Difference Between a Registered Verses an Enrolled Nurse

This article is written in collaboration with our sister site www.nursescollective.org and the article can also be found here https://nursescollective.org/registered-nurse-verses-an-enrolled-nurse/

The article offers a comparison between Registered Nurses (RNs) and an Enrolled Nurse (ENs) in Australia, covering roles, responsibilities, career trajectories, and factors influencing scope expansion. It highlights the essential contributions of both RNs and ENs to patient care while exploring advanced EN classifications, career opportunities, supervision dynamics, and patient management.

Before diving into the specifics, explore 300+ articles on The Nurse Break and Register an account on Australia’s first-ever 100% free nursing community called Nurses Collective to network, ask forum questions, access free resources and join the dedicated group just for Enrolled Nurses in Australia.

While the title suggests a comparison, it’s important to emphasise that both Registered Nurses (RNs) and Enrolled Nurses (ENs) are essential, collaborative members of the healthcare team, each bringing valuable skills to patient care. Understanding their differences is crucial for anyone considering a nursing career.

In Australia, the introduction of an industrial classification for Enrolled Nurses (ENs) with advanced skills aims to enhance healthcare responsiveness. The EN with advanced skills builds upon traditional EN roles and addresses changing healthcare needs. Advanced EN classifications vary across Australian jurisdictions, with titles like Special Grade, Exemplary Practice, and Advanced Skills Enrolled Nurse (ASEN).

Education and Qualifications

Enrolled Nurse (EN):

• Education: Completion of a Diploma in Nursing accredited by a certified TAFE or vocational institution.
• Duration: Typically involves approximately 2 years of full-time study. However, Enrolled Nurse Accelerated Pathways exist which can be an 18-month course. Often you will need to be employed full-time and remain employed during the course.
• Pathway: While many ENs choose to advance their careers by transitioning to become RNs, others find fulfilment in their roles as ENs, contributing significantly to patient care.

Registered Nurse (RN):

• Education: Attainment of a Bachelor of Nursing degree, usually offered by universities.
• Duration: Involves about 3 years of full-time study as a starting point, equipping students with theoretical knowledge and clinical skills.
• Graduate Entry: For individuals with a degree in another field, there are accelerated 2-year Graduate Entry programs available. These programs facilitate a streamlined pathway for career changers or those seeking to enter nursing with prior academic qualifications.
• Pathway: These degrees are the prerequisites for further post-graduate certificates, diplomas, Masters degrees and PhD.

Roles and Responsibilities

Registered Nurses

RNs have a broader scope of practice and greater autonomy in clinical decision-making. Some oversimplistic examples of their roles include:

• Conducting comprehensive patient assessments
• Developing and implementing nursing care plans
• Administering medications and treatments
• Supervising ENs and other healthcare workers
• Providing patient and family education
• Specialising in areas like ICU, emergency, paediatrics, and more
• Engaging in research and quality improvement projects

Enrolled Nurses

ENs work under the supervision of RNs and provide essential care. Their responsibilities include:

• Assisting with patient assessments
• Delivering nursing care and treatments
• Administering medications (subject to scope of practice)
• Monitoring patient progress and reporting to RNs
• Supporting patients with daily activities
• Maintaining accurate patient records

But wait a second, what is an ASEN?

Well, in South Australia at least, “An Advanced Skills Enrolled Nurse is an Enrolled Nurse who is registered with the Nursing and Midwifery Board of Australia (NMBA). The ASEN supports the Registered Nurse/Midwife in the provision of person-centred care and retains responsibility for their actions whilst remaining accountable to the Registered Nurse/Midwife for all delegated functions. An ASEN has more
indirect supervision from a Registered Nurse/Midwife, is a specialist in their area of practice. Employees working at this level are proficient to expert Enrolled Nurses within their specialist field” (SA Health Source).

How do you become an ASEN?

The Advanced Skills Enrolled Nurse will either:

• Hold an Advanced Diploma of Enrolled Nursing and have three years full time equivalent experience in the relevant clinical area; or
• Have five years full time equivalent experience in the relevant clinical area and have demonstrated advanced skills and knowledge in patient/client assessment, care management and leadership responsibilities equivalent to those set out in the Advanced Diploma of Nursing competencies (SA Health Source).

Are ASENs a substitute for Registered Nurses/Midwife?

ASENs are not substitutes for the Registered Nurse/Midwife (RN/RM). The ASEN supports the RN/RM in the provision of person-centred care. Employees at this level work under the direction and supervision of the RN/RM. However at all times, the ASEN retains responsibility for their actions while remaining accountable to the RN/RM for all delegated functions (SA Health Source)

What else is the difference between a Registered Nurse verses an Enrolled Nurse?

We’ve tapped into the insights of seasoned RNs and ENs at www.nursescollective.org which you should join here, to compile a breakdown

Career Trajectories

Registered Nurses and Enrolled Nurses have a plethora of career pathways and diverse roles they can undertake, spanning all domains of healthcare from rural and remote to military to humanitarian and beyond. However, the opportunities are limited for Enrolled Nurses, and clinically advanced positions (nurse specialist, nurse practitioners) or leadership roles such as Associate Nurse Unit Manager (ANUM) and Nurse Unit Manager (NUM) are reserved for Registered Nurses.

Supervision and Autonomy

Enrolled Nurses operate under the guidance of Registered Nurses, albeit exhibiting a considerable degree of independence in their practice.

Patient Management and Care Plans

Registered Nurses assume a more central role in developing and implementing patient management and care plans. They are to have a holistic understanding of the intricacies of nursing, enabling them to oversee all facets of patient care.

Clinical Acumen and Critical Thinking

The extended duration of their academic training cultivates an aptitude for dissecting the ‘why’ behind medical interventions and forging connections between patient conditions and underlying pathophysiology.

The blurring of the scope of practice

In contemporary healthcare, the traditional boundaries of nursing roles are increasingly blurring, allowing Enrolled Nurses (ENs) to undertake tasks traditionally reserved for Registered Nurses (RNs). This evolution is driven by workplace initiatives, additional training, and educational opportunities that enable ENs to expand their skill sets.

Factors Influencing Scope Expansion

Variation Across Institutions and Jurisdictions

The extent to which ENs can broaden their scope of practice varies across healthcare institutions and jurisdictions within Australia. Both RNs and ENs may be granted the ability to perform certain duties beyond their standard competencies.

Influence of Workplace Policies

The scope expansion for nurses is often influenced by workplace policies and regulations, with some employers being more proactive in facilitating skill development for their nursing staff.

Tasks and Scope

Additional Tasks some ENs said they do based on their workplace (an example):

• Handling Schedule 8 and Schedule 4 keys
• Preparing medications for subcutaneous or intravenous infusions (e.g., syringe drivers, ketamine infusions)
• Overseeing blood product transfusions
• Managing patients with tracheostomies or laryngectomies
• Administering chemotherapy
• Operating in community health settings independently
• Caring for patients with percutaneous endoscopic gastrostomy (PEG) or percutaneous endoscopic jejunostomy (PEJ) tubes
• Catheterising both men and women
• Utilising peripherally inserted central catheters (PICCs) or central venous access devices (CVADs)
• Administering medications such as warfarin and insulin

Considerations and Implications

Educational Background and Knowledge Depth

The depth of knowledge among nurses may differ based on their educational background. TAFE courses may offer less comprehensive coverage of anatomy, physiology, and pharmacology compared to university programs.

Dynamic Nature of Nursing Practice

The examples provided underscore the dynamic nature of nursing practice, with the expansion of roles influenced by clinical environment and employer policies. Nurses need to stay updated on relevant training and guidelines to ensure safe and effective practice within their expanded scope.

Where Can Enrolled Nurses Work?

Enrolled Nurses (ENs) have a diverse range of employment opportunities across various healthcare settings. Some of the places where ENs have been employed include:

• Clinical Specialty Areas: ENs have worked in specialties such as Emergency Departments (ED), Intensive Care Units (ICU), High Dependency Units (HDU), Anaesthetics, Paediatrics, and more, both in public and private hospitals.
• Correctional Facilities: ENs may work in prisons, providing healthcare services to inmates.
• General Practitioner (GP) Clinics: ENs are employed in GP clinics to assist in patient care and clinical procedures.
• Mental Health Facilities: ENs work in both public and private mental health settings, supporting individuals with mental health conditions.
• Operating Theatres: ENs are involved in perioperative care, including pre-operative, intraoperative, and post-operative care, in settings such as Operating Rooms (OR) and Post-Anaesthesia Care Units (PACU).
• Defence Settings: While not as Nursing Officers, ENs may work in military healthcare facilities, providing nursing care to military personnel. Or as ADF Medics.
• Medical/Surgical Wards: ENs are integral members of medical and surgical teams in hospitals, assisting with patient care and treatment.
• Cardiac Care Units (CCU) and Specialised Cardiac Settings: ENs may work in cardiac specialty units, providing care to patients with cardiac conditions.
• Rural and Remote Areas: ENs play a vital role in providing healthcare services in rural and remote communities where access to healthcare may be limited.
• Community Settings: ENs work in community healthcare settings, including home care, aged care facilities, and community health centers, providing nursing care and support to individuals in their own homes or within the community.

It’s important to note that employment opportunities for ENs may vary depending on the hospital, state, and region. Additionally, due to the competitive nature of some EN roles, it’s advisable to seek resume and cover letter review services to ensure competitiveness in the job market.

Registered Nurses (RNs) typically enjoy several advantages in their careers:

1. Higher Compensation: RNs generally receive better pay compared to Enrolled Nurses (ENs) due to their advanced qualifications and expanded scope of practice.
2. Increased Responsibility: RNs assume greater clinical and leadership responsibilities, contributing to patient care and guiding healthcare teams towards optimal outcomes.
3. Enhanced Job Prospects: With their education and skill set, RNs often have more diverse and plentiful job opportunities across various healthcare settings.
4. Career Advancement: RNs have ample opportunities for career growth, both in managerial and clinical roles. They can progress to managerial positions such as Nurse Managers, Operations Coordinators, or even ascend to executive roles like CEO of a Health Service.
5. Leadership Roles: RNs can serve as clinical leaders, taking on roles such as Nurse Educators, University Lecturers, Researchers, Clinical Nurse Consultants, Critical Care Nurses, or Nurse Practitioners, among others.
6. Specialisation and Research: RNs have greater opportunities to specialise in specific areas of healthcare and pursue further education and research, contributing to advancements in the field.
7. Flexible Employment: RNs often have more flexibility in their work schedules, making it easier to balance work and personal life commitments.
8. International Opportunities: RNs with advanced qualifications and experience may find it easier to secure overseas job opportunities, expanding their career horizons beyond national borders.

Delve Deeper

1. Explore Academic Offerings: Reach out to universities and vocational providers (TAFEs) to explore their nursing courses and educational programs. Understanding the curriculum and learning outcomes can provide valuable insights into the educational journey.
2. Engage with Nursing Communities: Join online forums and groups such as www.nursescollective.org, Australia’s first 100% nursing community for students and nurses, to connect with like-minded individuals and access exclusive resources. Interacting with hundreds of Registered Nurses (RNs) and Enrolled Nurses (ENs) can offer diverse perspectives, experiences, and valuable advice about the nursing profession.
3. Participate in Live Q&A Sessions and Podcasts: Tune in to live question-and-answer sessions or listen to podcasts featuring Australian health professionals. These platforms provide opportunities to hear firsthand experiences, learn about current trends, and gain inspiration from a wide range of nursing professionals.
4. Read Nursing Literature: Explore articles and blogs authored by both ENs and RNs. Delving into their writings can provide insights into their respective roles, challenges, and accomplishments within the healthcare industry.
5. Seek Mentorship and Guidance: Connect with experienced nurses within your network or at www.nursescollective.org Establishing mentorship relationships can offer invaluable guidance, career advice, and practical tips for navigating the nursing profession effectively.

By actively engaging with educational institutions, online communities, professional resources, and mentorship opportunities, you can gain a comprehensive understanding of the nursing field and make informed decisions about your career path.

Should I become a Registered Nurse or an Enrolled nurse?

Deciding between becoming a Registered Nurse (RN) or an Enrolled Nurse (EN) is a deeply personal choice, but here are some questions to help guide your decision:

1. Academic and Financial Considerations: Are you prepared academically and financially to commit to a 3-year full-time Bachelor’s program or a 6-year part-time program? If you’re looking to enter the workforce sooner, pursuing a career as an Enrolled Nurse might be more feasible. Keep in mind that you can always pursue further education to become a Registered Nurse while working as an Enrolled Nurse.
2. Educational Approach: Do you prefer a vocational study approach (EN) or the academic rigor required for Registered Nursing? EN courses focus more on practical skills, while RN programs delve deeper into theoretical and clinical knowledge.
3. Career Aspirations: What specific area of nursing do you aspire to work in? If your goal is to work in specialised fields like paediatrics and have a broader scope of practice, becoming a Registered Nurse would likely be the better choice.
4. Salary and Career Progression: Consider the differences in salary and opportunities for career advancement between RNs and ENs. Registered Nurses typically earn higher salaries and have more potential for career growth and progression.
5. Job Availability: Both Registered Nurses and Enrolled Nurses are in demand, so job opportunities should be plentiful. However, it’s essential to research the job market in your area to gauge the demand for each role.

Additionally, seek advice and insights from experienced nurses to gain a better understanding of the profession and its demands. Joining our groups and forums at https://nursescollective.org/forums/ can provide valuable guidance and support from fellow nurses who have firsthand experience in both roles.