ENROLLED NURSE WORKING WITHOUT SUPERVISION

Section 24(3) of the Nurses Act 1999 allows enrolled nurses to apply to the Board to vary the requirement for registered nurse supervision.

Enrolment

24 (3) The Board may, on conditions determined by the Board, authorise an enrolled nurse to practise in a field or fields of nursing without the supervision of an appropriately qualified registered nurse (or without the supervision of a registered nurse at all).

The Nurses Act 1999 defines supervision as:

"supervision" includes oversight, direction, guidance or support (whether given directly or indirectly)

and the Board definitions of direct and indirect supervision are:

Direct Supervision

Direct supervision means that a registered nurse is present and works with the enrolled nurse observing and directing his or her activities. The proximity of this supervision is such that immediate intervention is possible if problems occur. The registered nurse is able to observe and monitor the execution of the enrolled nurse's activities and retains accountability.

Indirect Supervision

Indirect supervision means the registered nurse is not present and supervision is provided by other than direct observation, of an enrolled nurse by a registered nurse. The absence of proximity of the registered nurse requires processes being in place for the direction, guidance, support and monitoring of the enrolled nurse activities. The registered nurse retains accountability.

When determining an authorisation the Board considers:

  • issues associated with public access to nursing care; and
  • the public interest in ensuring that appropriate standards of nursing care are maintained; and
  • the qualifications, experience and competency of the applicant.

    Issues associated with this provision
  • Authorisation is not meant to be used to replace registered nurses with enrolled nurses, that is, it does not enable an expanded scope of practice for the enrolled nurse;
  • Authorisation is not dependent or based on the availability of a registered nurse to provide direct or indirect supervision for an enrolled nurse;
  • Authorisation is context specific and therefore limited to the specific area of practice of the applicant;
  • Authorisation to practise without the supervision of a registered nurse means that the enrolled nurse is accountable and responsible for all nursing activities assigned within her/his scope of practice;
  • In supporting and recommending the enrolled nurse to work without the supervision of a registered nurse the employer retains accountability for the recommendation (delegation) and should provide a process of ongoing monitoring, review and continuing education.

The Application Process

The application process requires both the nurse and the employer to provide documentation to support the submission. Each of these components must be completed and submitted together with the supporting documentary evidence for the submission to be considered.

The enrolled nurse is required to provide the following:

  • completion of an application form;
  • documentary evidence which addresses the Standards and Criteria within this document;
  • the administration fee;
  • documentary evidence from the employer.

The employer is required to provide the following:

  • specific guidelines for the role which indicates how these will reflect the future practice of the applicant, that is, that authorisation will not expand the scope of practice;
  • additional evidence to demonstrate that the enrolled nurse will be able to work without the supervision of a registered nurse;
  • a statement which indicates the employer will support the enrolled nurse to maintain competence through ongoing education and other professional development.

Once the documentation and fee are received the application will be assessed by an Expert Advisory Panel who determine applications for authorisation using Standards endorsed by the Board. If the application is successful the Board will authorise enrolment in the area approved until the expiry of the current certificate of enrolment.