Enrolled Nurse Supervision and Standards of Practice Changes

APNA often gets a number of enquiries around supervision (specifically for Enrolled Nurses) and standards of practice. Below is a brief update around Standards of Practice and supervision.
As you may know, the Nursing and Midwifery Board of Australia (NMBA) recently updated Registered and Enrolled Nurses standards of practice. To practice in Australia, you must meet the NMBA’s professional standards. The revised standards can be found here.
They focused strongly on supervision of Enrolled Nurses. Below is a summary of supervision requirements for Enrolled Nurses.

Supervision of Enrolled Nurses by a Registered Nurse is a requirement of the Enrolled Nurse Standards for Practice.

  • Supervision by a person other than a Registered Nurse is not consistent with the professional standards of the profession and may contravene requirements. Professional supervision relates to the quality and safety of care and is provided by a member of the same profession.
  • A general practitioner or other Doctor, may have management responsibilities, but a member of the nursing profession, namely a Registered Nurse, must undertake professional supervision of an Enrolled Nurse. It is the obligation of the employing general practice to ensure that appropriate supervisory arrangements are in place.
  • Supervision and delegation of work to an Enrolled Nurse can be direct or indirect, and will vary depending on the abilities, education, qualifications, scope of practice, experience of the Enrolled Nurse, and contextual factors such as the geographical setting and size of the practice. Click here to read more around context of practice.

What does supervision of enrolled nurses mean?

Supervision of enrolled nurses by registered nurses can be direct or indirect depending on: the competence of the enrolled nurse for the scope of nursing practice; the condition of the person receiving nursing care; and the context in which the care is given. At all times, the enrolled nurse remains accountable for their own actions and is responsible to the registered nurse for all delegated functions

Direct and Indirect Supervision

Direct Supervision is when the supervisor is actually present and personally observes, works with, guides and directs the person who is being supervised.

Indirect Supervision is when the supervisor works in the same facility or organisation as the supervised person, but does not constantly observe their activities. The supervisor must be available for reasonable access. What is reasonable will depend on the context, the needs of the person receiving care and the needs of the person who is being supervised.

The employer must ensure that supervisory arrangements are in place. Registered Nurses should be aware of their legal responsibility in regard to supervision of Enrolled Nurses.

Another arrangement for indirect supervision of an Enrolled Nurse may occur in a general practice that has multiple sites. The Registered Nurse provides indirect supervision for Enrolled Nurses employed in that practice. In this type of situation the Registered Nurse may move between clinics giving supervision to an Enrolled Nurse/s. This model is particularly applicable to practices located in rural or remote settings, or multiple sites where geographical distances make direct supervision impractical. Registered Nurses should be aware of their legal responsibility in regard to supervision of Enrolled Nurses.

Some of the nurse regulatory authorities have produced policy statements and guidelines for delegation to and supervision of enrolled nurses and these must be considered by employers of enrolled nurses. The Australian Nursing and Midwifery Council has guidelines on delegation and supervision.

There are also decision making frameworks to assist registered nurses and enrolled nurses make decisions about the way that nursing work is delegated to enrolled nurses. Click here to view these and read more.

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…