Enrolled and Registered Nurses Competencies Consultation

Thank you to all the nurses who took the time to respond to the consultation on the proposed enrolled nurse (EN) and registered nurse (RN) competencies (and amendments to the RN scope of practice). We had substantial feedback that will help inform the next phase of this review.

In particular, we received considerable feedback on the number of competencies and the impact this has on continuing competence requirements, especially Professional Development and Recognition Programmes (PDRPs).

The Nursing Council Board has carefully considered all feedback and has agreed to make amendments to the competencies for further targeted consultation mid-year.

What was this consultation about?

The EN competencies were reviewed to align with the new EN scope of practice [available here].¹ The RN competencies were last updated in 2016 so were reviewed to ensure they remain relevant and reflect modern nursing practice in Aotearoa New Zealand. We proposed minor amendments to the RN scope of practice statement to reflect the new EN scope of practice.

Given the rapidly changing nature of healthcare and service delivery, the proposed competencies are intended to be broad, flexible, and future-focused while at the same time supporting safe and quality care.

How the competencies were reviewed

We established EN and RN design groups with members drawn from the Council, the New Zealand Nurses Organisation EN section, Te Poari o Te Rūnanga o Aotearoa, Te Kaunihera o Ngā Neehi Māori, Māori and Pacific nursing leaders, Directors of Nursing, educators, and employers. We also drew on wānanga held with Māori nurses to guide the review of cultural safety and Kawa Whakaruruhau guidelines.

The design groups analysed international competencies with comparative international jurisdictions and researched broadly within the realms of current and relevant academic literature. The design groups also considered the context in which nursing is practised and taught in Aotearoa New Zealand. The competencies need to reflect the increased expectations and evolving role of nursing over the last few decades and into the future.

Project leads and some members of each design group have been across both EN and RN projects to ensure alignment. Concepts have been tested through a broader sector reference group and wider sector engagement. In addition to the consultation call for submissions, the Council continued to seek wider sector engagement to hear a range of views and perspectives on the proposed changes.

How was this consultation conducted?

Consultation opened on 18 December 2023 and closed on 12 February 2024.

Respondents could submit on the proposal via multiple means. Respondents were encouraged to submit via an online survey using the platform SurveyMonkey. Respondents also had the option to submit via email and a template of questions was provided for this purpose. We received other email submissions in the form of messages and letters. The project team continued engaging with stakeholders virtually and in face-to-face consultation meetings.

Consultation materials are [available here].

What did we hear from the consultation?

The Council received 1,532 submissions overall: 102 submissions by email with one via post while there were 1,429 complete responses to the survey. Individuals completing the survey made up 98.5% of respondents (1404) and respondents representing organisations made up 1.5% (21).

Of the 1,429 survey responses, 121 respondents (8.6%) identified as Māori, 50 (3.6%) identified with a Pacific ethnicity, and 78 (5.6%) identified as having a disability or chronic health condition.

Feedback was received from ENs (4.8%), RNs (93%), nurses in other roles (0.4%), and other individuals (1.7%). Respondents gave feedback from the perspective of a large range of care settings, regions, employment settings, practice experience, and personal circumstances.

A summary of the analysis of the consultation is available here:

Summary of Consultation Analysis

Submitters who agreed to have their written responses made public are included at the end of this page.

We contracted an external agency to support the consultation analysis due to the high volume of feedback.

General themes from consultation feedback

We received a range of feedback which reflected the following:

Supportive feedback – the proposals cover all aspects of current and future nursing practice well.
Neutral feedback – the proposals are welcome but require further refinement.
Critical feedback – there are too many competencies, and they are too complicated.

The biggest concern was the number of competencies and the impact on completing a portfolio for a Professional Development and Recognition Programme (PDRP).

EN competencies feedback

The small number of EN submitters were more positive about the EN competencies than RN submitters. Supportive and neutral feedback indicated that competencies would support EN practice but would benefit from examples.

Some submitters noted concerns relating to the number of competencies, indicating that the competencies could be condensed to simplify them. There were also concerns about the repetitive nature of some of the competencies.

Critical feedback indicated that the competencies are too broad and do not cover all EN practice areas. Additional concerns were raised about the potential strain that new competencies may have on already overworked and stressed nurses, and their workloads.

RN competencies feedback

There was a greater level of disagreement with the RN competencies from RN submitters. Submitters were concerned about both the breadth and number of competencies. There was mixed feedback on the breadth of the competencies - many thinking they were too broad, and many considering they weren’t broad enough.

Supportive and neutral feedback indicated that the pou and new format are better. Submitters who supported the competencies being broad enough to cover all areas of nursing practice felt they provided more clarity on what is expected of an RN role. There were suggestions to refine, reduce, and revise language, noting that the more prescriptive competencies (e.g. relating to legislation, cultural safety, and critical thinking) provided a clearer example of what was required.

Critical feedback indicated concerns about the number of competencies and the impact this might have on the workload of nurses. In particular, nurses equated competencies with PDRP requirements. The complex and lengthy nature of each pou were considered overwhelming and unnecessary. The competencies were thought to be too broad but didn’t cover all RN practice areas.

RN scope feedback

Submitters noted that more work was needed to clarify the RN scope of practice statement, as well as a need for additional focus on clinical practice and changes to PDRP requirements. Submitters considered that the differences between the EN and RN scope of practice statements need to be further developed and clarified.

There were numerous suggestions for including, excluding, or changing specific wording and language to the scope of practice statement.

What has the Council decided?

The Council has decided to spend more time to refine the competencies and RN scope of practice statement and plans further targeted consultation mid-2024.

We will continue to engage with stakeholders, including ENs and RNs in practice, to get feedback on the revised competencies.

¹ The new EN scope of practice was approved by the Council in May 2023, but will not come into effect until late 2024