What can nurses in Victoria do?

There is often confusion about what a nurse can or cannot do.  Much of what we may think of a nurse being “allowed” to do may be just “custom and practice”. In fact, there are very few activities that are specifically restricted.

Nursing Regulatory Framework – 2007 onwards
In the past a more prescriptive and task orientated approach was often used to differentiate what nurses could and couldn’t do. The changing nature of health care means that such approaches can rapidly lag behind practice.  Over the past decade there has been a move nationally towards the use of decision-making frameworks to support contemporary nursing and midwifery practice decisions. 

In 2007, the Nurses Board of Victoria released its Guidelines: Scope of Nursing and Midwifery Practice, which provides guidance to nurses in making decisions about everyday practice and changes to their practice over time.  Using a principle based approach a series of threshold questions are posed to assist nurse and employers decide if a practice is appropriate. The questions cover the following aspects:

• Improved outcomes as a result?
• Statutory authorisation and certification issues?
• Organisational support for the practice?
• Competent and confidence of the nurse?

For more information about the decision making framework go to www.nbv.org,au

Specific Authorisation:

Here are some nursing activities that require separate and specific authorisation, that are part of the current legislation and regulatory framework:

Division 2 Nurses and Medicines administration
Those nurses registered in division 2 who have undertaken a course of study in medicines administration and have an endorsement of their registration granted by the Nurses Board (NBV) can administer medicines to patients that have been prescribed by a Doctor or Nurse Practitioner. 

The endorsement indicates the range of medicines that can be administered. Some division 2 nurses can administer oral, enteral and topical medicines, and some can also administer medicines by subcutaneous and intramuscular routes. The NBV practicing certificate/card carried by each nurse has the specific endorsement on it or this can be verified on the NBV register of nurses online.

When administering medicines from a dose administration aid, registered nurses including division 2 nurses (endorsed and not endorsed) follow the guidance prepared jointly by the Nurses Board of Victoria and the Pharmacy Board of Victoria. These are available from the NBV website.

Accredited Nurse Immuniser
Nurse immunisers are employed with local councils, general practice, hospitals, community health and occupational health services. 

Many nurses (Divisions 1 and 2) administer vaccinations as part of routine clinical practice however a division 1 registered nurse can become an Accredited Nurse Immuniser by completing a course of study that is recognised by the Nurses Board of Victoria for this purpose. Accredited Nurse Immunisers are authorised to administer immunisations and can manage adverse reactions if they occur in contexts where there may not be a medical practitioner.

Currently there is one course available for Division 1 nurses that is provided by La Trobe University. The course covers, epidemiology of vaccine preventable disease, the role of immunisation in public health, the immunisation schedule, guidelines and policy relevant to the field.  After successfully completing the nurse immuniser course, a division 1 registered nurse can apply to have the course noted against their name on the register and on their registration certificate.

Nurse Practitioners and prescribing
Nurse Practitioners (NP) who are endorsed by the Nurses Board of Victoria are legally able to prescribe¹ (supply) medicines to clients/patients according to a defined list.  In Victoria, the authority to prescribe (supply) is limited to a category of NPs and a list of drugs approved by the Minister for Health. 

As with medicines endorsed Division 2 nurses, each nurse endorsed as NP will have the category identified on their NBV practicing certificate/card (and on their NBV register) and this identifies the list they can prescribe from.  The lists of drugs for each approved category can be found on the NBV website  (www.nbv.org.au).

Taking Xrays
Whilst a number of health services have local procedures that enable nurses (and other member of a health team) to order tests such as xrays only a small number of nursing staff in Victoria are currently authorised to take radiographs (Xrays).   The nurses that are authorised to do so are generally working in rural areas only where a radiographer or a GP is not available for emergencies.

For a nurse to be able to take an Xray, they need to:

• Have successfully completed appropriate training course² , and
• Have a current operator license³ 

The operator license restricts nurses to take only chest and extremity (limb) Xrays.

-----------------------------------------------------------------------------------

¹Prescribe is not a term used in Victorian legislation.  The terminology is “obtain, possess and use, sell or supply poisons or controlled substances” (ie: drugs or medicines)
²GP radiography course is a prerequisite.   This course is provided by Monash University, Centre for Rural Health (contact Paula Robinson ph: 5173 8183, email: paula.robinson@med.monash.edu.au). 
³The Radiation Act 2005 and the Radiation Regulations 2007 (available on the Victorian Legislation and Parliamentary Documents website) require that a person must not operate or use any ionising radiation apparatus unless the person holds an operator licence with the Department of Human Services