Supervision – Enrolled Nurses

What has your experience been?

Supervision is an element of the code of practice of the profession. The prevailing principle is that you have a duty to supervise – this is a broad obligation to the training nurse as well as to the community.

The GP can observe but not supervise an EN. This is according to the regulatory requirements of the EN’s training. Nursing and general practice are two different professions which adhere to separate regulations.

The EN must be supervised directly or indirectly by an RN. Indirect supervision is when the RN is easily contactable but does not directly observe the activities of the EN. The RN may be offsite but must be available for regular, direct communication with the EN. The absence of proximity requires robust processes to be in place for the direction, guidance, support and monitoring of the EN’s activities. While an EN is responsible for their actions, the RN is accountable.

As such, you may be the supervising RN even if you are not on the premises. Or you may have a nurse in another practice working at the same time as the EN in your practice, however, this supervising nurse would need an understanding of the capabilities of the EN they are supervising.

When the EN is carrying out tasks under supervision of a nurse, the task must come under the scope of practice of the supervisor to ensure those tasks are carried out safely. If you are not able to perform a certain task, how can you supervise the EN to perform that task? Do you have competencies in the field to intervene if the EN is about to cause harm? As an RN you are required to determine the EN’s scope of practice.

If you are uncomfortable that the EN is working without supervision of an RN you should make this clear to your employer. It is also useful to have a written record of the arrangement.

APNA recommends that EN’s work under direct RN supervision, but acknowledges in some circumstances this may be the only option. The practice must ensure that patient safety is not compromised and the medico-legal risk of the practice is not increased.

  • What are your thoughts about this information?
  • Have you felt pressure, or have you been put in a situation that you have not felt comfortable about?
  •  Do you have any advice for nurses on how to facilitate EN supervision requirements?

What you had to say…