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Understanding your scope of practice as a new EN

Now that your education is almost complete and you’ve nearly fulfilled your registration requirements, you will likely be seeking to commence your nursing career shortly.

You have worked hard to get to this point, so it’s important you do not place your nursing registration at risk.

What is scope of practice?

Enrolled nurse scope of practice is determined by the:

  • extent of your educational preparation
  • NMBA Decision Making Framework for nursing practice
  • assessed level of your clinical competence as an enrolled nurse
  • degree of clinical judgement required to undertake nursing work as delegated by the supervising registered nurse
  • legislation in the state or territory in which the enrolled nurse practices, and
  • facility policies and procedures.

How do I know what is my scope of practice?

There are three core documents from the Nursing and Midwifery Board of Australia (NMBA) which you must read and familiarise yourself with:

  1. Enrolled nurse standards for practice
  2. Decision-making framework for nursing and midwifery (2020)
  3. Decision-making framework summary – nursing

The Enrolled nurse standards for practice are the core practice standards providing the framework for assessing EN practice.

The key features of the standards require an EN to:

  • work under the direct or indirect supervision of the Registered Nurse (RN)
  • keep responsibility for their actions, and
  • be accountable in providing delegated care.

These standards for practice must be read in conjunction with the NMBA Decision-making framework (DMF).

The DMF is a guide to assist you in assessing whether you can do a particular nursing activity and whether you can expand your scope of practice.

This is to ensure that your practice is safe, consistent, person-centred and evidence based.

If you answer “no” to any of the questions in the DMF summary document, then you cannot perform the activity and must refer to the RN in charge.

There is no set “list” of procedures or activities that an EN can or cannot undertake, this is determined by your educational preparation, assessed competence, organisational policy and procedure and in accordance with the NMBA Decision Making framework, Professional Standards and the delegation of the supervising registered nurse.

For more information, refer to the NMBA Enrolled nurse standards for practice factsheet.

Can all ENs administer medication?

If you do not have a notation on your AHPRA registration you can administer medications. This means that you have completed an NMBA approved EN medication administration course.

Can ENs administer intravenous (IV) medication?

Only ENs without a notation on their registration and who’ve completed intravenous (IV) medication administration education can administer IV medicines.

Enrolled nurses cannot administer medicines via intrathecal, intradermal, or epidermal.

Questions to ask yourself before you perform the activity

  • Has there been a comprehensive assessment by the RN to establish the patient/client’s care needs?
  • Is the activity in the best interest of the patient/client?
  • Will the activity comply with legislation in the state or territory in which I practice?
  • Do I have my organisation’s support to perform the activity?
  • Do I have the knowledge, skill and confidence to perform the activity?

What should I do if I don’t feel confident to perform the activity?

As a nurse, you have a responsibility to yourself and your patient to deliver safe care. You have a right to refuse to perform an activity if:

  • you are asked to do something you believe is outside your professional scope of practice
  • you have not been prepared/trained properly to complete the activity
  • the directions are unclear, unethical or against the law or employer policy.

You should inform the nurse in charge of your reasons for refusing to do the activity.

You can contact ANMF Member Assistance for advice and assistance about your nursing practice if required

ANMF wish you all the very best with your new career.