Today’s correspondent is a medic with the Royal Australian Navy. They write:
Currently, all Navy Medics hold a Diploma in Paramedical Science, and most of us are studying for a degree in same. We also hold Cert 4 in nursing (Endorsed Enrolled Nurse).
Question:
- When paramedics are recognised by ARHPRA and become registered, can we keep both EEN & Paramedic registration?
- How does this effect our scope of practice, if at all?
- How would this effect, Paramedic we can diagnose and issue the required medication (Prescribe, within our protocols). EEN cannot, and does this become a legal issue if the worst case scenario happens and the patient passes away?
As a Medic we work as a Medic, have Paramedic quals and registered as EEN under ARHPRA. I feel very uneasy in our Current circumstance. And this has never been Looked at or tested under the legal system, either DFDA or civilian, or the ARHPRA board.
I have previously touched on these issues – see:
- ADF medics and drugs (November 16, 2016); and
- Nursing standards and assisting in an emergency (May 22, 2014).
There is no reason to think that people will not be able to hold dual registration. There are plenty of paramedics who are already enrolled or registered nurses and they will no doubt want to continue both registrations when paramedics join the ranks of registered health professionals.
The standards set for each profession are indeed the minimum standard. As I said in my earlier post ADF medics and drugs (November 16, 2016):
The Enrolled nurse standards for practice may set out the minimum requirements for an enrolled nurse but it doesn’t mean that one can’t have other qualifications and skills. I suppose it is possible that a person could be both an enrolled nurse and a registered medical practitioner. Their practice as a doctor would not somehow mean they are breaching their registration standards as a nurse.
More likely there are enrolled nurses who are employed as paramedics. Their practice as a paramedic, in accordance with the authorities granted to them as paramedics would not be a breach of the minimum standards expected as an enrolled nurse. The definition of ‘unsatisfactory professional conduct’ that applies in NSW (Health Practitioner Regulation National Law (NSW) s 139B) is “Conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of the practitioner’s profession is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience”. An MT that applies his or her training and skills in accordance with the authority granted by the ADF [or as a registered paramedic] is not acting below, but in accordance with the standard expected of someone with that ‘level of training or experience’.
If their conduct does fall below the expected standard, they can expect to lose both their employment and their registration. For example, a paramedic who steals drugs or assaults their patient may lose both their job and their enrolment. But, in context, supplying drugs that one is authorised to supply as a paramedic or MT in accordance with one’s training, skills and authority is providing care beyond or above, not below, the standard of a person who is an enrolled nurse but not a paramedic or MT. Consider the ‘standards of practice’ as the minimum skill set, not the only skill set one can have.
I can’t see anything in the Nursing and Midwifery Board of Australia Standards for Practice: Enrolled Nurses 1 January 2016 that says Enrolled Nurses must not do something that a paramedic may do. The standards are all about acting within competence and training. I can’t see anything that would be inconsistent with appropriate professional practice if the EEN were also a registered paramedic.
Consider too, that if a registered paramedic declined to offer some treatment for fear that this might breach his or her standard as an enrolled nurse, that decision would be a breach of the paramedic standard. To again go back to an earlier post (Nursing standards and assisting in an emergency (May 22, 2014)), “No court or tribunal would ever accept that some statement on nursing ethics or practice is intended to, or does, stop a nurse providing assistance at an emergency” and that will be particularly true if the nurse is also a registered paramedic.
Australian Emergency Law 
I recall the days of the old ( NSW ) Nurses Registration Board, when an RN could also hold ‘Enrollment’ as an EN.
As far as I’m aware, on 1st.July 2010 when AHPRA came into effect, they canned the dual Registration.
You can be an RN and Midwife, but not an RN and EN.
I would guessing, that when paramedics are registered by AHPRA, they won’t be able to dual practice in NSW.
Isn’t the legal divide, that a military ‘medic’ operates under Commonwealth Law and not State law ?
Certainly at the moment the issue is that a military medic operates under Commonwealth law and s 123 of the Defence Act is relevant, that was the subject of my first post on ADF medics and drugs. I have no reason to think that one won’t be able to be both an RN or EN and a paramedic, just as you could be an RN and a podiatrist, or chiropractor any one of the other 14 (soon to be 15) registered health professions.
Unless I’m missing something, you can be a RN and an EN with considerable information provided here – http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/FAQ/Concurrent-registration.aspx
From discussions if a person holds registration with 2 boards and a complaint is made against the registered practitioner, the 2 boards will make a decision on which board is the most relevant to hear the complaint. If the board investigating the complaint makes a ruling against the practitioner the other board will be advised of this ruling and they in turn will make a decision on how this will impact on the person registration with them.
I would image the paramedic board will receive applications from a number of paramedics who already hold registration with another health profession.
Registered Nurses and Registered Midwives often hold dual registrations given that Midwifery has desired to be recognised as a separate profession from nursing. Having dual registration from Paramedic to Nurse (EEN or RN) is common also, though I would expect that if you are employed at a hospital as an EEN or RN, it tis the cope of practice of the EEN or RN that you would be reasonably expected to practice under as you are not employed as a Paramedic even if you hold the qualification and registration.
Yes, I must have been thinking of ’employment’, rather than ‘registration’.
I once worked worked for a public hospital as an ‘orderly’, whilst I was a junior RN ( because the hospital wasn’t employing 1st. Year RNs ).
Told after a while, this couldn’t continue.
Still lots of myths out there ….