This question again revisits the issue of people holding skills and qualifications beyond their current expected scope of practice.

The short answer (before I even get to the question) is ‘no-one is going to reward you for letting someone die when you can stop it.’

The question is:

What about dual qualified paramedics who are also registered nurses

Can they practice their skill set in an emergency department when employed as a registered nurse?

Say for instance a country nursing post. If the patient required intubation or cardiac pacing, which are invasive skills and not in a nurse’s scope of practice, can a paramedic initiate this treatment?

Dual qualified nurses who are also midwives can practice midwifery in the emergency department when employed only as a nurse. Just wondering if the same would apply to paramedics.

Remember that the Health Practitioner Regulation National Law works through protection of title, not strictly defining ‘scope of practice’. Your ‘scope of practice’ is defined by your training and to a lesser extent your employer. An employer cannot however limit a practitioner’s scope of practice to the extent that the practitioner would be guilty of “Unprofessional conduct” (that is “professional conduct that is of a lesser standard than that which might reasonably be expected of the health practitioner by the public or the practitioner’s professional peers…”) if they complied.

A registered paramedic is a registered paramedic even if today they are working as a nurse.  They still know what they know, they still have the skills they have.  If a paramedic was working in an emergency department and had the equipment required to perform a task that was within his or her skill set why would anyone not do it?

Imagine you are the patient’s family and the person dies. You find out that the nurse on duty was also a paramedic and knew how to intubate, had the equipment, the procedure was not contra-indicated but they refused to cover their employers or their own arse.  Ask yourself how persuasive this argument is: ‘today I’m employed as a nurse but I would rather see your family member die than get into trouble’. Are you going to complain about that person and sue the hospital, or are you going to complain about the person who tries even if it doesn’t work?

Putting aside that emotive question, the registered paramedic will be expected to perform to the standard expected of a paramedic.  If a panel or tribunal was satisfied that the ‘public or the practitioner’s professional peers’ would expect a paramedic to act to save his or her patient with a procedure was within their skill set, not contra-indicated and where they had the equipment, then the paramedic may be guilty of unprofessional conduct no matter what badge he or she is wearing today.  I can’t see that it makes a difference the patient relationship began as a nurse/patient. The nurse/paramedic still has a duty to act in his or her patient’s bests interests and that must include using all the skills and knowledge that they have.