Dr. Rebecca Leon is now the Director of People and Culture at one of NSW's largest health districts. Her career of over 30 years has taken her through clinical, educational and managerial roles.
In this episode she explains why she embarked on a PhD to better understand the organisational, team and individual factors that determine the satisfaction and occupational stress of the enrolled nurse.
She explains why how the role of nurses generally are designed globally and the lessons we can learn from other countries.
Importantly, she discovered three critical factors that must co-exist to enhance the enrolled nurse's satisfaction and reduce their occupational stress.
Like so many nurses, Rebecca is caring and compassionate and shares an anonymous, hand written letter she received from an enrolled nurse of over 30 years that prompted her valuable research.
She provides a range of practical suggestions for any healthcare service to enable the to optimise nursing roles to support delivery of safe and quality care.
The Reimagined Workforce podcast is brought to you by Workforce Transformations Australia Pty. Ltd.
All opinions expressed are the speaker's and not the organisations they represent.
If you have a story about a workforce transformation to share and would like to be a guest on this podcast, please contact us at kathhume@workforcetransformations.com.au.
Connect with Kath Hume on LinkedIn
Dr. Rebecca Leon is now the Director of People and Culture at one of NSW's largest health districts. Her career of over 30 years has taken her through clinical, educational and managerial roles.
In this episode she explains why she embarked on a PhD to better understand the organisational, team and individual factors that determine the satisfaction and occupational stress of the enrolled nurse.
She explains why how the role of nurses generally are designed globally and the lessons we can learn from other countries.
Importantly, she discovered three critical factors that must co-exist to enhance the enrolled nurse's satisfaction and reduce their occupational stress.
Like so many nurses, Rebecca is caring and compassionate and shares an anonymous, hand written letter she received from an enrolled nurse of over 30 years that prompted her valuable research.
She provides a range of practical suggestions for any healthcare service to enable the to optimise nursing roles to support delivery of safe and quality care.
The Reimagined Workforce podcast is brought to you by Workforce Transformations Australia Pty. Ltd.
All opinions expressed are the speaker's and not the organisations they represent.
If you have a story about a workforce transformation to share and would like to be a guest on this podcast, please contact us at kathhume@workforcetransformations.com.au.
Connect with Kath Hume on LinkedIn
I used the theoretical framework of organisational behaviour so that I could look at role clarification, job satisfaction, that occupational stress, level of motivation, all of those things that we need to feel fulfilled in the role that we do.
Voice over:This is the Reimagined Workforce Podcast from Workforce Transformations Australia the podcast for people and culture professionals seeking to drive meaningful, impactful and financially sustainable workforce transformation through curiosity, creativity and data science. In this podcast, we hear from talented and innovative people making a positive difference for their people, their organisations and those their organisations serve. They share stories and learnings to help others on their path to transforming their workforce today and tomorrow. Now here's your host, kath Hume.
Kath Hume:Dr Rebecca Leon is the Director of People and Culture for one of New South Wales Health's largest local health districts, but Rebecca is here today to talk to us about her research into the role of the enrolled nurse and the factors that must co-exist to enhance job satisfaction and decrease occupational stress for the whole nursing team. I was very fortunate to work with Rebecca several years ago on a project to develop workforce planning capabilities for people with workforce planning responsibilities. Rebecca was one of several leaders in this space who provided valuable insights and contributed significant support for the benefit of the system. Dr Rebecca Leon, welcome to the Reimagined Workforce Podcast.
Dr. Rebecca Leon:Thank you, and thank you so much for the invitation to participate.
Kath Hume:Thank you for agreeing to be here. I'm loving that we're doing this. Would you mind starting by telling us a little bit about your career to date?
Dr. Rebecca Leon:Absolutely! S o. I'm a registered nurse and I worked for approximately 25 years in the emergency department. Right in the coal face of things. During th at time I had opportunities to work in education, moved into management and it was through actually the emergency department workforce assessment tool, which was a Ministry of Health initiative into looking at workforce in the emergency department back in about 2010 that really sparked my interest on research in workforce, because in health we do research in so many things but actually how much do we look at the roles within workforce and look at the effectiveness on those? So that really has led me to so a combination of clinical background but also education, management, workforce planning, which has led me to where I am today.
Kath Hume:It's interesting that you should say that because Dr Cath Cosgrave, who I had a few weeks ago. She talked about the rural workforce challenges and she said when she was offered her PhD, her supervisor said this will make your career. It's such an important factor that no one is really looking into at the time, so that was a while ago. But yeah, it's definitely something that's well and truly on our radar now, that's for sure. Certainly is, and I know that you've done a lot of thinking about the future. What does your reimagined workforce look like?
Dr. Rebecca Leon:I think we need to move away from roles. So whenever I put my workforce planning hat on, I think about we need to focus on the skills and the attributes of what is needed. We're at health. Patient is at the centre. So in order to provide that safe, quality care consistently, doesn't matter where the patient is, what are the skills and attributes that we need, not what are the roles that we need, and in health we work in teams. So I really think it's about what are those skills and attributes in a team and how can we do that together.
Dr. Rebecca Leon:I think we feel constrained because we have roles and I think what contributes to that is mindset, and this is what we've always done. These are very medical workforce and nursing workforce, the allied health workforce, and then we have the corporate and support services and how they support and this is how it's done and there are areas that do it really well. But I think that working as a team and one of the skills and attributes that the team needs, therefore, will inform what roles need. A big factor that also, I think, influences it in a not so good way is especially in public health. We have industrial awards and we are constrained by those, which doesn't help in being able to sort of create a contemporary workforce.
Kath Hume:I think that mindset that you mentioned is so critical here and I think we can often see those industrial awards as constraints, but there's also opportunities within those areas that we can move around, so really understanding what the capacity is within those constraints and being prepared to work with other areas and really being those T shaped humans so to bring the skills that we have.
Kath Hume:But how do we actually work in these teams? And it's so important in health because everyone has their own specialisations and they're so capable and they've done so much study and have so much experience that's got them to where they are, but they really need to work across and bring those skills to light in that team environment. So it's really, really critical. It probably leads on to the question around what prompted you to start your research.
Dr. Rebecca Leon:Research? Yes, what started me? So when I was working as a manager of education and workforce development, we trained enrolled nurses so we actually ran the Diploma of Nursing Program. So the enrolled nurse is the second level regulated nurse in Australia and when I examined the first 12 months I was in the role, I examined the recruitment and retention from the last five years of running that program and it was not good. So I conducted a mixed method study to improve understanding on whether it was the investment of the education training.
Dr. Rebecca Leon:What is it that we were doing from an education perspective that informed or not the recruitment and the retention of the enrolled nurses that we were training? We were putting that investment into them but we weren't keeping them. So what the results indicated was that it was actually not the investment into education and training, but the work environment. And the work environment resulted in enrolled nurses not feeling valued. They felt underutilised. There was confusion with their scope of practice. There was a lack of standardised practice across the health service. So this research was only done in one health service and it also identified that there was limited professional development pathways for the enrolled nurse. So we did make some changes. We improved the recruitment process for our graduating ENs and we implemented a support program for them. But what I wanted to do was really understand what it was about this work environment, and I think what the catalyst was I received an anonymous. It was signed anonymous, but it was a handwritten letter that was posted. It wasn't put through internal mail and it was posted to me and it said I recently heard there was a questionnaire valuing enrolled nurses, because that's what I entitled it.
Dr. Rebecca Leon:It's nice that this has happened, but I am sure a lot of us would be worried about the boomerang effect it would have on us. Registered nurses, AINs, etc. Doctors believe we are the robots of the health system. Not many respect us or acknowledge us for our hard work. I've been in the health service for over 30 years. I've not seen a big change. I work harder than RNs. We pay the same registration fees. We miss out on in-services recognition and a lot of respect. There is never any opportunities given to us and we are overlooked by management. It will never change. And I thought, wow, this is somebody who has contributed 30 years of their working life to the health service and it was not dissimilar to what I was getting out. So I wanted to know then was this because, like I said, this was only done in one health service. So was this us, was this what was happening and what is the work environment? So I jumped in.
Kath Hume:That's a pretty emotional letter to receive and I can imagine the emotions that you would have felt when you received that, especially in the role that you were in, so that prompted you to start your research. I understand, yes, and can you just give us a bit of
Dr. Rebecca Leon:Yes, so the preliminary study I did was in 2016. So this was the letter arrived about then. So I formally enrolled in the June, 2017. It was a multi-phase exploratory mixed methods design because I wanted to gain a better understanding of the enrolled nurse in Australia. So, 2017 enrolled, really spent the rest of that year looking at the literature, looking what happens internationally to understand t hat. Started data collection in 2018 as a mixed methods I was doing it with. I did focus groups initially and then I used the focus groups to inform and design the questionnaire and then the questionnaire went out in 2019. The focus groups 2018, questionnaire 2019, covid 2020. So 2020 and 2021 were all a little bit of a blur and the analysis didn't happen. I'm so grateful that I got the data collected, but it was collected just before it all, like it was finalised just before it all hit. So, yes, the analysis and writing that up was a little bit delayed because in health we were a little bit busy doing other things?
Kath Hume:Yes, yes, I do recall. And what did you find from the research?
Dr. Rebecca Leon:So where we were starting from. So from a literature perspective, and what was happening was that there is the similar roles in many other countries, that second level regulated nursing role in Canada, USA, New Zealand, Singapore and very many. The role existed in the UK but under Project 2000 they phased the role out. They phased the role out because they felt that there was confusion with the registered nursing role, but once they phased it out they realised that they actually needed a second level role. So I think that's something that we have to really really mindful and learn from others. New Zealand debated about it for 10 years and then decided that they would keep the role out and look at how, or explore better how, the enrolled nurse and the registered nurse can work together.
Dr. Rebecca Leon:In Australia over the last 10 years there's been 154% increase in the dual Enrolled Nurse/R egistered Nurse registration. So there are enrolled nurses who have gone on to become a registered nurse but maintain their enrolled nurse registration. And that's in comparison to sort of 21% enrolled nurse and 45% registered nurses. So we're losing our enrolled nurses into becoming dual, into becoming registered nurses, and what the literature showed us was that there's a lack of understanding of the role, and this is internationally, not just in Australia, that there's role confusion, especially with the registered nurse role. Lack of standardised practice, limited career development for the EN as an EN, which actually translated to there's an expectation that the EN wants to become an RN and that the EN role is not a role and it's own right but actually a stepping stone of which enrolled nurses don't. The majority of them actually don't want to become registered nurses, which is quite contrary to the myth or the expectation and that this, I suppose this environment has existed for years.
Dr. Rebecca Leon:When I went back and actually broke the literature up into decades, the role started in the 1940s as a result of the need for more hands-on nursing, bedside nursing care around World War II period, and that's how the role commenced in Australia and Canada or in the UK, and how the role then, I suppose, has not matured, but lack of matured over the last 60 odd years is the same. W hich is what was reflected by my anonymous writer that I haven't seen. I've been here for 30 years and I haven't changed. But that's actually what the literature showed too is that there continues to be confusion, continues to be lack of understanding. That's where we're at.
Kath Hume:I think all that research that we have now around how important role clarity is just for your wellbeing and happiness at work, it's really important too, when you are working in teams, like we were talking about before, that we have that delineation so we know who's responsible for what. It's interesting that it's actually happening globally that no one's really cracked it yet. Is that what I'm understanding?
Dr. Rebecca Leon:Yes, nobody does. So that which is why I said lessons learned. The UK went down this, you know, obviously with any decision there's always fiscal influences, but there was this persistent role confusion. So that's what they did, but then they realised that they needed a role. But going on to your comment about that, the need for role clarity I use the theoretical framework of organisational behaviour, which is so that I could look at role clarification, job satisfaction, that occupational stress, level of motivation, all of those things that we need to feel fulfilled in the role that we do A
Kath Hume:I did.
Dr. Rebecca Leon:I did find three and I'll go into those three. But what I also found was the intrinsic and extrinsic motivators for the enrolled nurse are really strong. So the phrase being a nurse came through at every focus group, came through at why do you do what you do? Because I want to be a nurse, I want to be at the bedside, I want to make a difference. There was one quote that I wanted to share with you which essentially epitomised those ENs who want to be I walk out of here my heads up because I've done something for 20 people today. So it is that feeling and that is why they are enrolled nurses, because they feel that they are at the bedside being able to do that. So that influence of the intrinsic motivators, of why they're doing what they're doing, and then the extrinsic motivators, which is how they are then obviously valued in the workplace, or they feel they're valued in the workplace. And that's where your three determinants come in place.
Dr. Rebecca Leon:So the first one is that the enrolled nurse knows and understands their role and their scope of practice. Because what I found was that there are some nurses that don't understand their role and their scope of practice. We have enrolled nurses administering schedule 8 medications which is outside of their scope. There was one question that specifically asked about their role. Their workload and it said brackets, excluding schedule 8 medications, and the responses in the ability to add comments was well, I administer it, well, they do in my ward. And I was like, oh, ok, and that wasn't located to rural or that was public, private, yeah, metro rural. So I thought that that was interesting. So, yes, they don't understand. So the enrolled nurse doesn't understand, not all of them. T hey don't understand. Then it's the registered nurse. The registered nurse needs to understand the role of the enrolled nurse but also their role as the registered nurse in how to work with the enrolled nurse.
Dr. Rebecca Leon:It is in the enrolled nurses standards of practice. They are to work either directly or indirectly supervised by a registered nurse. So the role was not designed and it is still not designed to work as an autonomous role. And when you identify what standards of what that means direct or indirect. So direct is fairly obvious, but indirect so they can be, but they need to have a named registered nurse on site as their role for supervision. So there are many registered nurses who do not understand their role in supervising an enrolled nurse. So not just not understanding the enrolled nurse role, but their role, they don't understand their role. And then the third one was the organization's understanding and recognition of the role. So the understanding of the role, how they are being rostered. So enrolled nurses are being rostered to work equivalently like a registered nurse. So we are not recognizing that they actually need to work as a team.
Kath Hume:With the rostering and the relationship building. I'd imagine that that's really important. Is it is what you're saying, or did you find that it would be beneficial for an EN and RN to be almost put into some sort of mentoring arrangement, so as they're rostered on together? Does that happen? Or is it? Should it be that the EN should be able to work with anyone, and that varies all the time.
Dr. Rebecca Leon:Yeah, so under the standards of practice, they need to be either, like I said, directly or indirectly supervised by a registered nurse and specifically says registered nurse and the equivalent in the registered nurse is that they supervise enrolled nurses. What that looks like in the team environment. So I explored the concept of team. I asked the team question in different ways. I asked it about open ended. I did an open ended what does team mean to you? Yeah, and then I did a closed ended, you know, with a number of options and please indicate what team means to you. And both ways we ended up with an essentially A split on teamwork, as in teamwork, as in Working together. So we have a group of patients, we have a conversation at the beginning of the shift. I'm going to do this, you're going to do that. How are we going to work together? Who's going to do the medications? Who's going to write which notes?
Dr. Rebecca Leon:Because enrolled nurses can administer, you know, a limited medications, except for those that do the schedule 8 medications. That said that they did. But so they. But they have a conversation. They have a conversation at the beginning of the shift on their work allocation. But the other half, that's your lot and that's my lot and there's no conversation. So even if it's they're allocated eight patients between them, it's their yours and their mine. No overlap, there's no conversation. So those that describe teams working well use very good team that works very cohesively. Everyone works well together. Everyone works to share the load. That was a language that was used for those people that work together as a team. And then the opposite is you have some nurses say this is your lot and I'm not helping you with anything. They're your responsibility. That's an RN who doesn't understand their role as an RN in how they work with an enrolled nurse. You know comments like very loose term, that supervision. They only see them, the EN at handover. So that's what we have to change.
Kath Hume:And were you able to identify ways that you could change that. Where it was working well, we were able to see why it was. Were there organizational factors? Was it part of the education? Was it documentation within the workplace? What things did you start to see?
Dr. Rebecca Leon:So in the areas that the team worked as a team and worked well as a team, they understood each other's role, but the organization also understood the role. So when I said about rostering or skill mix or skill set, the way the rosters were set up, the way that that was all, was that they could work in that environment. Everybody acknowledged that you have short shifts. When I say short shifts, I don't mean length of time, I mean short on staffing shifts. Yeah, yeah so, but the intent was always that this was a skill mix and so when that skill mix existed and everybody understood their role, the I was going to say the old. When I say the older, it's not older is in age, but more experience. What was interesting is that age does not correlate with experience. I find that there was a lot of nursing workforce that are 35 plus with less than 10 years experience.
Dr. Rebecca Leon:So we have got people going into the workforce older as opposed to both, both but there was a definite increase in the enrolled nurse workforce in that you had again it was almost a split. You had those that were going straight from you know, essentially straight from school or that you know, that sort of late teens, early twenties, but you had a group that were over 35 who were coming into the workforce and with less than 10 years experience. So the more experienced registered nurse seemed to have a greater grasp of the enrolled nurse role than the less experienced. When I spoke to the registered nurses who were one, two, three years out of university, especially the first and second year out of university, they all shared that they they didn't really understand what their role was with enrolled nurses and didn't really understand what the enrolled nurses really needed to do. So do we need to look at clinical? You know they come out in clinical placements and what is their role with enrolled nurses in clinical placement? You know, how can we teach registered nurses how to work with enrolled nurses?
Kath Hume:Because my understanding is the student placement is they're already being supervised. So when you're a student RN, you're not actually delegating anything or working with an EN in the model that you would actually be expected to work in when you graduate.
Dr. Rebecca Leon:No, and in in many places, the student registered nurse may be being buddied up with an enrolled and experienced enrolled nurse, and so there is that total lack of understanding on what is the role of the enrolled nurse and what is my role as a registered nurse, and how do we work together. The enrolled nurses that are very experienced. They are the ones feeling least valued.
Kath Hume:Right.
Dr. Rebecca Leon:Because they cannot work to their their full scope. They are the ones that feel that they're being so when, when we looked at the significant differences and explored what that looks further. Because the significant differences were between the understanding of allocation of work, between working as a team, level of supervision. So the registered nurse is going, yeah, we do it. And the enrolled nurse is saying we don't, we don't get supervised. But that it was the most disgruntled, are the most experienced enrolled nurses.
Kath Hume:And they're the ones that you mentioned feel that there's this expectation that they're aspirational to become an RN, when they just want to be recognised as professionals in their own right for the expertise that they have. Yes, yes, it's really interesting insight. I think, and I can imagine, that happens across a lot of professions that have these assistant roles. And do you think it is also has anything to do with gender that we've got a female dominated workforce and maybe they're there because they're wanting to and I don't want to stereotype, but are they doing that for other reasons?
Dr. Rebecca Leon:I think gender represents the older aged, you know, the mature age enrolled nurse commencing. I think that is a representative of females because when I asked them what made you become an enrolled nurse, it was, well, my children were all at school and I wanted to do something meaningful and I've always looked after people. So they weren't coming in at the age of 19 and 20. They were coming in at the age of 35, 40, even starting their nursing career. So the study sample represented the national, in that we had 90% female and 10% male, and so I don't know that it is so much. g ender didn't come through as significant. What came through was years of experience and level of education. So those enrolled nurses who had greater experience and had gone on and done an advanced diploma because they want to be the best they can be as an enrolled nurse, so they've done all that they could do, they've done an advanced diploma, they've gone and done everything that they can do, but there is no career pathway for them and they are the ones that were speaking up against. No, the most significant difference between them and the registered nurse in regard to supervision, allocation of work, how they work together, and it was that cohort that understand their role? It was those with less than 10 years experience who didn't understand their role. So you've got those with less than 10 years experience as a registered nurse that don't understand the enrolled nurse and you've got the enrolled nurses with less than 10 years experience that don't understand their role. It's that group that have the most lack of understanding and they're the ones that are then I don't feel valued. They do that. I don't do this. Why can't I do that? Well, you can't do that.
Dr. Rebecca Leon:No, well there was one story from an enrolled nurse who said that she feels they don't trust us. They don't trust us and I expect why don't you feel trusted? Well, we're not allowed to carry the drug keys. So the drug keys are the schedule. Yes, we're not allowed to carry the drug keys, but the casual can carry the drug keys. So a casual who's never set foot in this hospital and I've worked in this hospital for the last 10 years and I can't carry the drug keys. No, you can't carry the drug keys because that's a breach of legislation. This is, you know, the Poisons Act. This is legislation. This is not. So it's that lack of understanding.
Kath Hume:It is not a personal judgment call.
Dr. Rebecca Leon:I t's not a personal judgment call and we almost have that split. Like I said, it's a split in how they work as a team. That's not against you as an individual, but it's that cohort of enrolled nurses that rely more heavily on their extrinsic motivators. They are the ones that need the patient allocation, not the team. They are the ones that need to carry the keys, although they're not allowed to actually feel that they are valued.
Kath Hume:It's really interesting. I'm interested too around. You mentioned I think it was 154, leaving the profession no they're not leaving the profession, they're becoming a registered nurse. Sorry.
Dr. Rebecca Leon:Yeah, so in a 10 year window 2010 to 2011, that financial year, to 10 years later, that 2020/ 2021, that final that 10 year window there's been 154% increase in enrolled nurses becoming registered. So they are carrying a dual registration.
Kath Hume:Right.
Dr. Rebecca Leon:So they're not saying because everybody's. You know I speak to locally. I speak to my director of nursing. She says I can't retain enrolled nurses. I know why you can't retain enrolled nurses, but that's why. But there is an expectation. That is the myth. Well, you're a really good EN, you should go and do your EN, you should go and do that.
Dr. Rebecca Leon:I don't want to do that. They say, why can't I? I am happy. I am happy being an enrolled nurse. And that came up, that phrase. I am happy being an enrolled nurse. Why can't I be a good enrolled nurse? Everybody keeps saying I should go. I don't want to.
Kath Hume:So what are the implications then on our health systems If we are not able to retain this level of role or expertise? What are the risks then to patient safety and quality of care and the things that we are aiming to achieve in healthcare?
Dr. Rebecca Leon:We are risking people working outside the scope. So let's split the two in that you know 50% that work really well as a team are getting on, they are satisfied in the work that they do. There is minimal occupational stress. That will improve patient care. They get on, they do. That's really good. But you've got 50% that you've got patient allocation.
Dr. Rebecca Leon:So an enrolled nurse isn't going to know what they don't know. So if something is happening or there is a deterioration and they are not got a good working relationship with a registered nurse or the registered nurse doesn't want to have a good relationship because they don't. o resent was used by registered nurses. I resent having to be responsible for somebody else's work and that's again a lack of understanding, because it is very clear in the standards of practice that everybody is responsible for their own work. You are not responsible for an enrolled nurse, but that is a misperception. So that occupational stress that is then created in that working environment. And I obviously I didn't study the impacts directly on the patient, but you can, you know, I think you can quite.
Kath Hume:There's lots of research about
Dr. Rebecca Leon:S atisfaction, how teams work, how they work together, and the benefit of a good working team on the benefit of improved so. So, yes, but they are the ones that there is. That is the challenge. Or another, I've got an enrolled nurse who is got their own patient allocation. There is the risk of them working out of scope as well, doing things that they are not trying to do. There's a whole lot of risks in that area if you don't have people who are working as they should.
Kath Hume:Yeah, and if you go back to that, intrinsically motivated, they want to do the best for the patients that they're caring for. So that's directly threatening what they're motivated to do. Yes, and I think that that word resent is a really strong word too. So if you're working in a workplace where the person who's supposed to be supporting you actually resents you being there, that you would sense that, even if it wasn't over, your sense of belonging would deteriorate. And, yeah, I can just see how it's critical that this problem is solved to improve the culture and to ensure the quality and safety care continues. What would you recommend? Have you got some top tips for us that the systems cross the world?
Dr. Rebecca Leon:who are grappling with it. I think so. Like I said, I did it based on the organizational behavior frame. So we've got the individual, you've got the team and then you've got the organization. So at an individual level there is actually the title of the role. There was, I think, 70 something percent who said the title of an enrolled nurse and a number of comments were well, what does enrolled even mean? I'm not enrolled in a course.
Dr. Rebecca Leon:Overseas they use licensed practical nurse. Canada and the US they use the term licensed or registered practical nurse. Registered practical nurse came through as an alternative because I am registered, not licensed. In Australia we register, so registered nurse or registered practical nurse as an enrolled nurse. So even a change in title. And then how do we then represent and value the individual enrolled nurse who has gone on and done further education? So I've done a diploma of nurse. Within the registered nurse you can become a clinical nurse specialist, which means that I have done some qualifications and some experience and I can say that I can work in this specialty area and I am seen as a resource person in that area. I can do that as an enrolled. I can do a diploma of nursing with a focus in aged care and mental health, but I'm still called an enrolled nurse, so there is no way of recognizing from their title.
Dr. Rebecca Leon:So title for an individual is really important and that was something that both the enrolled nurse cohort and the registered nurses both of them said that the title is not right. So title, I think, is something that we need to look at as a governing body of nursing in the state. We need to look at title At the team level. I think this is where we need to look at what is the education is not the panacea, but what is the education? How do we do clinical placements? How does the student registered nurse learn about the enrolled nurse and their role in supervising? Where does that happen? How does that happen? How does that happen? How does that learning about our roles?
Dr. Rebecca Leon:Because the other thing that we have, which I didn't look into but it was commented on within Australia we have the assistant in nursing, which is not a regulated role, and there are two pathways to working as an assistant in nursing. You've got the undergraduate nursing student who works as an assistant in nursing while they're studying, or you have a certificate through in healthcare assistance, which predominantly work in nursing homes, but you have them in hospital. You have those qualified workforce in hospitals, so we actually have a third nursing workforce. We don't know what to do with two, but we've got a third and I think that holistically, we actually need to look at the nursing workforce and what are the roles that we need in the practice of nursing. There has been discussions should the assistant in nursing be registered, be regulated? Be well, we have got two that we don't know how to work together. So I really think if we're going to be serious about this and I know that there's a national nursing workforce strategy review which is happening by the Australian Chief Nurse, so I've put myself down for a consultation we need to look at all of that, like what is nursing, what is nursing now?
Dr. Rebecca Leon:There is clearly a need for two roles. I think the UK clearly showed us that. You know they tried to get rid of one and just have one and that didn't work. I believe that there is the two. I think having this third is and what is going to happen with this assistant in nursing. That's going to be problematic, the challenges with so in we have attempted to standardise the enrolled nurse.
Dr. Rebecca Leon:In Australia we standardised the title because it was called Registered Nurse, division Two in Victoria for a period of time, which created confusion when medication came in. We then had an endorsed enrolled nurse and an enrolled nurse. So the fact that we've taken the endorsed off because everybody now does medication training, that has created a you know, you've removed the only thing that recognises me as some I've done additional training in education and you've taken it away. So that was something that was commented on. You've got education. We now have a standardised diploma there. So the national education. We have a diploma of nursing now, so it's the same standard to become a enrolled nurse. So we have standardised education nationally. We have standardised registration, so when the registration 2010, when the registration was standardised. So we have national registration, national education, national standards of practice, but we all do it differently.
Kath Hume:You can see how complex it is and I'm really glad that you've said that there's this review going on, because I just feel like there's. Yeah, it just sounds confusing. The more layers you're adding here, the more I just feel like I'm a bit overwhelmed by it. I have to say, and that's one profession within our organisations, you know, we've still got the medical workforce, allied health workforce and all of the streams that happen within that. So it's an amazing piece of research. Can people access the research?
Dr. Rebecca Leon:I've published the literature and I've published how I because I developed the questionnaire. I've presented it at a couple of conferences. I'm happy to share the conference papers because they would be out there in public and if anyone wanted to reach out to you.
Kath Hume:How would they best go about that?
Dr. Rebecca Leon:Ah well, I am on LinkedIn. I'm getting better at social media. I just have to say I'm one of those migrants into it, as my children tell me. I'm a migrant into it, so I am on LinkedIn. I am on New South Wales Health, so I'm happy for people to email me.
Kath Hume:I'm sure people will be very interested to talk to you about this, because there's many, many systems across the country and across the world, I'm sure, who are really keen to hear and learn from what you've learned.
Dr. Rebecca Leon:Thank you and I am happy to share because it's yeah, it's something that we can only, I think, improve.
Kath Hume:Excellent. Well, thank you so much for sharing all of that with us. It's very, very intriguing. I'm really keen to watch this space and see where it leads, but I'm sure it will only lead to good things. So thank you so much. Dr Rebecca Leon, thank you, it's been a great pleasure to see you with you, as always. Thanks, kath. Thank you very much.
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