On being a State Enrolled Nurse

Comment & Opinion

Professor Ian Peate, Head of School, School of Health Studies, Gibraltar Health Authority

Background reading



The issue of bringing back the enrolled nurse is a superb debating point.


From my own perspective, the two years Enrolled Nurse (General) (EN(G)) training I undertook prepared me well to deliver care as a second level nurse, the bedside nurse. The circumstances that led me to undertake EN training are manifold. I did not have the academic qualifications that would allow me to commence RGN training; I left school with no academic qualifications. The School of Nursing where I undertook EN training was running its last intake of pupil nurses and I suspect they wanted to fill the course, I was told the only difference between the EN(G) and RGN training was one was two years and one was three years. I had to sit something called the E test to satisfy the UKCC entry requirements.

Scope of practice

My work as a pupil nurse (and we did work, we were salaried apprentices) and as an EN was an absolute joy, I loved every minute of it and I am convinced having gone through that route that really did prepare me for the rest of my practice and academic career. Pupil nurses undertook 24 weeks of geriatric care and students did 8 weeks – we were often looked down on as only being able to care for the ‘geris’ – I loved geriatric care (bring back the specialty geriatrics please). We did not do specialties such as ITU, A+E and theatres – we did ‘basic care’. Often we were referred to in abusive terms such as the green belt (green by belt and green in brain), or worse the ESN not the SEN (ESN = educationally sub normal). We were, I am sure, seen as being at the bottom of the professional ladder.

I worked as an EN(G) in a regional neurosurgical intensive care unit – this was the most enjoyable aspect of my whole professional career. I was truly a member of a great team.

I had to undertake a three year student nurse course to become an RGN – no shortened course, and remember I had no academic qualifications so I had to sit the DC test (a revised version of the E test). Again my EN training was categorically invaluable here, I was confident and confident in delivering care.

So should the EN be brought back? Yes BUT:

  • only if abuse of position is negated and the pupil nurses are treated with respect, offered the same quality theory and practice as the student nurses and their terms and conditions are the same as the RN. There is a danger that EN training will be seen as RN training on the cheap, this has to be prevented and managers and regulators must ensure that this is avoided
  • the public, the profession and others understand the role and function (the scope of practice) of the EN, failing to do this may put the public and the nurse at risk. The must be a career structure in place that ensures the EN is able to access CPD appropriate to their role and function on same basis as their RN counterpart.

There have been concerns in the past (I think it was debated at RCN Congress) that bringing back the EN would also bring back the problems that were previously experienced with the second level nurse (what ever these where!). It is up to the regulator, legislation, staff side and management to address these problems and come with solutions not to just dismiss it because it might be ‘messy’. The ‘abuse’ experienced by many ENs must never be allowed to happen again.

Gibraltar has just reintroduced the role of the EN and they offer pupil nurse training, New Zealand  (reintroduced it in 2003) and Australia have regulated for the EN ensuing that care delivered by this valued member of the nursing team is safe and effective.

If there is shortage of RNs then the reason for this must addressed, using ENs as a stop-gap is unacceptable. The need for the return of must be based on patent need, what it is a patient needs and not what it is that service needs to adjust the manpower shortage.

My work as a pupil nurse... and as an EN was an absolute joy, I loved every minute of it and I am convinced having gone through that route that really did prepare me for the rest of my practice and academic career.