Industry insights on skills needs
The Enrolled Nursing IRC's 2019 Skills Forecast identified the top priority skills for the sector as emotional intelligence, teamwork and communication, critical thinking, resilience, stress tolerance and flexibility and technical / job specific skills.
The top five identified generic skills are:
- Communication / Virtual collaboration / Social intelligence
- Design mindset / Thinking critically / System thinking / Solving problems
- Learning agility / Information literacy / Intellectual autonomy and self-management (adaptability)
- Science, Technology, Engineering, Mathematics (STEM) skills
- Language, Literacy and Numeracy (LLN) (Foundation skills).
According to the job vacancy data, the top requested skills by employers in the sector were communication skills and computer literacy. The most advertised occupations were Enrolled Nurse, followed by Endorsed Enrolled Nurse. The top employers were the New South Wales Government and Government of Victoria.
According to the Enrolled Nursing IRC's 2019 Skills Forecast, both the health care environment in which Enrolled Nurses work and their clinical practices have evolved significantly in recent times. These changes have resulted in evolving skill and competence requirements for the Enrolled Nurse workforce. The sector overall has been experiencing several challenges which are impacting workforce skill requirements and, in summary, include:
- Skills shortages
- An ageing workforce
- Low retention of staff
- Lack of career progression opportunities
- The initiation of the first independent review of Australian nursing preparation since 2002 – Educating the Nurse of the Future.
Skills shortages
A combination of factors continues to drive the evolution of the clinical practices required of Enrolled Nurses, and the environments in which they work have changed significantly, shaping the evolution of Enrolled Nurses skill and competence requirements. These include changes to the Diploma of Nursing qualification, differing team environments, advancements in patient care and treatment, changing societal demographics, such as an ageing population, and treating and caring for vulnerable populations and people with chronic and acute conditions and comorbidities.
Technological innovation and development are also factors, with nurses increasingly using digital health technologies in the delivery of safe, quality and person-centred care. The National Nursing and Midwifery Digital Health Capability Framework, by the Australian Digital Health Agency outlines the core skills, knowledge and behaviours required for professional practice to guide contemporary practice that can be used by nurses and midwives, organisations and educators to help support professional development and training.
According to the Enrolled Nurses IRC 2019 Skills Forecast, the Australian health care system must keep pace with the impact of societal demands. To ensure these demands are met and to keep pace with the rapidly changing landscape, the Enrolled Nurses workforce requires ongoing skill development, particularly through the Health Training Package. The Enrolled Nurses IRC 2019 Skills Forecast, for example, identified that gerontology is an important skills and knowledge area in which the Enrolled Nurse workforce should be better equipped.
The Royal Commission into Aged Quality Care and Safety also recommends the incorporation of gerontology care into the Enrolled Nurse Accreditation standards, which the Commonwealth Government supports in principle (see Royal Commission into Aged Care Quality and Safety: Submissions by the Commonwealth). However, it states the curriculum delivered must be in accordance with the Health Training Package and that the recommendation be considered as part of a review of Enrolled Nursing skills requirements.
In response to the Review of HLT54120 Diploma of Nursing and HLT64120 Advanced Diploma of Nursing, the National Enrolled Nursing Advisory Council (NENAC) suggests that to achieve the best outcomes for students and employing industry, the qualification needs to be reviewed holistically and not only at a unit of competency level. Further to this, consideration needs to be given to the interplay between, and alignment with, the Enrolled Nursing Standards for Practice and the Enrolled Nursing accreditation standards to ensure best outcomes for students and the profession.
The challenges of skills shortages (and overall workforce supply shortages) are further heightened in regional and remote communities. Geographical isolation and low populations are some of the factors which present challenges to health providers in these communities in terms of accessing Enrolled Nurses as well as other skilled health professionals. Further, Enrolled Nurses working in remote communities are often tasked to take on activities (for example, mental health care) that might not necessarily be within the scope of the role in other locations, in order to meet the health demands of patients; and overall in these environments they work with little supervision.
In the article Issues Impacting on Enrolled Nurse Education for Aboriginal and Torres Strait Islander Students: A Discussion, the authors highlight the concerning fact that the number of Aboriginal and Torres Strait Islander students graduating from Diploma of Nursing courses in the vocational education and training sector has failed to translate into registrations as Enrolled Nurses. The article also explores why the uptake of Aboriginal and Torres Strait Islander students into nursing has stalled and their attrition from tertiary nursing courses is considerably higher than for other students. The authors argue that more research that contributes robust evidence-based knowledge specifically on strategies addressing issues in Enrolled Nursing education for Aboriginal and Torres Strait Islander students and their employment uptake is required.
It is also critical that workforce strategies focus on attracting staff (and specifically graduates) to the profession and the wide range of settings Enrolled Nurses can work. An example of such is the Australian Apprenticeships Incentives Program which includes an initiative that aims to drive apprenticeships and traineeships to increase the national skills base by providing additional payments where Australian Apprentices are working towards a Priority Occupation, which include Enrolled Nurses.
Ageing workforce
The ageing workforce trend presents a new challenge in adopting workplace arrangements that will retain a substantial level of mature-age workers. Three quarters (76%) of Enrolled Nurses are aged 35 years of age or over. The average age of an Enrolled Nurse is 46 years which is significantly higher than the national job age average of 40 years. Job redesign, for example, is being considered as the sector seeks to retain mature-age workers.
Retention of staff
The Enrolled Nursing IRC 2019 Skills Forecast reports that nearly a third of nurses were considered leaving the profession. Some of the reasons why nurses do leave are poor levels of pay, working conditions, an increased workload, greater complexity of patient care, and poor recognition of the skills and knowledge required to be a nurse. In recent times several initiatives have been implemented in an attempt to address the sustainability of the health care workforce, particularly in nursing, and to improve recruitment and retention of both Registered and Enrolled Nurses. Such initiatives have included the Clinical Training Funding (CTF) program, the Rural Health Professionals program and the Expanded Scope of Practice program. The research An integrative review of Enrolled Nurse recruitment and retention, explores the factors impacting recruitment and retention of Enrolled Nurses.
Lack of career progression opportunities
The Enrolled Nursing Training Package Products provide individuals with a learning and employment pathway into Enrolled Nursing occupations and facilitate further learning progression opportunities via an Advanced Diploma and/or Higher Education qualification. In instances where career pathways are established, courses and training are clearly important, but the accessibility of these courses and training, together with varying state/territory requirements, can be an issue (for example, position descriptions and roles available). The development of a stronger support system for continual learning (for example, informal education, part-time courses and conferences) and career progression for Enrolled Nurses will improve job satisfaction and will positively contribute to the quality of patient care.