The Future of the RN – Part 1


RN and NSWNA member Jennifer Tuckwell, has written the following article ‘The Future of the RN’ we will be bringing you Jennifer’s three part series over the next week and a half so keep checking Nurse Uncut to read the full article.

Your thoughts and feedback are welcome in the comments section below.


The Future of the RN – part 1

As a registered nurse of many years who has witnessed what I could only describe as ‘the erosion of the nursing role’, I have a need to question the path that the current education of nurses is taking us.

From what I am witnessing, and on examination of the current education on offer, I ask ‘why’ and does it meet, evidence based best- practice? I think not.

The inadequate clinical preparation and the underlying educational directive of specialisation for the undergraduate, is one of the reasons for the inability to retain our graduates. This in turn has led to an erosion of the nursing role itself with the resultant emergence of ‘skill mix’.

The University education in its current format is not giving us a nurse who is staying in the profession – the Garling Report emphatically declares that.

This fact came to light as far back as the Battersby Report of 1990, where the factors identifying the nurses most likely to leave the profession, included the University educated nurse.

When you think that this was a mere six years after the introduction of this style of learning, one would have thought that alarm bells would have rung and a closer monitoring of this education would have ensued – apparently not.

We now have a nursing shortage approaching crisis point. We have less registered nurses now than we had in 1986.

We have an ageing workforce with 22% of our registered nurses eligible for retirement this year alone and it does not take too much imagination to see a further 22% disappearing in 2012.

The Garling Report states that by 2012 one quarter of the entire nursing workforce will have to be replaced!

In a mere 25 years we now have “skill mix” in the acute hospital setting – unheard of 25 years ago. This skill mix encompasses approximately 40% of the entire nursing workforce in the hospital – this nurse has one year or less education!

Reality is, we are not retaining our graduates.

Nursing needs to be a vibrant exciting profession, that is always “up to date” and semi-autonomous.

To accomplish change, nurses themselves need to take control of what is best for them – another recommendation from the Garling Report but known to nursing research for decades.

I would like to put forward an alternative education.

The basis of the education I am mooting, has its root in the “old” whilst mixing it with the “new” and this has been achieved most successfully by the Ambulance Service of NSW. I am advocating that we pursue this same format of education.

I would also like to see the registered nurse re-classified as Paramedic Registered Nurse and Assistant Paramedic Nurse. This re-classification for the sole purpose of instilling in the nurse just how important our role is.

We are clinicians, or we should be, and we are the very backbone and the alarm system of the health care industry. For that we need a diverse and broad based relevant clinical preparation that can be continually updated.

To become an Ambulance Officer in training to be a Paramedic (3yrs) one must first pass an interview and then a six hour examination that takes in your ability to read and write effectively, comprehend and express yourself adequately in English, pass a maths examination and an assessment of your suitability to perform your role, as well as an IQ test.

So simple, a system that has identified your ability and suitability to perform your role from day one and before you are even contemplated for a position.

The ABS in 1968, and no statistics can I find since, showed that of over 22000 nurses who started their education in NSW and the ACT, only 46% completed it.

I think not suitable played an enormous part in those statistics.

That one may enter University today, with a known, less than satisfactory English competency, undertake a full three years education at University, and then sit the remainder of the English competency test defies belief.

Your commitment to being an ambulance officer does not stop here.

For the first year of your education you will be stationed close to the vicinity of your abode, after that, you may be placed anywhere in NSW where an ambulance officer in training is deemed necessary.

Once you have been accepted you will spend the first eight weeks in the classroom setting in preparation for your placement with a Paramedic. The Paramedic is assessing you for you alertness, assessment ability, competence for the expected level of education, and communication skills. This assessment is on-going for the full three years of your education.
During this time you will be studying from prepared manuals and online courses.
You will spend, in first year, the eight weeks in class, then ten months hands-on. There are exams at regular intervals with a pass mark mandatory. A failure results in one ‘post exam’ and a second failure in a dismissal from the service.

This form of education, aside from the on-line courses, is identical to the hospital educated nurse. Pass or be dismissed – a level of knowledge and competency expected for your level of education.

The second and third year of this education incorporates another three weeks in class and then eighteen months practical with the continued supervision and assessments and exams and on-line learning.

So simple, so effective – learning “on the job”- with the added bonus of gauging if this is really the role for you.

If we cannot replicate this form of education, refine it specifically for nursing and bring nursing into line with what is needed in the 21st century, we would not be trying.

What I envisage by this, is that whilst you are gaining your knowledge base and nursing skills in hands on nursing, and getting used to shift work, – you are also studying the prepared DVD’s on respiratory disease, cardiac disease etc, with actual patients displaying the symptoms and the medications that are currently on offer for these conditions, and the nursing interventions that make this patients life comfortable and prevent complications.

This RN would be capable of reading blood results, ordering and taking blood and cannulating and initiating an IVI if necessary, the ability to read an ECG and know what drugs are applicable or may be interfering with the treatment of any abnormality seen. Ordering tests if necessary, having the ability to perform a basic physical examination, be proficient in hearing air entry to the lungs and diagnosing and reporting when there is an abnormality.

We would have compulsory annual updates of cardiac, respiratory, diabetes with the ability to upgrade your knowledge in an area of your choice, i.e. palliative, gerontology.
All of this education would be available online.

I also would advocate that along with the compulsory CPR we are taught how to intubate if necessary, and have the same drug administering rights as the Ambulance Paramedic.

These skills and knowledge base are truly not difficult. They can’t be or you wouldn’t have The College of Nursing offering a three day course for such skills as “clinical assessment”.

Australia, with a little imagination, could actually lead the world in changing the face of nursing.

What do you think of the current university-based education system? Do you feel this alternative education system may work? Tell us below!

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  1. I completely agree, and it sounds like a wonderful idea. I am amazed that in this day and age, a simple thing such as IV cannulation isn’t part of the education of a registered nurse as it is in the United States, instead we have to go and do a “further education” course in order to be allowed to put an IVC in someone! when will we wake up and push for these changes, nursing NEEDS to move forward and grow as a profession, I love the idea of actually having more autonomy, maybe that will also increase the respect we get from the general public sometimes…

  2. Its has been a long held view by many that undergraduate nurses undertaking the B Nursing degree have not enough practical experience provided in their courses. This view is often shared by the nursing students and new grads themselves. I agree that there needs to be some form of restructure in the way that the course is provided to allow much more practical, I am not sure really if the NSW Ambulance Service model will really work. My point of view that has developed over the past few years is that the Area Health Services or Local Hospital Networks may affiliate with the nearest or local University and between them provide a model of theoretical learning that is consolidated with genuine and consistent practical experience. While it has been identified that there appears to be a lack of practical experience within the undergraduate nursing degree courses, theoretical training is still required and is an integral part of learning. Learning of theory does require time also and cannot be rushed otherwise there will be large gaps and misunderstanding taken into practice. Perhaps the students can be employed after the first year in a form or internship by the hospital or LHN for their practical while receiving appropriate amounts of theory at the university affiliated with the hospital? This way there is some financial incentive to continue with the course for the student who will be providing the hospital with their ever increasing knowledge and skill. I do not think that the word “Paramedic” is appropriate to be added to the title of Registered Nurse.

    There are many reasons why nurses leave the profession and an experiential and studied look around the hospitals can reveal that working conditions often play a large part. This will also filter down to the undergraduate nurses who observe these poor conditions. This may well be one of the reasons that some undergraduates in the past have not completed their training. They have been caused to consider if they really want to work their working lives after completing 3 years of uni in poor working conditions. Furthermore you may find that many undergraduates have left their training because they have felt very poorly supported on their practicals by clinical educators and professional nursing peers. The nursing profession is noted for eating its young and sadly workplace bullying is and ongoing issue. Jennifer makes note from the ABS in 1968 that only 46% of 22000 nurses completed their training and makes an assumption that this was because many were unsuitable…..I find this to be a bit weak in that there are many reasons that people (particularly in 1968, where the profession was notably more female dominated than today) did not complete training. It would not have been that they were unsuitable, but there were many inflexible expectations of the nursing student in the past such as remaining unmarried and not having children in some cases…..I know of many women in my mothers age group who dropped out of their training, not because they were ‘unsuitable’ but because they decided they wanted to get married and have children, or in some cases had become pregnant. There were many hospitals who frowned upon married and/or pregnant student nurses. There was also no maternity leave allowances either so there were no avenues back into the course to complete it. Later on in the 70’s and 80’s and in some cases the early 90’s there were some people who did not complete training because they found they could earn more money in other jobs….jobs such as a checkout operator or a factory production line worker that required less knowledge and skill provided better pay and conditions! It wasn’t because these people were unsuitable for nursing….nursing did not provide incentive to stay! I agree that nurses should have higher skills as mentioned….however are there not nurses who are gaining these skills (Blood orders, IVI ordering and administration etc) in order to become a Nurse Practitioner?

  3. The College of Nursing ??

    The same College that wants to charge $10,000. for a few weeks of ‘refresher’ training??

    The college used to be about education. It’s now nothing more than one of dozens of private RTOs in NSW. Money is the word… not education…. not the ‘future’ of Nursing at all.

  4. If you look at why nursing went to bacheloreat-based, it was to recognize nursing as a true profession, even though hospital-based training was putting out quality nurses. It was to try and get nurses (predominantly female) the recognition for their knowledge as well as allow for proper compensation.
    There are many still today that do not see nursing as a true profession. (Our pay still reflects that, too.)
    I never went through the Australian system, but I felt very prepared with my bacheloreat degree. At my uni, once accepted into the college of nusring (end of sophamore/2nd year) one started at nursing health (lectures and clinicals geared toward the healthier bits) and then progressed to diminished health (lectures and clinicals reflective of that). As one progressed through, the classroom time became less, except when you met with your clinical instructor/group. By your senior year you were ‘working’ the same schedule as your clinical preceptor. In most hospitals, new grads are put into a learning track that adapts to their needs, some people needing weeks of orientation others months. I saw this in mainly the larger, university associated places, and don’t think this is the industry standard.
    I do think my first two years had somewhat wasteful courses, but I recognize they were the weed-out process to gain entry into nursing. Some of the courses (ethics, anatomy and physiology) are completely necessary, others probably didn’t need as much time (2 semesters of English – nah, a full semester of statistics – nah). For those, an abbreviated version would suit.
    I think, unless a person has that burning desire to be a nurse, choosing nursing as a major just isn’t worth it to young people entering tertiary education. Why spend time, money, and effort on a degree that is not valued by society? Unless, of course, they are laying on a gurney in front of you, then they wished they valued nurses more.
    The undecided young will go for the degree that promises them a decent life.

  5. I have just completed my Bachelor of Nursing. Personally, I believe it completely missed the mark. As I already practice as an EN, the transition for me may not be so challenging and dare I say it, confusing. But for others, well let me just say I know many young graduates who have simply not gone into the profession because they feel inadequately prepared, that’s a disgrace on the whole system. The other complete joke is the total lack of available graduate places, the one hope that you have of securing a supported year of on the ward training, REAL nursing work. It’s like this funnel – many enter the degree only to be filtered out at
    the end. And in most circumstances, no ward experience, no job but ward experience for the graduate can only come via the elusive ‘graduate year’.

  6. Sounds to me like you are saying go back to the three year diploma type education I received. We had no reality shock on graduation. If you remember it was the BSN elite that were administration bound and for the most part professional students that wanted no part of the bedside that destroyed those programs. Now we are reaping what they sowed.

  7. The ongoing nursing crisis is multifaceted. While I do not disagree the educational preparation is not as good as it could be, the greater problem facing the profession, and in fact health care in general, is the declining numbers. Baby boomers are retiring, taking a very large proportion of the workforce out of the picture. Gen X isn’t too far behind, perhaps as little as 10 years will see them start to retire. The numbers entering, and remaining in, nursing are way too inadequate to meet the expected losses.

    Retention is possibly more important than recruitment. It’s no good recruiting if there aren’t enough to pass their skills and knowledge on. We need to keep some of the “ageing nurses” to this end. However, the decreasing number of nurses has another little thought of impact…there will be less nurses to move into education. The tertiary nursing education sector is facing the same problem of dwindling numbers.

    Recruitment is currently a waste of time, to a large degree. Who wants to work all hours of the day any day of the week for so little return (and not just financial return)? Who wants to be bullied and abused? Who wants no work-life balance or pathetic career progression/prospects? Who wants to be overworked while being understaffed? The public, including school-leavers, are in no doubt as to the conditions we work under. The profession has very little to make it attractive when there are a multitude of career options that offer so much more.

    Australia is not unique in facing these challenges, nor are we unique in that our governments and other key players have known about these problems for over 20 years and yet have successively done little to address the issues. I would go as far as to say, their lack of appropriate action has compounded the problem.

    We are about to reap what has been sown. Who will be there to care and who will be there to teach how to care?

  8. I have been working as an RN since graduating as a mature age student in 2007. Despite winning the academic award for our graduating class I lasted just over a year on a hospital ward. Throughout my training I despaired at the lack of clinical experience gained on placement. We need less emphasis on writing in-depth essays with thirty references on conditions we have not yet seen and more opportunities to have hands-on experiences. I would have retained far more of my learning if I had been exposed to some of the more common conditions. I am now working part-time in general practice which is far more manageable than a dangerously busy ward with too much responsibility and little help. Yet I would have been happy to stay doing shift work and working on wards if the staffing levels were better and I had come out of my degree with more clinical experience and, therefore, greater confidence.

  9. I worked an Agency shift last night in an Aged care Facility. This shift could have been allocated to a first year ‘new grad’. Think of how they would have managed:
    Never been here before. In Charge of 4 AINs & just over 100 residents. I had something like 20 odd S8s to ‘correctly’ and ‘legally’ sign out of the drug cubboard at 0600 hrs. ( can they ALL be given at 0600 hrs. ?? ). During the night, one resident needed hourly suctioning ( hyoscine S/C given – no effect ). Two falls, wanders, and the ‘expected’ general aches and pains, and panadol here and


  10. I am a new graduate nurse, throughout my course I never thought my practical component was anything less than adequate. I know that my university makes us do a lot of hours, and I took the initiative to actually make use of those times to practice my skills and everything I learnt with the help of RNs. I am glad that everywhere I went I was taught well by the nurses who took my under their wings. Yes, nursing is a profession where your hard work is hardly acknowledged, general public thinks you are a dumb bunch who keeps striking for better pay, the only people who understands are your sane patients who realise, upon their stay in hospital, how the health system ‘actually’ works. The shocking pay, and the conditions we have to work under, no wonder people won’t want to stay. So far I can still say I can see mysel in thie profession for a few years, as I hope that it will change and our profession will see us being recognised for our knowledge, we are not all stupid, and we deserve more pay. For those who think we don’t, you come and work one of my shifts and then judge me.

    Nursing is alot more than what it seems. Drs get all the glory and glamour, but behind them is a nurse who has saved their ass and alerted them about their illegal/wrong medication charting skills.

  11. Thank you Ang, and we really are being “kept back” – nursing is a stale old and tired profession in need of an urgent make-over if we are to survive as a profession at all.

    Nurses have all the responsibility with absolutely no authority – an untenable position to put anybody in!

    We need autonomy and we need clinical skill that can only be obtained by “hands on nursing” backed by relevent theoretical knowledge. Not the add on ad-hoc and expensive education workshops now on offer.

    It is even more important today in our multicultural society that the nurse has maximum exposure. That the novice/trainee nurse will somehow just absorb observational skills by osmosis so to speak, is to my mind gross negligence.
    Acute observation not the usual domain of an unseeing eye nor the young adult.

    This exposure more relevent today with our diverse cultural presentations of patient needs and presentation symptoms, after 38yrs I am still learning.

    Thank you too Celticangel and Gordo, I hope you all continue to contribute to my paper and lets start to make nursing a profession that people line up for – no not joking – there is a waiting list to be an ambulance officer.!
    Perhaps that is because one has the ability to utilise your skills along with autonomy and in depth skill knowledge – citing again the Garling Report, ” the demarcation line between nursing and doctors needs to be consigned to history” – I don’t have the exact wording but that’s the gist of it.

    The ABS statistics I have quoted celticangel, show that nursing as a profession, like police, is one where many are drawn but few are suitable – it is a service profession and one from which a great deal of pleasure and satisfaction can be derived if one is adequately prepared and suited to – the ambulance service certainly think that this criteria needs to be identified “straight up”

    I am very aware Celticangel of why nurses leave nursing – it has been researched ad-nauseum by academics for decades, – at least 50yrs,- what we have not had is any will to change what we already know!
    Top down administration that is known to be a failure is still in situe, and identified once again, this time by the Garling Report, of where things need to change. The Garling Report stating that reform of nursing must be “bottom up driven”.- nurses knowing what is best for nurses.

    As identified by Gordo, nursing education is no longer for nurses, there are far too many bodies, some small and some very powerful who are now dependent on this form of education continuing.

    As an aside Gordo, and in response to your last entry, we have a never ending body of people that are not “doing the job”, yet keep parrotting meaningless spiel that governments are taking note of.

    We have a Ms Cerano, of the RCNA, they receive $20 million a year to advise government of nursing needs! – Well there is Ms Cerano in the Australian newspaper early this year espousing the virtues of persueing a career in aged care – Ms Cerano obviously never having done a shift in a nursing home in recent days with meds needed to be given to 80+ patients, all from a blister pac to save time (forget the need to know what you are giving), – we really don’t need any more aged care consultants with clip boards, an “after the event”, telling us how to do our job,- we just need relevent clinical knowledge and support when we do our shift – and yes, a novice would not have a clue about an elderly residents needs nor how to prioritise the mess that you found yourself in.

    Keep talking aye – I am in remote WA at time of writing so my replies may be a little delayed.
    Thank you all.

  12. The future of the ‘profession’, is not only about how RNs fit into the system…. there must be thoughtful debate about those who have trained as ENs, and those who are designated ‘assistants in nursing’ ( or now often designated as ‘care workers’ ).
    We have AINs doing a few extra hours of education, and being awarded a cert.IV. This then allows them to administer medications. What does that mean??? According to NSW TAFE, the course prepares selected AINs to ASSIST an RN in the medication round. IT DOES NOT ALLOW AN AIN TO REPLACE A REGISTERED NURSE !!! But try telling Aged Care employers that !!

  13. Thank you Gordo, please stay reading as I have posed that very question – hopefully with a suitable answer that can inspire debate.
    We definitely do need debate re what is happening to nursing, EN’s and where the AIN fit into all this.?
    It’s a mess and nurses need to pose these questions.
    I think you may like part 2 and 3 of my paper.

  14. Dear Jennifer,

    l read your entry with great interest down here in Melbourne, Victoria
    Yes. Great challenges awaits us all on how university education will prepare our nurses for the near future. The nursing profession is not only facing pressures with ourself on the debates on the merit of a hospital/ or university trained nurse, but also mounting pressures external to that of nursing.

    The operation/ management of the hospital setting wields significant influence on how nurses operate on the floor. Take for example our case-mix DRG funding system in Victoria. It thorough- through system to ensure as much patient get into the system creates enormous pressures for nurses working on the floor. The workload itself is enough to drown so many nurses, experience or inexperience, young and old, grad or clinical nurse specialist. It brutal ‘ the tough gets going’ or ‘pushing the broken wheel hard enough and it will keep going’ mentality is something we nurses cannot control. Because we are never ‘up’ there in the real management of things, decision in the policy making in making our workplace safer, friendlier and our practice more evidence-based.

    My point is to highlight the many external factors that affects the way we function and survive together as a whole, in the real world.


  15. I’m not a nurse but so support these views Jennifer, having witnessed the hospitalisation of a dear friend, very much in pain and distressed. The very busy nursing staff did not have the expertise or responsibility to make decisions for her – it took two “old” nursing friends who visited to take simple measures to make her more comfortable – bathe her, rub her back, change her position, swab her mouth. Medication could not be administered until doctors visited in subsequent days.
    I would love to see nurses being given greater responsibility, training and hopefully job satisfaction,with multiple career paths to inspire them in their wonderful and much needed career.

  16. Thank you Chee,
    I think another “unacknowledged factor” is that nursing is a caring and predominately female occupation (over 90% female)
    With that must go the “psyche” of the caring person, ie. predominately female and predominately overlooked because there will always be “someone” who will do this work! – it appears to matter little, who that “someone” is.
    It really is “past time” for nurses to stand up and say what they want and need and be “heard”.
    No true leader would send their novices to a place where they themselves could not function! – it is a damming inditement of our leaders that we have progressed so far “down this road”.
    I think part 3 of my paper wraps it up pretty well, lets hope that together we can “change the face of nursing”

    Thank you too Chris,- as my own mother bounced in and out of two major Sydney Hospitals I can only say the care/knowledge was terrifyingly inadequate.
    Indeed something needs to be done to empower nurses.
    Please keep reading, maybe it will be the general public that bring about change.


  17. I am a university trained nurse and I remember studying a lot of irrelevant subjects when I did my training. However I also how to assess patients (though I only learnt from books), but after I graduated I realized that I was not allowed to use most of the skills I had learnt and my role as an RN was to simply follow the doctor’s orders, keep the patients clean, dry, nourished and monitor them. I constantly feel my skills and knowledge are devalued for example: As an RN I am not allowed to say a patient is haemorrhaging because this is a medical diagnosis; instead I have to say the patient has lost about 600ml of blood in the last 15 min. When it comes to nurse initiated medications I am limited to panadol, mylanta, and a few laxatives; in spite of having a nursing degree I am permitted to nurse initiate panadeine, even though patients can buy this themselves from a pharmacy without a prescription. It didn’t take too long before I became disheartened with the profession. In all honesty I feel that RNs should be given more recognition and a broader scope of practice that would reduce the burden on doctors. Many of the irrelevant subjects nurses learn should be replaced by practical subjects such as conducting thorough head to toe assessments, IV cannulation, catheterisation, ordering IV therapy, blood tests, certain X-rays and interpreting these tests. Nurses should be taught how to put a plaster on and they could perform minor suture procedures. As far as the title nurse goes, I believe the public see nurses as doctors’ handmaidens and feel that it is time to change this, so yes I agree we need a title but I not include the word nurse in it.

  18. I am a university trained nurse and I remember studying a lot of irrelevant subjects when I did my training. However I also learnt how to assess patients (though I only learnt from books), but after I graduated I realized that I was not allowed to use most of the skills I had learnt and my role as an RN was to simply follow the doctor’s orders, keep the patients clean, dry, nourished and monitor them. I constantly feel my skills and knowledge are devalued for example: As an RN I am not allowed to say a patient is haemorrhaging because this is a medical diagnosis; instead I have to say the patient has lost about 600ml of blood in the last 15 min. When it comes to nurse initiated medications I am limited to panadol, mylanta, and a few laxatives; in spite of having a nursing degree I am not permitted to nurse initiate panadeine, even though patients can buy this themselves from a pharmacy without a prescription. It didn’t take too long before I became disheartened with the profession. In all honesty I feel that RNs should be given more recognition and a broader scope of practice that would reduce the burden on doctors. Many of the irrelevant subjects nurses learn should be replaced by practical subjects such as conducting thorough head to toe assessments, IV cannulation, catheterisation, ordering IV therapy, blood tests, certain X-rays and interpreting these tests. Nurses should be taught how to put a plaster on and they could perform minor suture procedures. As far as the title nurse goes, I believe the public see nurses as doctors’ handmaidens and feel that it is time to change this, so yes I agree we need a new title but I would not include the word nurse in it.

  19. In my opinion AINs and ENs should not be allowed to administer medications at all. I thought ENs were supposed to assist RNs and they were originally called nurses aids. AINs were originally placed in hospitals to stock up supplies in the treatment room, make beds, do a tidy round on the ward and clean pan rooms. The roles for ENs and AINs were initially created to ease the work load on RNs, but somehow they have managed to step into the RN role without studying the RN course. How did this happen? And why are they claiming that RNs need three years training, when they are replacing them with ENs and AINs. Are we just there to improve the training of ENs and AINs so that they can take over our jobs? Well I have no intention of ever training an EN or an AIN so that they can push me out the door.

  20. Also I agree with you Cordo about the aged care employers, but I don’t think AINs should be giving out medications at all unless they are supervising someone in their own home; they are only allowed to help the client to take his or her medication from the webster pack.

  21. After 32 years in nursing and having trained in all 3 systems, hospital based, TAFE, then university, my personal view is that TAFE wins! I really think university and all of the B/S they go on with where referencing is far superior in terms of assessment than actually learning what you NEED to learn to become a nurse in a practical sense. At what point did we get education of nurses SO wrong? How do these university educators think that the students they are teaching will possibly be better nurses by placing such importance over such trivia! We need to get to the point of where someone has to stand up and say NO MORE. We need to look at something different, a different model of education that is practically based. When the Holmsglen TAFE Victoria was approved to conduct RN Div 1 Degrees in 2010 there was outcry from academia stating that this will devalue nursing and the students will not be as well prepared…What a load of rubbish! Was this just an elitist view that university education is the only way? I think so… Does it really matter where an RN gets her/his degree from if the program is Board Approved? No of course it does not, the institution would never have been approved in the first place if this was so. I personally think that TAFE is far more grounded and courses delivered more practically than what university nursing education will ever be. So, I hope more TAFE Colleges are approved across Australia to deliver all nursing programs, from Cert 111 right through to RN.

  22. I went to a medium-sized (about 15 participants who were CEOs of private nursing homes and hospitals) heads of care meeting about 2 years ago and we actually informally workshopped what the future of the RN was. I still have a photograph of the whiteboard. Here’s a summary:

    1. Registered nurses are expensive
    2. Enrolled nurses are cheaper, but better trained and deliver value for money
    3. Cert IV carers deliver value for money
    4. Nurse practitioners deliver value for money and are financially self-sustaining

    Future of private healthcare
    – Increase role and scope (esp. medication admin) and numbers of Cert IV staff
    – Give ENs increased clinical role to absorb RN duties
    – Reduce RN numbers substantially and revise role
    – Promote use of NPs as point of expertise

    At the end of the day, it was apparent that it’s never, ever going to be about perceived roles, but about who delivers value for money.

  23. How telling that I stumble across this while I am researching for an assignment! I am a first year Bachelor of Nursing student and agree with everything written here! I find myself fantasising about training the way you have envisioned. Instead here I am slaving away at the keyboard, with the topic of “in the university setting, undergraduate nursing courses involve too much theory and not enough practical”.

  24. I first perused this blog of Jennifer’s and the related responses when I subscribed to Nurse Uncut last year and felt quite angry that the nursing profession was taking such a hit by the introduction of ‘skills mix’ and that ENs are being put in charge of Nursing Homes. I know of at least one chain of reputable Aged Care facilities that now has an RN Mon-Fri 9-5 and I’ve retrained in an acute hospital that now hires AiNs on the wards.
    We are heading for dangerous waters and we have Uni students like Rebekah who realise this. It’s time we continued this conversation.
    Further to the lack of suitable clinical placements, the review of the NMBA Competency Standards, that have been and still are (for now) the basis of our University curricula and Performance Reviews, will water down the elements of the domains we refer to as we strive for excellence. The word competency is going and we will soon have RN Standards of Practice instead.
    If you wish to read more about this, go to the AHPRA website, click on ‘News’ scroll down to’ Nursing and Midwifery’ and then on ‘public consultations’. It is disconcerting to see that only 44 RNs have been observed and consulted in a study that has been going on for one year. The Southern Cross Uni team states they have reviewed the relevant and available literature and evidence, but does not provide any references.
    I have just read an abstract of a relevant and available paper from authors Tsai CW et al (2014) ‘A study of nursing competency, career self-efficacy and professional commitment among nurses in Taiwan.’ Contemporary Nurse. They studied 762 nurses. Just Google them to read about their methodology. Prof Andrew Cashin and colleagues don’t mention what theirs is.
    As it is clear this team need more input, please spend some time doing the survey that is available on the AHPRA website. The consultations are only open for another few days. Hurry, last days, “sale ends 3 July” … look forward to your comments.

  25. This is happening so much today. 2015. I was an EN (diploma) and now an RN. Although I think an RN should be in charge in nursing homes at all times, I’m comfortable with an EN doing what they’re trained to do in their Diploma education, however they need to be under the direction of an RN to confer and report to. ENs do the same anatomy and physiology, sit the same medications test and need to achieve 100%, learn when to give a PRN or withhold a medication… However they need to report this to the RN. ENs aren’t really trained to critically think in the same way as the RN education but I’m confident in working with well trained ENs who know when to report. I don’t believe AINs should be administering medication unless they do the anatomy and physiology and medication course that an EN or RN must pass.

    It is evident that EN training and education has extended to be able to cross into RN territory, however it depends on who’s delivering this training and ensuring these diploma ENs really are competent.


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