I have been approached by a new, volunteer community health service operating in New South Wales. The organisation is ‘a registered charity that provides first aid & health monitoring services…’ The team is made up of registered nurses, an emergency medical technician and others with Occupational First Aid certificates.

During a meeting to discuss their operations, a representative from a local public hospital ‘stated that she did not believe Registered Nurses or Paramedics have the authority to use their skill set outside the NSW Health environment.’ I am asked

‘Are you aware of any legislation that prohibits Registered Nurses (employed by either NSW Health of Corrective Services) from providing care in a volunteer capacity outside the NSW Health environment?’

It is suprising that anyone could make a statement to the effect that ‘Registered Nurses or Paramedics [do not] have the authority to use their skill set outside the NSW Health environment.’ The HEALTH PRACTITIONER REGULATION NATIONAL LAW (NSW) governs registered health professionals, which includes Nurses (but not paramedics). An Act designed to establish various health registration boards, to empower that board to determine who can be registered and how they are to be disciplined if their conduct is sub-standard is unlikely to say, and does not say, that there are some limits on where those registered health professionals can work.

Further we have to consider what skills are nurses using in this context? They are trained to provide patient care, to recognise illness and injuries, to apply dressings, administer medication, use equipment like oxygen and defibrillators and other monitoring equipment, they could take a blood pressure and I’m sure many other things. None of those skills are regulated, that is anyone who knows how to do those things can do them. What you can’t do, if you are not a registered nurse, is call yourself a registered nurse and engage in some practices primarily related to dentistry (HEALTH PRACTITIONER REGULATION NATIONAL LAW (NSW) ss 113-123).

So let us think about the suggestion that nurses cannot use their skills outside their employment. Would that mean a nurse at a car accident couldn’t say ‘you need to go to hospital I can see that you have a serious injury?’ Does that mean a nurse couldn’t do CPR because they learned that in their nurse training and not in a first aid course? Merely saying that shows how silly the assertion is. A person who is a registered nurse is a registered nurse, they don’t unlearn things when they go off their shift. Of course they can use their skills and knowledge outside work unless there is some regulation to stop them.

Relevant limitations do exist with respect to scheduled drugs.

  • In order to possess, use, supply or prescribe a poison, restricted substance or drug of addiction for the purposes of the practice of nursing, a nurses registration must be endorsed with specific authority or the nurse must be registered as a ‘nurse practitioner’ (POISONS AND THERAPEUTIC GOODS ACT 1966 (NSW) s 17A). ‘A nurse practitioner must not supply a restricted substance to any person otherwise than in the course of practising as a nurse practitioner’ (POISONS AND THERAPEUTIC GOODS REGULATION 2008 (NSW) r 43) but practice as a nurse practitioner need not be limited to employed practice but would depend on the terms of the registration.
  • A nurse in charge of a ward in a public hospital is entitled to be in possession of and supply drugs of addiction or prescribed restricted substances (POISONS AND THERAPEUTIC GOODS REGULATION 2008 (NSW) rr 62 & 101). This clearly applies only at work, the nurse volunteer is not ‘in charge of a ward in a public hospital’ when they are ‘off shift’ and volunteering with a community service.
  • There is no offence if a nurse, or anyone, takes possession of and administers a restricted substance to the person that it was prescribed for (POISONS AND THERAPEUTIC GOODS REGULATION 2008 (NSW) r 59).

Who or what is an emergency medical technician is undefined by law. Presumably they have a qualification in that name but it gives them no more, or less authority, than anyone else, but remember one doesn’t need authority to do lots of things, and use first aid equipment and skills. If you are trained to use oxygen, a defibrillator, a splint etc you can use them as there is no law to say you cannot.

A person who holds a WorkCover approved occupational first aid certificate ‘is authorised to possess and use methoxyflurane and nitrous oxide if required in connection with the carrying out of first aid’ (POISONS AND THERAPEUTIC GOODS REGULATION 2008 (NSW) Appendix C, clause 9).

In short nurses are nurses and have been volunteering to provide nursing care across the community for many, many years. To suggest that they cannot use their skills and knowledge is just, to put it bluntly, silly. The limitation that does exist is in the possession of and use of drugs. They cannot carry restricted drugs, no matter how well trained and experienced they are, outside their employment unless that is endorsed or their registration and subject to that endorsement that is unlikely to extend to their volunteering in this context.

The fact that the nurse is a nurse and is providing care means that the care that they deliver has to meet the standard expected of a reasonable nurse in the circumstances. That would be the standard in any civil litigation alleging negligence and would be the gist of the issue should there be a complaint of unsatisfactory professional conduct or professional misconduct.

An organisation that uses volunteer nurses should of course ensure that either the organisation or the nurse has adequate professional practice insurance.  An organisation providing a first aid service should also be mindful of the provisions of the Health Services Act 1997 (NSW) s 67E that makes it an offence to provide an ambulance service without the permission of the Director General of Health.

Michael Eburn

(via iPad).