Fact sheet: Dual registration with both the NMBA and the Paramedicine Board

This fact sheet sets out the regulatory requirements for practitioners who hold dual registration with the NMBA and Paramedicine Board, that is registration on Ahpra’s Register of practitioners as an EN, RN and/or midwife, and a paramedic.

It is also for students, graduates, and internationally dual qualified practitioners who intend on holding dual registration in the future.

The NMBA and Paramedicine Board recognise that nursing, midwifery and paramedicine are separate professions, and dual qualified practitioners need to register in each profession separately and meet the requirements of each Board relevant to the profession.

The registration requirements, education, responsibilities and scope of practice of a nurse, midwife and paramedic are different. Practising in more than one profession may create potential risks including:

• being able to differentiate and change between practising as a nurse, midwife or paramedic, and working within the relevant responsibilities and scope of practice, and
• employer or colleagues clearly understanding whether you are practicing as a nurse, midwife or paramedic, and supporting you to work within the relevant responsibilities and scope of practice.

You can reduce these risks by ensuring that you are fully aware of, and always work within, the scope of practice, professional standards and capabilities expected for each profession. You should also ensure that your employer and colleagues are clearly aware of the profession in which you are practising.

Practitioners with dual registration are required to have recent practice in, and connection to, both the nursing and/or midwifery profession and the paramedicine profession. They must also ensure they are safe, competent, confident and current, in each profession’s specific skills and knowledge, relevant to their context of practice.

To ensure that you are safe, competent and can demonstrate the knowledge and skills required by that profession for practice within your scope, dual registered practitioners are expected to meet the following requirements for each profession in which they are registered:

• respective professional standards and capabilities set by the Boards for each profession,
• respective registration standards set by the Boards for each profession including:
• recency of practice registration standards,
• continuing professional development registration standards,
• professional indemnity insurance requirements relevant to your practice, and
• any additional requirements related to an endorsement.

Because the scope of practice for each registered practitioner may be different, the evidence that you keep and present to demonstrate you meet the registration standards, as a dual registered practitioner, are assessed on an individual basis.

All registered health practitioners have a responsibility to ensure they provide culturally safe health services to Aboriginal and Torres Strait Islander peoples, and contribute to the elimination of racism in healthcare, as enshrined in the National Law.

Dual registered practitioners must have recent practice in each profession they are registered in to ensure they are safe, competent, and current in each profession’s specific skills and knowledge, relevant to their context of practice.

You need to declare annually when you renew your registration, that you have met the hours requirement to meet recency of practice for each profession. If your compliance with the recency of practice requirements is audited, you will need to provide evidence of practice and connection with each profession.

To be recent in your scope of practice for a particular profession, you need to demonstrate:

• you have recent practice using relevant knowledge, skills and abilities required for the profession in your context of practice, and
• you have maintained a connection with the practice of that profession.

Maintaining knowledge, skills and abilities in the profession(s) you are registered in

The easiest way to maintain the relevant skills and knowledge for the practice of a profession is to be employed or working in that profession

If you are only employed or practising in one of your registered professions, your practice will be limited to the scope of the professional standards and capabilities that you demonstrate in that profession. For example, if you are only working as a registered nurse, your scope of practice as a paramedic will be limited to the elements you use in your nursing practice that are also common to your paramedicine practice.

Dual registered practitioners are encouraged to map their practice against the professional standards and professional capabilities to demonstrate how common elements are shown in your context of practice. These documents indicate the expected practice standard and provide the framework for assessing your practice.

You should use these documents to consider if you meet the requirements for the respective Board’s Recency of practice registration standard for each profession when renewing your registration each year. For nurses, these are the Enrolled Nurse standards of practice, Registered nurse standards for practice, Nurse practitioner standards for practice. For midwives, these are the Midwife standards for practice. For paramedics these are the Professional capabilities for registered paramedics.

If you are proposing to make changes to your scope of practice, you may be required to complete any additional training, advanced training or preparation that your peers would reasonably expect to ensure you are competent to practise in your new scope of practice.

Maintaining a connection with the profession(s) you are registered in

The easiest way to maintain connection with the practice of a profession is to be employed or working in that profession.

If you are not practising or working in a profession, you could demonstrate maintaining a connection with that profession by either undertaking profession specific education CPD or engaging in profession related activities on a volunteer basis.

If you have not completed the minimum hours required by the NMBA or the Paramedicine Board to meet the Recency of practice registration standards, you will need to notify the respective Board when you renew your registration. Any common elements of practice should be determined within your own context of practice using the Standards for practice for enrolled nurse, registered nurse or midwives and the Professional capabilities for registered paramedics.

Practitioners who do not meet the requirements of the respective Boards, noting currently the Boards have different requirements, can submit an application for consideration. Your application will be assessed on an individual basis. When considering the matters relating to recency of practice and re-entry to practice it is open to the Board to refuse registration (or renewal of registration) or:

The NMBA may require you to successfully complete:

• supervised practice as approved by the NMBA (pathway 1), or
• a re-entry to practice program approved by the NMBA (pathway 2)

The Paramedicine Board may require you to successfully complete:

• a period of supervised practice and/or
• a competence assessment and/or
• specified retraining or reeducation.

The continuing professional development (CPD) activities you undertake should be relevant to your context of practice, maintain your competence and build on your knowledge and expertise as a dual registered practitioner.

To demonstrate compliance with the respective Board’s Continuing professional development registration standard you will need to complete the required hours of CPD related to your nursing and/or midwifery practice, including any requirements for endorsement, and the required hours related to your paramedic practice.

There may be some CPD hours that can count towards multiple contexts of practice, but the NMBA and the Paramedicine Board would also expect to see separate activities specific to nursing and/or midwifery and specific to paramedicine to demonstrate your connection with the practice of each profession.

Under the National Law, all registered health practitioners must not practice the profession(s) in which they are registered unless they hold appropriate professional indemnity insurance (PII) arrangements in relation to their practice. If you are a dual registered practitioner you must have professional indemnity insurance relevant to all aspects of your practice in nursing, midwifery and paramedicine to demonstrate compliance with the respective Board’s professional indemnity insurance arrangements registration standard.

Context of practice: Context refers to the environment in which nursing or paramedicine is practised, and which in turn influences that practice. It includes:

• the characteristics of the consumer and community demographic being cared for
• the complexity of care required
• the model of care, type of service or health facility and physical setting
• the amount of clinical support and/or supervision that is available
• the resources that are available, including the staff skill mix and level of access to other health care professionals.

Cultural safety: Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practise is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.

Endorsement: an endorsement of registration recognises that a person has an extended scope of practice in a particular area because they have an additional qualification that is approved by the National Board. There are a number of different types of endorsement available under the National Law, including scheduled medicines, nurse practitioner, and approved area of practice.

Practice: Practice means 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 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.

Recency of practice: Recency of practice means that a health practitioner has maintained an adequate connection with, and recent practice in the profession since qualifying for, or obtaining registration.

Scope of practice: Scope of practice means the professional role and services that an individual health practitioner is educated and competent to perform.

• Visit www.nursingmidwiferyboard.gov.au and www.paramedicineboard.gov.au for profession specific standards, codes and guidelines
• Contact us to lodge an online enquiry form
• Aboriginal and Torres Strait Islander people can get culturally safe, one-on-one help with registration from the Aboriginal and Torres Strait Islander Engagement and Support team. Yarn with us at [email protected]
• For all other enquiries: 1300 419 495 (in Australia) +61 3 9125 3010 (overseas callers)