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.