The journey from enrolled nurse to registered nurse: A mixed-methods study

Abstract

Objective: To explore the experiences of nursing students undertaking a vocational entry pathway of a Bachelor of Nursing course.

Background: In Australia, there are three levels of nurses: Nurse Practitioners (NP), Registered Nurses (RN), and Enrolled Nurses (EN). ENs typically undertake vocational diplomas, while RNs complete bachelor’s degrees, and Nurse Practitioners undertake postgraduate master’s degrees. Many ENs seek career advancement to become RNs through degree pathways, a transition that offers expanded knowledge, skills, and scope of practice. This study examined the difficulties and experiences of ENs undertaking bachelor’s degrees to become RNs, particularly under challenges posed by the shift to online education during the COVID-19 pandemic.

Study Design and Methods: A concurrent mixed-methods approach was employed. Qualitative focus group interviews, individual interviews, and cross-sectional surveys were conducted among transitioning ENs at an Australian university in 2022 and 2023. The qualitative component comprised of three focus groups with a total of 18 participants and five semi-structured individual interviews. The quantitative survey was disseminated to the same student population. Descriptive frequencies were used to analyse demographic and rating survey questions, summative content analysis for open-ended survey questions, and thematic analysis for individual interviews and focus groups.

Results: Of the 77 students surveyed, 70 responded (90.91% response rate), with most participants being female and Australian-born. Survey data showed academic writing and referencing as the top academic challenge (mean score = 2.21), while managing work and study was the leading personal challenge (mean score = 1.81). Content analysis of open-ended responses revealed key concerns such as pace of learning, work-life balance, and short-notice placements. Thematic analysis of interviews and focus groups identified five overarching themes: academic challenges with course structure and online learning, balancing diverse commitments, adapting to university expectations, course management and support systems, and the transformative impacts of COVID-19.

Conclusion: The transition from enrolled to registered nurse is marked by numerous obstacles, further exacerbated by the pandemic. Educational institutions and healthcare stakeholders need to recognise these challenges and provide individualised support. The study underscores the importance of holistic support mechanisms in assisting ENs in their professional development and ensuring the healthcare industry benefits from competent RNs.

Implications for Research, Policy, and Practice: Research should focus on effective educational models for transition programs, considering online and traditional environments. Policies need to support flexible learning, resource allocation, and clinical placement management. In practice, institutions should implement support systems and individualised learning approaches, and healthcare settings should develop holistic development programs for transitioning nurses.