Enrolled nurses’ scope of practice

Nurses are an integral part of a medical practice, and the practice may employ registered and or enrolled nurses.

Like any other healthcare practitioner, there are limits to the scope of practice for an enrolled nurse (EN) with mandatory supervision requirements. All practice staff need to understand the limits and requirements, so they know what everyone’s roles and responsibilities are.

Supervision requirements

To support the professional development of ENs and the quality of patient care, under the Nursing and Midwifery Board’s Enrolled nurse standards of practice, ENs must work under the direct or indirect supervision of a registered nurse (RN). They must always have a named and accessible RN to support and guide them – this could be over the telephone when indirect supervision is in place.

While doctors can provide direction in the management and overseeing of their patients care, they cannot be the nominated supervisor for the EN. The Registered nurse standards for practice state that RNs are responsible and accountable for supervision and delegating nursing activity.

Although supervised, the EN is responsible for their actions and accountable for providing delegated nursing care and bound by the code of conduct for nurses.

More information on supervised practice can be found on the Nursing and Midwifery Board website.

A detailed position description

To ensure the EN operates within their scope of practice safely and effectively, they should have a detailed position description outlining their specific roles. This description should consider several factors, including:

• capabilities and competence
• education and training
• any restrictions or notations on their Ahpra registration
• the supervising RN arrangement
• the doctor’s process for directing.

The EN must understand their position description and agree to comply.

It is imperative the EN has an appropriate induction, so they clearly understand what’s expected from them. The induction should include a competence assessment.  

Clinical governance

To maintain good clinical governance, achieve consistency for delegation and ensure understanding of the role, the practice should have appropriate processes in place, such as:

• annual review of ENs competency
• annual checks of EN’s registration status
• clear policies regarding the EN’s role in clinical tasks
• an induction for the team that outlines the role of the EN
• an induction for doctors so they understand what they can delegate to the EN
• regularly reviewing policies where the EN is delegated responsibilities
• ensuring all staff understand the role of the EN in the practice.

Key lessons                                                                  

• There are limits to the scope of practice for an enrolled nurse (EN) with mandatory supervision requirements.
• The EN must be supervised by a named and accessible registered nurse (RN). The (RN) must agree to supervise the EN and be appropriately qualified.
• An EN should have a detailed position description, appropriate to their education and experience.
• A practice should regularly review policies where the EN is involved in clinical care.
• Staff should be familiar with the EN’s role in clinical care.
• The induction processes for the team should outline the role, responsibilities and scope of the EN.