had left the health sector all together. "They thought, if this is how nurses treated each other, they didn't want a bar of it." King wants the EN title for all second-level nurses, with their different training recorded on annual practising certificates--"just like they do for registered nurses (RNs)."

Another who completed the CPIT training, Trish Wright, says the NA title is demeaning. She doesn't support RAN either--"I'm not assisting anybody. I'm the team leader in a 28-bed rest-home." She could live with associate nurse as this implies a support role to RNs.

Wright acknowledges she has a very supportive employer and completing the CPIT course has meant more clinical responsibility and more money. "I'm one of the lucky ones. My employer regards me as an EN and I see myself as an EN." Annals cautions against winning the EN title battle but losing the fight for a less restrictive scope of practice and a higher education level. "That would be a symbolic but hollow victory." He's confident once the title issue is dealt with, the Council will move on those two issues. "It is ironic that the Nursing Council is putting a lot of resources into the nurse practitioner scope of practice for a small number of nurses, white a large group of nurses, ENs, are constrained by their scope of practice."

He believes the Council should be leading the support and development of the second-level nursing workforce and that the safe staffing/ healthy workplaces committee of inquiry should address the rote of ENs in the staffing mix.

Currently, there are 184 nurses registered in the NA cope of practice, 153 trained in New Zealand and 31 overseas. Of these registered NAs, 120 hold current practising certificates.