Today’s correspondent, a dual registered paramedic and nurse, has been in touch regarding his dispute with NSW health to have his practice as a paramedic recognised as relevant service as a nurse when it came to determining pay and seniority. What follows is his report on the dispute and the outcome. He writes:

In June 2020, I escalated a pay grade dispute, emphasizing the disparity between my allocated pay grade and my extensive experience as both a paramedic and a registered nurse. I argued that although I was employed as a paramedic I was practicing as a registered nurse as defined by the Public Health System Nurses’ and Midwives’ (State) Award 2023. I submitted that my paramedic service should be recognised by the nursing profession as relevant practice and service for the purpose of determining appropriate seniority and salary grade. I argued that the diverse paramedic roles align with the NSW Award Registered Nurse hours of practice and responsibilities, warranting equitable recognition.

The NSW Award’s says ‘”Registered Nurse” means ‘a person registered by the Board as a Registered Nurse and/or Registered Midwife.’  Service, for the purposes of determining an employee’s salary rate ‘means service before or after the commencement of this award in New South Wales or elsewhere as a registered nurse …’  [The employment level is determined by years of service.  Table 1 to the award sets out the salary rates for Registered Nurse/Midwife 1st Year, 2nd Year, 3rd Year etc until ‘8th Year and Thereafter’.  What is ‘service as a registered nurse is not defined]. The Australian Health Practitioner Regulation Agency (AHPRA) defines practice as a registered health professional as:

… any role, whether remunerated or not, in which the individual uses their skills and knowledge as a health practitioner in their profession. Practice in this context is not restricted to the provision of direct clinical care. It also includes using professional knowledge (working) in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on the safe, effective delivery of services in the profession.

AHPRA’s definition of practice encompasses various roles beyond direct clinical care, reflecting the evolving landscape of healthcare professions.

I argued that if an individual practices as a registered nurse or midwife, the hours spent in roles traditionally labelled as paramedic should contribute to their nursing service and vice versa. This aligns with AHPRA’s definition of practice and supports the cross over and experience of these professions.

To support my case that practice as a paramedic also meets the definition of practice as a nurse, I provided evidence of diverse clinical roles, including positions that cross over as a paramedic and registered nurse including retrieval roles, GP super centre roles, Remote Area Roles with nurses in Ambulance, Extended Care Paramedics performing traditionally Nursing based skills, Remote Community Paramedics as well as university subjects that are shared.

I noted that the Hon Mark Butler, Minister for Health in Victoria had discussed the use of paramedics in urgent care and extended care setting in a media statement in January 2023. The Australasian College of Paramedicine’s CEO John Brunning also pushed for similar use of paramedics (13/04/22 & 29/03/23). Many ambulance services including NSW Ambulance and St John Ambulance (WA) have had employment pathways for registered nurses to become registered paramedics.

After many months of meeting and advocacy, supported by my local MP, senior health directors and a former senior MP, NSW Health accepted that my service as a paramedic, prior to commencing employment in NSW Health as a nurse was to be recognised for incremental salary progression. Adjustments to previous assignments and relevant back-pay was also granted.

Throughout the correspondence, the underlying theme was the importance of advocating for an inclusive and dynamic modern interpretation of awards. This necessitates recognizing the evolving roles within healthcare professions and ensuring that professionals with diverse backgrounds, additional qualifications, and additional relevant health registrations receive equitable recognition and remuneration.

My case reflects part of the journey towards achieving fair recognition and compensation for years of dedicated service between health professions where there is a direct cross over in expertise, knowledge, and skills. The positive resolution by NSW Health signifies a step towards a more inclusive and equitable approach in determining pay grades for healthcare professionals with diverse backgrounds.

Discussion

I have seen the letter from NSW Health which says (emphasis added):

            … I have determined that your service prior to commencing employment in NSW Health is recognised for the purposes of incremental salary progression as a Registered Nurse.

This determination will have the effect of your previous assignments across the NSW Health Service … up to your current assignment as a Registered Nurse … being adjusted accordingly.  Any underpayment of salary entitlements resulting from these adjustments should be paid to you forthwith.

To avoid doubt, please note that this determination is personal to you and is made on a without prejudice basis. It should not be used or seen to be a precedent for other employees in the NSW Health Service.

A settlement on a ‘without prejudice’ basis is used where parties wish to settle a dispute but not to have the settlement used against their future interests. People in disputes want to settle them for many reasons – including to avoid the cost, inconvenience and publicity that an ongoing dispute may involve.

Clearly my correspondent was in ‘dispute’ with NSW Health, and we cannot know what the thinking within NSW Health was when they agreed to meet his request for recognition of prior service. The letter makes it clear that NSW Health is not accepting, as a general principle, that service as a paramedic can and should count for the purpose of determining salary increments for nurses.  In light of that letter we cannot say that ‘The positive resolution by NSW Health signifies a step towards a more inclusive and equitable approach in determining pay grades for healthcare professionals with diverse backgrounds.’  Notwithstanding these limitations, the outcome of this case will be of interest to dual registered practitioners and may point to a future where the overlap between health care roles is better recognised.

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 the 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.