Today’s question relates to the use of protected titles. Whilst this question relates to nurses, it will also be relevant to paramedics. Once registered under the Health Practitioner Regulation National Law the title of ‘paramedic’ will, like the title of ‘nurse’ be a protected title.
The question is:
Given that the word nurse is a protected title under law and may be taken as someone who is registered with AHPRA. What would be the legal standing of an assistant in nursing who is not eligible for registration under AHPRA identifying themselves as a nurse? I ask as we have student nurses (RN etc) working as AINs in acute hospitals and nursing homes etc and identifying themselves as nurses. Could they be placing future registration at risk by identifying themselves as “nurse”?
As with most questions the answer depends on the context. The word ‘Nurse’ is both a noun ‘a person trained to care for the sick or infirm, especially in a hospital’ and a verb ‘give medical and other attention to (a sick person)’ (Oxford Dictionaries Online). A person can nurse another without being ‘a nurse’. One might imagine that in a nursing home or other place a person may describe the person who is providing nursing type care as a nurse without distinguishing the various categories of nurse that there may be. And a person may chose not to correct that or may identify that they are ‘nursing’ Mr Jones or say ‘I’m one of your mum’s nurses’ in order not to confuse matters where the people they are talking to are not aware of all the different categories of people involved. If a person is not trying to pass themselves off as something they are not, are not trying to obtain any advantage or mislead anyone then I can imagine the health regulators may not see that as an issue.
But let us turn to the letter of the law. The Health Practitioner Regulation National Law is set out as a schedule to the Health Practitioner Regulation National Law Act 2009 (Qld) and is then adopted, with some local variation, in each state and territory to create the national scheme. To answer this question I’ll refer to the national law as adopted in Queensland, that is the Health Practitioner Regulation National Law (Queensland) but the answer will be the same nationwide.
The Health Practitioner Regulation National Law does not define scope of practice nor does it make it an offence to practice one of the registered professions without being registered. There is not clear definition therefore of what it is to be, or practice as, a nurse or a medical practitioner or in due course, a paramedic. What it does do is make it an offence to adopt or use any of the protected titles. Section 113(1) says:
A person must not knowingly or recklessly—
(a) take or use a title in the Table to this section, in a way that could be reasonably expected to induce a belief the person is registered under this Law in the health profession listed beside the title in the Table, unless the person is registered in the profession, or
(b) take or use a prescribed title for a health profession, in a way that could be reasonably expected to induce a belief the person is registered under this Law in the profession, unless the person is registered in the profession.
Note, consistent with my opening comments, the offence is committed not so much by the use of the title, in this case ‘nurse’, but the use of the title ‘in a way that could be reasonably expected to induce a belief [that] the person is registered under this Law…’ as a health professional. For an individual the maximum penalty (at least in Queensland) is a fine of $30 000.
With respect to nurses, the protected titles are ‘nurse, registered nurse, nurse practitioner, enrolled nurse, midwife, midwife practitioner’ (s 113).
A person may be registered as a student health professional (ss 86-93). There is nothing in the National Law about the title for students’ but I would suggest someone who described themselves as a ‘student nurse’ is not adopting the title ‘nurse’ in a way that would mislead anyone into thinking they are registered as a nurse. And of course, a registered student nurse is registered in the profession of nursing, albeit as a student. Accordingly, although there is no specific mention of the title ‘student nurse’ it seems that the use of that title by a registered student of nursing is unproblematic.
When considering whether or not a person should be registered as a health professional, the relevant Board must determine whether or not ‘the individual is a suitable person to hold general registration in the health profession’ (s 52). Section 55(1) says:
A National Board may decide an individual is not a suitable person to hold general registration in a health profession if—
(b) having regard to the individual’s criminal history to the extent that is relevant to the individual’s practice of the profession, the individual is not, in the Board’s opinion, an appropriate person to practise the profession or it is not in the public interest for the individual to practise the profession; or …
(h) in the Board’s opinion, the individual is for any other reason—
i. not a fit and proper person for general registration in the profession; or
ii. unable to practise the profession competently and safely.
If the Board is satisfied that the person has been using a protected title and holding themselves out as a registered health professional or at least acting in a way that is likely to mislead others, then even without conviction the Board may determine that this indicates that the person is ‘not a fit and proper person for general registration’ (s 52(1)(h)). Where the person has been charged with and convicted of an offence contrary to s 113 then a finding that the person is not a fit and proper person is even more likely (s 52(1)(b)).
It is illegal to use the term ‘nurse’ ‘in a way that could be reasonably expected to induce a belief the person is registered under this Law’. Where a student nurse is practicing, in any capacity, to describe themselves as a ‘nurse’ may well induce a belief that are registered as a nurse (and not as a student of nursing). The aim behind the legislation is that anyone who is not eligible for general registration as a nurse should not, indeed must not, use the title ‘nurse’. Anyone who does could well be asking for trouble if they later seek registration as a nurse and that practice is brought to the attention of the Board.
The same answer will apply if, in the future, a person uses the title ‘paramedic’ without being registered as a paramedic and who subsequently does apply for registration in that profession.