NZNO to get more 'aggressive' in its support of ENs.
Annals said if DHBs acted on the letter, risks to patients could increase. "Experienced ENs, who are practising safely, will be driven out of acute settings. The idea that replacing these practitioners with inexperienced registered nurses (RNs) or unregulated health care assistants (HCAs) improves patient safety is ludicrous."
The letter, written in May, refers to the Health and Disability Commissioner Ron Paterson's inquiry into the quality of care Mark Burton received from Southland DHB's mental health services and states the inquiry raised specific concerns about the employment of ENs in mental health settings. Recommendation 31 of the Commissioner's inquiry stated: "Review the employment of enrolled nurses in the acute psychiatric setting, including consideration of whether there is a place for enrolled nurses, and, if so, ensure implementation and audit of policy with regard to scope of practice." Recommendation 32 states: "Ensure sufficient supervision and staffing support so that the practice of enrolled nurses remains within enrolled nursing scope of practice." (1)
The letter to DHBs states" in the Minis try's view, this concern is broader that just mental health and also relates to the employment of enrolled nurses in any other acute settings."
NZNO challenges this interpretation in light of the Commissioner's actual recommendations and does not believe his inquiry should be used to question the role ENs in all acute settings. Annals said the letter was consistent with an "irrational strategy" proposed by some in the profession "to undermine and denigrate the practice of ENs in the name of patient safety. Where is the evidence of unsafe EN practice that supports this strategy? Why do its proponents refuse to face up to the fact that properly prepared, experienced ENs will always have an important place in the health workforce?" he asked.
Patient care compromised
Removing safe and experienced nurses from acute settings would compromise patient care and exacerbate current nursing shortages. "That scenario is the antithesis of what the Commissioner recommended. It doesn't make any sense to remove nurses who have been practising safely in acute settings such as theatre for years and who have built up an immense amount of experience."
Annals also fears some DHBs may unwittingly accept the interpretation in the letter "as the last word, when we believe the interpretation by the Ministry and the Nursing Council is incorrect."
The Otago DHB is taking steps to gradually move ENs from acute mental health settings over a three-year period. The ENs have a total of 130 years' experience in the area. While acknowledging these staff were a "valuable addition to the mix of staff on the ward", the manager of mental health and intellectual disability services, Colleen Crop, has proposed that no new ENs be employed in acute mental health wards from this month. The proposal is that from September 1, 2006, there will be no EN positions within the three acute mental health wards. Those employed there now would be offered three options: redeployment when an EN position becomes available in one of the three rehabilitation wards; redeployment when an EN position becomes available in another service; assistance to retrain as an RN with a guaranteed position at the end of the training. If there are still ENs working ha acute mental health by September 1, 2006, their job descriptions will be changed to that of, mental health assistant, although their terms and conditions will remain the same.
Annals said the Otago DHB's "solution" to the "problem" of ENs in acute mental health settings was ludicrous. "Either ENs are safe to practise in acute settings or they are not. How can they be safe now but not in three years?"
Chair of NZNO's EN national committee Robyn Hewlett said ENs were feeling "gutted" by the board's proposal. "Enrolled nurses in all areas across New Zealand are currently feeling undervalued."
She called for more support from RN colleagues "because it does not seem to be forthcoming at the moment".
NZNO has decided on a multi-pronged approach in supporting ENs. It is to develop a national plan for the employment of ENs in DHBs; and it is to develop a case for EN training courses to be at level 5 on the New Zealand Qualifications Authority (NZQA) framework. Annals said it was wrong that both EN and HCA training programmes were at the same level on the framework. "Clearly ENs' roles and responsibilities are very different to the work of HCAs and that difference needs to reflected fairly on the qualifications framework."
Annals suggested that instead of removing ENs from acute settings, DHBs should concentrate on ensuring adequate direction and supervision of ENs so ENs could work within their scope of practice--"just as the Commissioner recommended."
1) Health and Disability Commissioner (2002) Southland District Health Board Mental Health Services February-March 2001.A Report by the Health and Disability Commissioner. Auckland: Health and Disability Commissioner.
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|Title Annotation:||news and events|
|Publication:||Kai Tiaki: Nursing New Zealand|
|Date:||Sep 1, 2003|
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