The scope of enrolled nurse practice: a grounded theory study.

This paper follows an earlier paper presented in this journal where the scope ofj practice of Enrolled Nurses (EN) was critically reviewed from the available literature on this topic. In this paper the authors (Milson-Hawke & Higgins, 2003) recommended the need for research into the scope of practice of ENs. The purpose of the paper presented here is to describe the outcomes of a grounded theory study that explored the nature of EN practice within an acute hospital setting and the processes that ENs used to guide their practice. Although the findings of the study are incomplete because of the limits of time and scope of the study, the theory developed provides a useful description of how of the ENs in this study determined their own scope of practice in the acute hospital setting. The processes that the ENs used emerged as 'doing the work without overstepping the mark'. 'Doing the work without overstepping the mark' required ENs to make judgements about the nature of the work they were being asked to do. The nature of the work of ENs emerged as 'doing routine work' and 'deciding to do non-routine work'. Routine work comprised 'essential nursing' and 'advancing practice'. Essentially, the ENs in this study determined their own scope of practice as they undertook nursing activities beyond their level of preparation. The impact of the care provided by ENs, however, was not within the scope of this small study. This needs to be the focus of future studies along with the impact on health care of the changing roles of ENs.