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#NurChat - Bring back the enrolled nurse?


Did you miss the latest #NurChat twitter debate about the enrolled nurse? Let us sum it up for you …

“Should we bring back the Enrolled Nurse?” was a NurChat discussion subject suggested by @cherylwilson2 who is an Enrolled Nurse. Enrolled Nurses have often been touched upon in NurChat debates and participants have extolled the practical virtues of the Enrolled Nurse. So, with recent reports stating the quality of fundamental care is lacking, this was an important subject to discuss in full.

The chat started by asking if anyone remembered the role of the EN? There were a few nurses who had trained as ENs and had either converted, or were still on Part 2 of the register. Many participants remembered ENs as having good hands-on skills and being experienced and committed.

@cherylwilson2 tweeted “I trained as an EN in 1986 to 1988, I am still on part 2of the NMC register”

@anniecoops stated “I had EN’s on ward when was sister (long ago) they were often the people who held the team together, experienced and committed”

@PamNelmes007 said “Remember EN’s I started my nurse journey as an EN”

One participant suggested that it was a sad day for nursing when the EN went:

@CarolineKin tweeted “It was a sad day for nursing when the disappeared. EN’s were valuable members of the team.”

Many agreed, @amnerisuk said “When I was sick post op with MRSA I was desperate for an EN’s care. RNs avoided me and I saw nice HCA’s with few skills”

Another participant stated that we should not bring back the EN; @Caltwit tweeted: “Should we bring back EN’s I don’t think so as we would create a 2 tier system pts already get confused by SN and HCA imagine adding EN”

The role of the Assistant Practitioner was discussed, with one of the participants, Assistant Practitioner @MissFBA tweeting “Some Trusts are now trying to “bridge the gap” between HCA and RN with the new AP role which some say is the new EN??”

@Jam3sPJ stated that the EN is “now superseded by Assistant Practitioners, allowing for a more responsive workforce”.

However it was pointed out that APs are unregulated. @MissFBA said: “The trouble with the AP role is that they are not registered where as the EN’s were”.

Why APs can’t be registered was discussed; @ChiefExecCWPT tweeted: “We need to give new professional roles a means of registration/recognition, without continuing to create new “Royal Colleges”“.

Finally, NurChat asked if we should bring back ENs? The full range of answers can be found in the transcript on the NurChat Blog, but one of the tweets which summed it up best was by @cherylwilson2, who said: “Let’s move with the times and if the AP’s are trained similarly lets get them on part 2 of the register - there’s room!”

I think that this is a great approach. Nursing is dynamic and we do have to move with the times but at the same time, if Assistant Practitioners are delivering fundamental care, we need to have regulation and registration. Nursing at any level is a highly skilled job and Enrolled Nurses did provide a middle ground which, according to recent reports, now seems to be lacking. Can Assistant Practitioners bridge this gap? I hope so, but in a safe and regulated way.

Teresa Chinn heads up NurChat for Newcross Healthcare Solutions - Nurchat is a fortnightly twitter chat for nurses exploring different topics that vary enormously.Anyone can suggest a NurChat discussion subject simply by tweeting @NurChat or by visiting the NurChat blog.


Readers' comments (9)

  • of course you should bring back the enrolled nurse, it isn't even worth debating. HCAs are just cheap labour. There is absolutely no need for nurses to have a degree, the appalling standards of care have highlighted that what is needed is caring people who actually have an interest in looking after people. There are countless people who would make excellent nurses but cannot get on a course because they don't have the academic qualifications - biggest mistake ever made.

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  • I totally agree with the above comment, we are going to lose a lot potentially extremely good nurses that have a lot to offer because they can not get on to the degree course. What we need is compassion and sensitively in future nurses not essay writers. Teach future nurses to deliver high quality care and pay the academics to do the nurse research.

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  • I wish all those who are qualified to access educational levels would just stop looking at academic ability. "Intelligence" comes in many forms and sadly, those who decide who can be doctors and nurses have not yet grasped they are judging human ability on one thread alone. Didn't we find concern at the poor level of communication in many GP surgeries, in many consultants, good at medical model processing, but terrible at empathy, and what people need to know?
    Even the Govenrment have lost it now, but giving this group even more power to mismanage, not understand and exclude wherever possible.

    "Ability", I beleive, comes from a balance of compassion, a degree of emotional intelligence, spatial intelligence, vision, self-awareness etc. etc.

    I beleive that the message has not yet got through. We have a self fullfilling prophecy style system where many who think in a linear way, are making decisions encouraging the same restricted type of thinking, academically driven, but devoid in many instances of the balance of intelligence, an all rounded thinker that includes empathy.

    I was an SEN, but it wasn't my choice at the time, but I do think APs are the next generation of something very similar. I just think a degree led caring system is throwing the baby out with the bathwater.

    Google "John Gardner Multiple Intelligence" and you'll get more of what I am trying to say.

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  • We all know it, we all say it any opportunity but still academia rules. The truth of this is not about how nurses need degrees but how can we reduce the numbers of trained nurses - give them a degree and let them supervise HCA's. We call ourselves 'trained nurses' not educated nurses because we know that nursing cannot be learned in university.

    I just don't know how we get the message across that trained nurses are cost effective.

    Bring back EN's - I would rather scrap the degree only nursing and get back to recruitment based on aptitude in all appropriate areas.

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  • Assistant practioners what ever next! I was a 1976 Enrolled nurse and enjoyed the hands on experience but people have to realise that patient care at bedside level is basic something that needs bringing back by the correct title of nursing auxillary [1974] which may I add I was one of them too and the training was inbedded in me to perform the most inportant care skills on the ward, this has never left me but before these poeple are aloud to perform nursing tasks they should learn to walk before they can run this reflects now on the amounts of complaints regarding basic hygiene,lack of help with hydration, help with feeding,toileting because they are "given OTHER nursing jobs to do" The EN had two years of training and went on different wards was awarded a PIN number and was the patients front line nurse beside the bed

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  • Liz Fletcher

    The University of Southampton was the first higher education institution to have all of its nursing degrees accredited by the Nursing and Midwifery Council.

    The adult nursing degree course runs for three years, after which graduates will be eligible to register as qualified professionals in the adult nursing field.
    Adult nursing is the career choice which offers extraordinary opportunities to be with amazing people with different challenges on every working day.

    Adult nurses also work in specialist areas such as intensive care, theatre and recovery, cancer care and care of older people.

    It is the career that offers a multitude of opportunities to work around the globe, as well as at home, in the richest variety of roles that offer exciting challenges.

    To find out more about the Adult Nursing Degree go to

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  • I trained as an SEN in the early 80s. At that time it was sold as the more hands-on type of nursing and was what I wanted to do. I left nursing for 12 years and returned 2 years ago as a Trainee Associate Practitioner. I would like to re-register but am finding it impossible to find a course that accepts the SEN qualification.
    Before leaving I worked as a Practice Nurse on a F Grade, as they were then, but now I am considered little more than an HCA.
    There are many SEN's out there who would love to get back into nursing, yet no way for them to do this. How much experience is being lost with this short sighted view?? i Recently spent 4 days in hospital following a total hip replacement. While the nurses were lovely, they had no time for basic nursing care, and the only person who helped me wash and actually washed my feet was an HCA.
    I was always taught that looking after patients required an Holistic Approach, but these days all the nurses have time for is medication and paperwork. This is not a criticism, but an observation
    The other point was that when I did my training I learned on the wards as an extra pair of hands. I learned in a practical setting with periods in training to consolidate. I was paid next to nothing, but was an extra body on the ward.
    I apologise for the rant, but it saddens me to see this wonderful profession degenerating into a system whereby people are cared for by unqualified carers, whilst the qualified personel spend their time writing . Dear Florence Nightingale would spin in her grave if she could see what has become of a once vocational profession, even if the first nurses were from the oldest profession!!:)

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  • Why were SEN's phased out? was this another cost saving measure? I worked with them as a student nurse and they were highly valued members of the team from whom I learned many of my skills. They were allowed to do everything except ivs and taking charge of a ward. In my view, it would be good if they were to return as many people would like the option to train at this level and it would contribute to raising the standards of care which unfortunately does not rest with them alone but with many other factors.

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  • I really wish there was a return of the 2 year training to become a SEN. There is room to have different levels of nurses, and I too remember some highly skilled SENs training me when I was a student nurse. However other factors in my life forced me out of my nurse training (I unexpectedly found myself homeless and unable to claim housing benefit because I was in receipt of a bursary) and I had to chose between my nursing diploma course and a roof over my head. It was both heartbreaking and maddening, because had the rules been different, I would have had 14 years of nursing under my belt by now.

    So seeing as nothing has changed with regards to such rules, now my options are being a level 3 HCA that I am at present, and progress to AP, and from there, maybe do another year or so to gain extra credits to become a RN, all whilst being able to work to help fund study. I am sure I would love the role of an AP, as I do being a HCA, and I may just have to accept I will never be termed a nurse. I truly do wish there was the option to train as an SEN, because two years of student loans is less daunting and more realistic for my situation, than three years and the added pressure of a degree.

    I have seen many a good potenial nurse working as a HCA, unable to progress to into nurse training, be it for academic reasons such as the diploma level was phased out, or for personal/social circumstances.

    There is room for different level nurses, and nursing is expanding in its role, so why do some nurses on here have such negativity towards HCA's and AP's also expanding their role? Once upon a time, state registered nurses only did what HCA's do now. It doesnt have to be a threat to RN's to have HCA's trained to a high level, and become secondary nursing staff with some form of registration. It could be the missing piece and both RN's and patients would benefit from having another trained nurse on the team, even if at a lower grade. America did not rid itself of its own SEN (Licensed Practical Nurse) and we should not have said goodbye to a valued nurse, only to later try and replace with some obscurely named "Assistant Practioner"

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