title: ENsCOPE: Scoping the Practice of Enrolled Nurses in an Australian Community Health Setting.
abstract: BACKGROUND
  A continuing shift of healthcare delivery from hospital to the community has increased the acuity and complexity of care provided in the home. Global financial crises and nursing shortages have prompted policies supporting two tiers of nursing and expansion of the licensed practical nurse, second level or enrolled nurse role and evoked debate surrounding roles traditionally undertaken by registered nurses. Community nursing offers unique challenges for enrolled nurses wanting to enact their full scope of practice.
  
  
  OBJECTIVE
  To compare and describe registered and enrolled nurse opinions of their current and potential enrolled nurse scope of practice in the community health setting.
  
  
  METHODS
  A cross-sectional survey of 136 nurses (115 registered and 21 enrolled nurses) was undertaken within a large community nursing team in Australia. Participants reported their opinions of enrolled nurse scope of practice based on 27 core community nursing skills.
  
  
  RESULTS
  Although substantial agreement was evident, there were statistically significant differences between registered nurse and enrolled nurse opinions in core skill areas; 'Patient Education' and 'Clinical Observation'. Registered nurses identified some specialized skills-catheter and gastrostomy care-that could be undertaken by enrolled nurses with further education.
  
  
  CONCLUSIONS
  We confirm that registered nurses do agree with extending the skills of enrolled nurses. Education approaches that build shared confidence in enrolled nurse advanced skills are recommended.
  
  
  CONCLUSIONS
  The future supply of nurses is at risk. There are limited resources and increasing demand for quality health care where people live and work. While there may be opportunities internationally to improve productivity through advanced nursing roles, these policies should prioritize efficiency by firstly promoting the full enactment of nursing skills in these settings.
authors.affiliation: Centre of Cardiovascular and Chronic Care, Faculty of Nursing Midwifery and Health, University of Technology Sydney, Sydney, NSW, Australia.|Caroline Chisholm Centre, Liverpool Hospital, Liverpool, NSW, Australia.|Primary & Community Health Nursing, SWSLHD, Liverpool, NSW, Australia.
authors.forename: P
authors.identifier: http://orcid.org/0000-0002-6444-1150
authors.initials: P
authors.lastname: Murray-Parahi
authors.affiliation: Primary & Community Health Nursing, SWSLHD, Liverpool, NSW, Australia.
authors.forename: V
authors.initials: V
authors.lastname: Edgar
authors.affiliation: The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.|South Western Sydney Clinical School UNSW, Sydney, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Descallar
authors.affiliation: The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.|Centre for Health Equity Training Research and Evaluation (CHETRE), UNSW Centre for Primary Health Care and Equity, A Unit of Population Health, South Western Sydney and Sydney Local Health Districts, NSW Health, Sydney, NSW, Australia.
authors.forename: E
authors.initials: E
authors.lastname: Comino
authors.affiliation: The Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.|Faculty of Health Sciences, Australian Catholic University, Sydney, NSW, Australia.|Centre for Applied Nursing Research, South Western Sydney Local Health District & University of Western Sydney, Liverpool, NSW, Australia (Affiliated with the Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia).
authors.forename: M
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003152:Community Health Nursing / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007587:Job Description; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D009740:Nursing Staff / Q000523:psychology*
keywords: Australia; Community Nursing; District Nursing; Enrolled Nurses; Registered Nurses; Scope of Practice; Skill Mix; Supervision; Workforce