About 110 attendees at the annual EN section conference in Christchurch responded positively to the announcement on Tuesday, delivered by Te Kaunihera Tapuhi o Aotearoa — Nursing Council of New Zealand chief executive Catherine Byrne.
“I think it’s very exciting, it’s going to open things right up,” said EN Jenny Lopes, who works in an aged-care facility in Palmerston North.
The updated statement, which will take effect in early 2024, recognises te ao Māori, including te Tiriti o Waitangi and the kawa whakaruruhau framework, and changes the relationship with registered nurses (RNs) from working under their “direction and delegation”, to working with them.
The first part of the new statement says enrolled nursing “reflects knowledge, concepts, and worldviews of both tangata whenua and tangata tiriti”. This is followed with the role’s scope as it relates to te Tiriti.
“Enrolled nurses uphold and enact Te Tiriti o Waitangi ngā mātāpono – principles, based within the kawa whakaruruhau framework for cultural safety, that promote equity, inclusion, and diversity.”
The statement goes on to describe ENs new relationship with health consumers, whānau, communities and the wider health care team – and in the last line, spells out how they work with RNs.
“Enrolled nurses work with access to and seek, when appropriate, guidance from a registered nurse or other registered health practitioner.”
Tōpūtanga Tapuhi o Kaitiaki Aotearoa – NZNO director of professional services Mairi Lucas, who was on the design team for the scope statement, said inclusion of a commitment to te Tiriti was something NZNO and Te Rūnanga had asked for, “for a long, long time”.
Lucas said ENs needed to understand te Tiriti and tino rangatiratanga (self-determination), so that they can look after the people properly, and address the huge inequity in health outcomes for Māori.
“So, by putting it into the scope there’s an expectation that nurses understand, and know what it means, and if not go and learn, go and find out, because it’s about the mana of the people we are looking after.”
Lopes said the changed scope would mean she would no longer need to phone an RN to gain approval to administer paracetamol to a rest-home patient who had a headache – which was the policy of her employer.
“I have to go and phone the RN, having done a clinical judgment, and say, ‘Mr R has a headache, his last paracetamol was two days ago, can I please give him something to take away his headache’.”
There are just under 2500 ENs, representing 3.5 per cent of the nursing workforce, and those at the conference say the change will improve their status, job satisfaction and make the role more attractive.
Byrne said “ENs are skilled nursing professionals in their own right”.
“They can work across a wide range of possible practice areas and settings, and this statement recognises that.”
A design group, including representatives of the Nursing Council, Te Poari o Te Rūnanga o Aotearoa, the NZNO EN section, employers and educators, worked together on the statement review over the past year.
Next on the agenda for the design group is a review of the EN competencies and qualifications, with the full scope of practice coming into effect in early 2024.
NZNO enrolled nurse section chair Michelle Prattley, who is on the design group, said throughout the history of ENs, the scope review was the first time representatives of the group had been “at the table” to have a say in changes to their profession.
“Enrolled nurses will be able to practice in a wide range of health-care services with this less restrictive scope of practice and enrolled nurses have lobbied for these changes.”
EN Debra Handisides, who works in Burwood Hospital’s spinal unit, said she would be able to work to the “top of her scope”, and there would be more recognition of her professional competence within her team.
Handisides said some RNs were not confident in their understanding of the EN scope and, as a result would restrict EN practice in the team.
“Now, we’ll be able to collaborate a lot easier, and there won’t be as much miscommunication around what I can and can’t do.”