Enrolled nurses (ENs) make up approximately one sixth of the nursing workforce in Australia. By sheer numbers (52,944), they significantly contribute to the health workforce when compared with other health professions (eg. general practitioners 30,066; other medical practitioners 68,329; pharmacists 25,139) registered and employed in Australia in 2018. [1] They are employed in a range of care settings – 47.1% working in a hospital setting and 29.7% in residential aged care facilities. [2] Enrolled nurses are involved in the day to day care of people affected by life-limiting illnesses. EN practice providing culturally appropriate end-of-life care, is outlined in the Code of Conduct for Nurses and referenced in the Enrolled nurse standards for practice. Under the direct or indirect supervision of a registered nurse (RN) they implement symptom management interventions, provide emotional support, and communicate patient needs to the RN.

ENs are educated in the Vocational Education and Training (VET) sector, completing an 18 month to two-year program to fulfil the qualification requirements of a Diploma of Nursing. The Diploma of Nursing curriculum is derived from a ‘training package’ which includes ‘units of competency’ and a minimum of 400 hours of clinical experience. [3] Inclusion of palliative care is not a core component of the curriculum. Palliative care is offered as an elective unit of competency. Its inclusion in a training package is influenced by the capacity of the Registered Training Organisation and educators to deliver the unit of competency and perceived industry requirements.  

To promote the inclusion of the palliative care unit of competency in EN qualifications and support nationally consistent palliative care education, PCC4U developed the PCC4U EN Toolkit. It is a suite of case-based eLearning modules and teacher resources. The modules are aligned to the elective unit of competency HLTENN010 Apply a Palliative Approach in Nursing Practice, and EN standards for practice. The availability of a reputable, evidence-based learning and teaching resource has supported increasing implementation of palliative care education in EN training packages. Currently, 56% of RTO are using the PCC4U EN Toolkit and 37% are reviewing it for inclusion. Pre and post student evaluation has indicated increased knowledge, confidence and preparedness after participating in education including the PCC4U EN Toolkit. Industry feedback has reinforced the positive impact of this education.

'EQUALS’ Diploma of Nursing students have improved awareness and understanding of palliative care within an Aged Care setting. Since EQUALS implemented the use of the PCC4U toolkit, we have noticed a significant increase in students’ confidence in working with clients who are receiving palliative care. Graduates understand the privilege associated with providing a client and their loved ones with support during end of life care, and can apply the principles of care in a practical, personalised manner.'
Melissa Slattery RN, DipNg, BHlthSc, BNg, MNg (Cwk) Academic Manager (VET) and Head of Discipline for Nursing, EQUALS International

Entry to practice education, which includes knowledge and practice of palliative care, is critical to prepare industry ready ENs. SkillsIQ, under the direction of the Enrolled Nursing Industry Reference Committee, has embarked upon a project to review the skills needs of Enrolled Nurses. This will inform potential changes to current enrolled nursing qualifications to ensure skills training is in line with workforce needs and expectations. The health industry needs to reinforce the need for development of palliative care knowledge and skills in all enrolled nurses. You have an opportunity to respond to this consultation now.

Visit the PCC4U website for more information about the PCC4U EN Toolkit and keep updated by following @PCC4U_team on twitter. 

References

1. Australian Government Department of Health. Health Workforce Data: Summary Statistics [Internet]. Canberra (ACT): Australian Government Department of Health; 2019 [updated 2019 Jan 28; cited 2020 March 23].

2. Australian Government Department of Health. Enrolled Nurses 2017 Factsheet [Internet]. Canberra (ACT): Australian Government Department of Health.; 2018 [updated 2018; cited 2020 March 23].

3. Schwartz, S. Educating the Nurse of the Future – Report of the Independent Review into Nursing Education [Internet]. Canberra (ACT): Commonwealth of Australia; 2019 [updated 2019 Dec 4; cited 2020 March 23].

Kylie Ash, National Project Manager PCC4U, Queensland University of Technology

Melissa Slattery, Academic Manager (VET) and Head of Discipline for Nursing, EQUALS International

For more information and resources on education for nurses providing palliative care visit the nurses Education section in the CareSearch website.