My first correspondent in the new look blog says:
The private company I work for wishes to not delineate between paramedics and nurses anymore, calling them instead ‘Medics.’ Fair enough I guess, it’s only a contractual name, however my concerns lie with the company taking that a step further by placing nurses in remote solo operator locations and expecting them to practice efficient pre-hospital care in pre-hospital situations without doctors present using paramedic clinical guidelines.
What do you see as the risks to the nurse (and then to the employer) that is placed in a predominantly pre-hospital role and being expected to use paramedic clinical guidelines, and vice-versa the risk to the paramedic that is placed in nursing scenarios without a doctor present using paramedic clinical guidelines? Both scenarios have emergency physicians available by phone, but nurses aren’t trained in paramedic processes and treatment decisions so would need to call the physician immediately/earlier? Can nurses practice paramedicine I guess is the crux of the issue.
The Health Practitioner Regulation National Law does not define scope of practice, it works by protecting titles. There is no law that says ‘this is what nurses do; this is what paramedics do’. Nurses and paramedics work in many areas and many nurses do work that others may consider ‘paramedic’ work – think flight nurses and nurses in remote medical facilities. Equally, one of the arguments in favour of paramedicine registration was that paramedics could add to a flexible health workforce and paramedics are moving into areas that some might think is nursing work – think extended care and palliative care paramedics and see various posts by ‘the Paramedic Observer’).
I can demonstrate this point with the venn diagram below:
What is ‘paramedicine’ (and what is nursing) are largely matters for the relevant boards. The Paramedicine Board sets out ‘Professional capabilities for registered paramedics’. This document sets out the minimum skills expected of a paramedic but even that doesn’t go into details of particular clinical interventions. The Board also accredits programs leading to registration (https://www.ahpra.gov.au/Accreditation/Program-accreditation-and-approval.aspx) and that in turn gives some indication of what it is that paramedics (at least new paramedics) must be able to ‘do’. Newer paramedics and nurses may have clear ideas of what is ‘nursing’ and what is ‘paramedic’ practice but a practitioner with many years’ experience in different areas may feel comfortable and experienced in skills that cross over the two professions.
Fundamentally then what is paramedic, and nursing practice is determined by individual paramedics and nurses. A nurse who is employed as a ‘medic’ (as described) is practising nursing as a paramedic is practising paramedicine. Each is answerable to their registration board that will ask did they practice as a good member of their profession but that mostly involves issues of professionalism, self-reflection and being able to draw their own lines on what they can do and what is beyond their skills, knowledge and experience. The issue is not whether ‘nurses [are or] aren’t trained in paramedic processes and treatment decisions’ but whether the particular nurse, or paramedic is trained and competent to perform the tasks they are being employed to do.
As the Paramedic Code of Conduct says (at [1.2]):
Professionalism … includes self-awareness and self-reflection. Practitioners are expected to reflect regularly on whether they are practising effectively, … They have a duty to keep their skills and knowledge up to date, refine and develop their clinical judgement as they gain experience, and contribute to their profession.
Practitioners have a responsibility to recognise and work within the limits of their competence and scope of practice. Scopes of practice vary according to different roles; …. To illustrate, in relation to working within their scope of practice, practitioners may need to consider whether they have the appropriate qualifications and experience to provide advice on over the counter and scheduled medicines, …
The risk for nurses and paramedics in the context given, and, in any context, is that they will be asked to perform tasks that they are not competent to perform. That competence does not depend on a fine line between nursing and paramedic practice but on their own experience. Many nurses practice in ways that overlap with paramedicine and vice versa.
This blog is made possible with generous financial support from the Australasian College of Paramedicine, the Australian Paramedics Association (NSW), Natural Hazards Research Australia, NSW Rural Fire Service Association and NSW SES Volunteers Association. I am responsible for the content in this post including any errors or omissions. Any opinions expressed are mine, and do not necessarily reflect the opinion or understanding of the donors.
Australian Emergency Law 
The roles of nurses and paramedics is vastly different as is their training, competencies, responsibilities and scope of practice. Even nurse practitioners are vastly different from nurses and paramedics. Each have unique important roles. Unless you’ve both nursing and paramedic qualifications I see issues when nurses are faced with prehospital emergencies that require paramedic skill.
This is a blog about the law and the point is that the law does not say the ‘roles of nurses and paramedics is vastly different…’ The law does not prescribe the scope of practice of either profession. If you look at the Codes of Conduct (without going through them line by line) the basis of good paramedic and nursing practice is to provide evidence based, patient centred care within an individual practitioner’s competence and it is up to individual practitioners to reflect on their own skills and practice and make sure they are competent to deliver the care they intend to offer.
As I tried to say in the post, if you look at university curricula and ask new graduates you may see quite significant difference between nurses and paramedics, but that may not remain true over time. A person with many years in either field may well have developed relevant skills. Consider too a person may have been both a nurse and a paramedic but may have let their registration in one of the professions lapse; but they still have the relevant skills and knowledge.
I agree there will be ‘issues’ if nurses are faced with prehospital emergencies that require paramedic skill if they don’t have that skill; but the question is indeed whether they have the necessary skills, not the profession under which they are registered.
While Remote Area and Community Nursing has been around for a long time, I can see a problem with the situation described, and that is that the employer and Nurse could be seen as “holding out” to be a category of health professional that they are not. Uniforms and insignia provided by some private operators could further increase the potential for mistaken professional identity. The National Law has clear restrictions on the use of protected titles. These are addressed in sections 113, 116, 117, 119 and 120 of the National Law. https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/faq/the-use-of-health-practitioner-protected-titles.aspx
Employers must be honest about the registration of their employees and Nurses should identify as Nurses and Paramedics as Paramedics. I am sure an ANMF Professional Officer would be happy to provide support on this matter.
That is indeed correct; The Australian Health Practitioner Regulation National Law s 113 says “”(1) A person must not knowingly or recklessly… (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.” Certainly nurses should not use any title to suggest they are paramedics and vice-versa.
Regarding the original post question “Can Nurses practice paramedicine I guess is the crux of the issue.”, I would like to add that Nurses since Florence Nightingale have worked and continue to work in war torn areas, in 3rd World countries and all manner of out of hospital environments.
“Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles…”(ICN, 2002)
Nurses nurse, they provide Nursing services. Identifying as a “medic” is somewhat disingenuous. If an employer is set against acknowledging the Nursing profession it is probably time to look elsewhere.