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Enrolled Nurses: a study for the UKCC
Seccombe I, Smith G, Buchan J, Ball J
For some time the UKCC has received anecdotal information from enrolled nurses who have experienced problems with respect to their professional practice as second level registered nurses, particularly by the narrow interpretation of Rule 18(2) by employers. More recently, the implementation of Project 2000 and the cessation of training for entry to second level Parts of the Register has raised concerns about the future role and employment prospects of the second level registered nurse, as well as highlighting the need for more opportunities to convert to first level registration.
This report presents the findings from national surveys of second level registrants and their health sector employers. These surveys were designed to explore the key issues around the role and employment of enrolled nurses, and their conversion to first level registration. It also presents relevant statistics from official sources.
Decline in entries
New entries to second level Parts of the Register declined markedly as training for second level registration was phased out from the mid-1980s. The number of individuals with effective second level registration reduced by a quarter between 1992/93 and 1995/96. Currently, 110,529 individuals hold second level registration. They represent just under one-fifth of all registered practitioners, compared to 23 per cent in 1992/93. The registrants survey shows that half of all respondents first ‘qualified’ as nurses between 1970 and 1979. This qualification profile closely matches the age distribution: three-fifths were aged between 35 and 49. Two-fifths of respondents have potential careers in nursing of 20 years or more.
The registrants’ survey also shows that participation in nursing is high. Eighty per cent of respondents were employed in nursing work and a further eight per cent were employed in non-nursing jobs. This suggests that the ‘pool’ of those available for nursing work is comparatively small.
More than half the enrolled nurses reported working part time. Two-thirds of enrolled nurses worked in the NHS. Of these one-fifth were deployed in elderly care. Nearly all were on clinical grades; 64 per cent were on grade D.
Most enrolled nurses worked some type of shift pattern. There was marked variation by employment sector. A slightly higher proportion of enrolled nurses in the private sector (31 per cent) worked permanent night shifts, compared with those in the NHS (28 per cent). Internal rotation, on the other hand, was more prevalent amongst those in the NHS (27 per cent) than the private sector (18 per cent).
Fewer enrolled nurses in NHS
Analysis of official statistics shows a decline in the number of enrolled nurses employed in the NHS, and that they represent one-fifth (n=42,788) of the registered nurse workforce. One likely reason for this decline is the movement of enrolled nurses from NHS to non-NHS employment (including nursing homes, agencies, hospices, etc.). The number of enrolled nurses employed in the non-NHS sector more than trebled between 1982 and 1992 and now accounts for 22 per cent of all enrolled nurses. Enrolled nurses in the non-NHS sector represent 24 per cent of the registered nurse workforce. The employers’ survey shows broadly similar results: a large majority of employers reported a decline in the number of enrolled nurses they employed over the past three years, and forecast further reductions in the near future.
Some employers reported that it was their policy not to accept applications from enrolled nurses for vacant D grade or equivalent posts. This was mainly reported to be because of conversion costs and perceived restrictions on practice. Meanwhile the majority of registrants appeared pessimistic about their future job security and employment prospects in nursing. Seven in ten agreed with the statement: ‘there is no future for enrolled nurses’, and three in five agreed that: ‘there are no jobs for enrolled nurses anymore’.
Deployment of enrolled nurses
Three-fifths of enrolled nurses reported that they were unable to perform some nursing activities because of their second level registration. This was substantiated by employers; two-thirds identified activities which second level registered nurses were not allowed to perform. Most employers said this stemmed from their own, or UKCC policy.
Seven in ten employers reported that they had heard of Rule 18(2). (Note that a similar proportion of enrolled nurses indicated that they had heard of Rule 18(2).) There was variation by sector with 79 per cent of NHS employers reporting that they had heard of it, compared with 51 per cent of non-NHS employers. Overall, one-third of employers indicated that Rule 18(2) influenced the deployment of enrolled nurses within their organisations. Again, a higher proportion of NHS employers (36 per cent) reported that it influenced deployment, compared with 17 per cent of non-NHS employers. Supervision of second level registered nurses by first level registered nurses was the most frequently cited influence.
Evidence from the registrants’ survey revealed that almost half agreed that they were under pressure to convert. Yet nearly half of the registrants indicated that they did not plan to convert to first level registration. The most common reason cited was that they were happy as an enrolled nurse. Second level registered nurses, therefore, are likely to remain a significant element of the nursing workforce for the foreseeable future.
Fifteen per cent of registrants reported that they were undertaking conversion courses at the time of the survey. Better job prospects and personal development were the main reasons given for converting. Frequently cited barriers to conversion were long waiting lists and funding difficulties. Three-quarters of these registrants reported that they received full funding from their employer. Enrolled nurses employed by the NHS were more likely to be in receipt of full funding (79 per cent) than those in the private sector (31 per cent).
The remaining registrants (37 per cent) were trying to get on a conversion course or planned to in the future. They showed similar reasons for wanting to convert as well as similar problems in gaining access. This large minority suggests a continued high demand for conversion course places and that up to 36,000 second level registrants plan to convert in the near future.
Enrolled Nurses: a study for the UKCC, Seccombe I, Smith G, Buchan J, Ball J. Report 344, Institute for Employment Studies, 1997.
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