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Experts Discuss Why a NDIS (National Disability Insurance Scheme) Delegated Model of Care from RN’s to Support Workers is Illegal

Patrik Hutzel:  Hi, my name is Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home.

Welcome to another podcast here at intensivecareathome.com and today I have a very special guest, Kristi Gilbert. Kristi Gilbert is a CCRN, a critical care nurse by background, but also a legal nurse consultant.

Kristi, why don’t you introduce yourself to our audience and then we will go into what we want to talk about today?

Kristi Gilbert:  Thanks, Patrik. Thanks for the introduction. I’ve been in nursing for just over 30 years now. It’s gone really quickly. Most of that was in intensive care and emergency departments. My career took a bit of a change just before COVID when I got the opportunity to work as a legal nurse consultant, and that side of my nursing has really grown as its own business now. Also, COVID promoted a change in my career into community nursing and palliative care. So, I’ve got a graduate diploma in critical care and I’m now doing a master’s in advanced nursing as a nurse practitioner in palliative care. It’s an interesting space.

Patrik Hutzel:  Yeah, that’s fantastic. I know with you doing palliative care in the community, you see a lot of the things that we are seeing with Intensive Care at Home. You see the benefits of home care, but you’ve also observed some of the negatives of home care, and that’s also something we want to talk about today.

Kristi has done a lot of work for us in the last two years, with some specialist nursing assessments for our clients, predominantly for our clients on ventilation with tracheostomy, but also for some clients with tracheostomy that are not ventilated, and also for some clients on non-invasive ventilation, BIPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure), and it’s been great to have you on board Kristi, with those nursing assessments. They are very, very detailed.

Kristi Gilbert:  Thanks.

Patrik Hutzel: And really gives the NDIS (National Disability Insurance Scheme) no way out to fund support worker, what can’t even be done by a registered nurse, which needs to be done by critical care registered nurses in the community, which is all we do here at Intensive Care at Home. So, it’s been really great to give us your deep dive of those assessments. We have been doing them for the last 10 years and they’ve always gotten the funding for the clients. But yours are so much more detailed because of your legal nurse consultant qualification as well, and your extensive critical care nursing experience. So that’s been really great.

Now, we sometimes have clients come to us and they say, “Hey, we know we need your service, but we don’t have the funding.” Then I say to them, “Look, you need an NDIS Support Coordinator, and then once you’ve got an NDIS Support Coordinator, we can help you with a detailed specialist NDIS nursing assessment.”

Can you talk a little bit about what those assessments look like from your perspective? I know what they look like, but for our audience, can you explain it more?

Kristi Gilbert:  Yes, I guess once I get the referral from you, I get a lot of information. I might get other specialist reports, OTs (occupational therapists), dietitian, physiotherapists, medical specialists. I will often meet the client and the family. Sometimes we’ve had to do that over Zoom calls for one reason or another, but it gives me a sense then of what the home environment’s like and what supports they’ve got in place already, and then what level of care that they need. Because you’re not only assessing where they’re at right now, but also those reports are assessing their funding ongoing, so for at least another 12 months.

So, you’re looking at what’s their level of deterioration been? What level of support do they need now? What will they need likely in the next 12 months to make sure that they’re safe at home? Ultimately, that’s the goal, is to make sure that the care that they’re getting is appropriate and safe to be able to maintain their level of function and to have high quality care at home.

Patrik Hutzel: Have high quality care at home, and to avoid hospital admissions, that’s one thing.

Kristi Gilbert:  Absolutely.

Patrik Hutzel:  I also need to highlight once again, and I mentioned it on many of my other videos, people have died in the community if they didn’t have the critical care nurse, 24 hours a day, for ventilation plus minus tracheostomy. That’s how serious this is.

So, if you are a family member watching this and you have a loved one either at home already with insufficient support, or if you are an NDIS Support Coordinator watching this, unfortunately we are not making it up when I say people have died because they didn’t have the critical care nurse, 24 hours a day, at home or they bounce back to ICU all the time. Either can be avoided with having the critical care nurse funded, 24 hours a day.

Most of that funding that we are referring to here is NDIS funding, but there are other examples too. Whether it’s the TAC (Transport Accident Commission) in Victoria or iCare in New South Wales. Often the advocacy needs to be done as well for the CCRN for a ventilated/tracheostomy client.

Unfortunately, the consequences are so grave if you don’t get the right support, and it might be fine 364 days of the year. But it’s that one day where the tracheostomy comes out or where there is an airway management issue that the support worker or even a general registered nurse can’t manage, where a client can die. That’s how severe or significant it is what we are talking about here today.

Kristi Gilbert:  I think that’s a really important point you make, Patrik, is that in a hospital setting, it’s predominantly ICU nurses who are looking after people with tracheostomies and especially if they’re ventilated. Certainly, a general RN can look after most tracheostomies, depending on the level of support that they need. But they’re in an environment that’s very well supported, and you’re talking about people who are at home with no backup and no support, and a general RN would feel very unsupported even in a hospital looking after a ventilated client.

I think that’s a distinction that has to be made, is that when you’re looking at caring for someone with really high needs at home, that you have to have that level of education, training, and experience to not just be able to do the day-to-day things, but to recognize when things are going wrong. And then to intervene so that you’re not relying on an ambulance that might take an hour.

Patrik Hutzel: We’ve talked about this extensively offline, Kristi, that even if the ambulance arrives after maybe an hour, there’s no guarantee they know what to do with the ventilator or tracheostomy. We’ve seen that in real time now that, yes, you might get an ambulance, you might even get an ambulance within 10 or 20 minutes, but there’s absolutely no guarantee that they know what to do with a ventilator or an unstable airway in general.

Kristi Gilbert:  Yep, unless you’re getting a MICA (Mobile Intensive Care Ambulance), it’s pretty unlikely. It’s very tricky and I think that that’s why it’s so important to have the right level of care in the home.

Patrik Hutzel:  Right, right from the start. One thing that I can confidently say here, and I’ve been saying it on other videos too, I can confidently say that our clients stay at home predictably because we wouldn’t be in business if our clients were going back to hospital all the time. It is also from a family perspective, you want your family member home predictably, you just don’t want it.

Kristi Gilbert: That’s right.

Patrik Hutzel:  You don’t want your family member go back to hospital all the time. I think the other thing that’s important here, Kristi, and I know the palliative care that you are doing is not Metro, it’s on the-

Kristi Gilbert: Regional.

Patrik Hutzel: Regional, thank you. Especially if you are regional and especially if you’re in the higher acuity sphere in the community, well, you certainly don’t want to go to a hospital. There could be even a bigger delay in regional areas to get an ambulance.

Kristi Gilbert: Oh, absolutely. Yep, absolutely. Especially overnight, which is, sadly, when a lot of things seem to go wrong.

Patrik Hutzel: Absolutely. No, thank you for sharing that. Now, Kristi, another thing with the work that you are doing and with the work that we are doing, obviously something that we have come across in the last few years is the NDIS wanting to implement what they refer to as a delegated model of care where they pretty much ask us as critical care registered nurses to teach support workers how to look after someone on a ventilator with a tracheostomy, or look after a tracheostomy without a ventilator.

Now, you and I cringe, and many other nurses in this space cringe when we hear that, and there’s a number of issues with that. Where do I even start?

The first issue that comes to mind is, well, if we can train support workers to basically do CCRN work, why are our intensive care units not staffed by support workers? That’s the first question that comes to mind.

But the bigger issue here is where do nurses stand with that delegated model of care in terms of our responsibility, in terms of our liability? My take on it, if I teach a support worker what to do with a ventilator and a tracheostomy, they don’t have all the background, the general nursing care, the anatomy, the physiology, none of that. I just show them how to basically try and keep someone alive with all the other knowledge that you need to have to underpin that. Well, that’s the first thing.

But the next thing is if I teach them and something goes wrong, I really can’t take that responsibility for it. On top of that, AHPRA (Australian Health Practitioner Regulation Agency) doesn’t allow us, the regulator body, to allow us to delegate care.

Where do we stand with all of that, Kristi? I know you’ve done a lot of groundwork there more.

Kristi Gilbert:  Yeah. I think it’s really important that nurses who are working in the disability space have a really clear understanding of what AHPRA’s requirement is for delegation. They’re very clear on what it involves, and that is that you have to make sure that the delegation is safe, that the person that you’re delegating to has the appropriate knowledge, skills, and experience to be able to carry out that task to the same level that you would, with the same outcome. That’s the first part of it.

The second part of it is that you can’t delegate the accountability. That remains with you. It also remains with the person who’s accepting the delegation, so they have to make sure that that’s within their own scope of practice as well, based on their knowledge and skills, training, and experience, and that you’re also responsible for the outcome of that delegation, and making sure that you have checked that what was delegated was done correctly and that the desired outcome was achieved. I think that that’s the part that’s really important.

So, you can’t delegate away that accountability and say, “Well, I gave it to them to do and they said that they are fine to do it, and so therefore my responsibility is now gone.” It’s not, the responsibility remains with you. I think that’s part one of it.

The second part is that in teaching, you might teach a support worker, but they’re a highly transient workforce, which the NDIS has recognized themselves. So, you might teach one, but then that person might have numerous support workers involved in their care, and unless you’re teaching all of them and then that base of support workers remain stable, you’re constantly retraining people to do the task that you could’ve just done yourself. You’re not there 24/7, so it’s direct or indirect, but the RN should really be on site to be able to make sure that that delegation is being carried out safely.

Patrik Hutzel: Yeah. But that’s also not what the NDIS wants. They basically want RNs to run support workers through a crash course.

Kristi Gilbert:  They do. It’s basically some online modules which are not comprehensive. Then, watching them do the task and then signing them off that they’re safe to do it, which is not how delegation works. That’s not delegation. You can’t just teach someone to do it with an online module and a little bit of training.

What they’re asking support workers to do in the communities, to perform tasks that it takes an RN, who has already got a three or four year bachelor degree and clinical experience, and then a postgraduate degree in critical care, which is another 12-month postgraduate certificate or graduate diploma, that’s a lot of knowledge and experience, to then teach it to someone who doesn’t even have a basic degree. It’s just a TAFE (Technical and Further Education) course.

There’s not even actually a legislated requirement for their education like there is for nurses. We have standards that we have to adhere to. We have legislation that guides our practice. Our education is regulated by AHPRA and the nurses’ board, there’s none of that with a support worker.

Most agencies will require that they have some kind of TAFE course behind them, but it’s not mandated. So, you could get a support worker who’s had no training, or you can get a support worker who might’ve done a short course in a certificate III or a certificate IV level, but that’s nothing compared to the training and knowledge that a registered nurse has. You just can’t compare the two.

It’s unfair then to expect that a support worker will be able to perform the same tasks to the same level as a registered nurse or a critical care registered nurse in a lot of the cases where you’re talking about patients with tracheostomies and ventilation, or even BIPAP.

Patrik Hutzel: Yeah. But isn’t it interesting, what we’ve also dug out as part of the research, is that there was a court case in November 2022, where the federal court basically overruled the NDIS that certain clients within the NDIS need a registered nurse, not a support worker, and that wasn’t even in regards to ventilation, tracheostomy. This was in regards to general nursing care.

Kristi Gilbert:  Yes.

Patrik Hutzel: Can you talk more about that?

Kristi Gilbert: Yeah, it was three NDIS clients with high needs, but not high intensity needs, who were being cared for in a shared facility. NDIS basically wanted to have this delegated model of care where the RNs would come in and train up some support workers who would then take over the care. The nurses would only have some kind of semi-regular input in terms of, I’m not sure exactly what their requirement was, but it was maybe six hours a week or something where they would do the care planning and just monitor. But the actual day-to-day care was just being provided by support workers with no oversight from RNs.

It went through the Administrative Appeals Tribunal where the Appeals Tribunal found in favor of the clients, that they should have registered nurses. NDIS obviously took it to court to appeal, and it was overruled in the federal court, that it wasn’t safe for those clients to have no day-to-day registered nurse oversight of their care, and that that was not safe. That was not inconsistent with their delegation requirements for registered nurses, and that you are looking at a transient population of support workers who you would be constantly training them anyway, and you’re not there to make sure that the outcome of the delegation was safe. So, they were overruled, and the clients got the registered nurse funding.

Patrik Hutzel:  From memory, Kristi, like you’ve mentioned, it wasn’t about ventilation, tracheostomy, this was about catheter care, PEG (Percutaneous Endoscopic Gastrostomy) tube management. I think there was some insulin management as well?

Kristi Gilbert: Yes, medication management, which is really-

Patrik Hutzel: Medication management.

Kristi Gilbert:  These are things that if you’re doing them on a day-to-day basis, you know how things can change or go wrong. It’s one thing just to recognize the normal, but then you need to recognize what’s abnormal and then what to do about it.

I think that was again highlighted in, I know we talked about this the other day, a coroner’s case where a client was an NDIS client who had some support workers looking after him overnight, and he had a fall in the bathroom on the evening shift. They put him to bed without doing any kind of assessment, not a formal assessment. He complained of some leg pain. They had a look at his leg and said, “It looks fine to us.” In the morning when they went back to check him again, he was very unwell, and they called an ambulance, and he’d actually fractured his femur and had bled out into his femur, into his thigh all night. When he got to hospital, he died of hypovolemic shock.

That’s just one simple example of how not having people with the right skills, knowledge, and training can impact someone’s life, and that cost that man his life. Had he been appropriately assessed post the fall like a nurse would have on the night before, he wouldn’t have died. Not from hypovolemic shock the next day, anyway.

Patrik Hutzel:  Now, look, this is how significant this is, what we’re talking about today. The NDIS is almost treating some of their participants as second-class participants, quite frankly because the reality also is if the clients that need whether it’s ventilation, tracheostomy, whether they need medication management, whether they need catheter care, PEG tube management, whatever it is, if they do go back to hospital, there’s no support worker looking after them. There are registered nurses looking after them, so what is the difference in the community? Because the level of care is not changing for these participants.

Kristi Gilbert: No, and look, I think it’s really important to highlight that there’s a lot of really good support workers out there who do some really fantastic work within their scope of practice. What we’re highlighting is that there is definitely a space for support workers, and we know that we’ve got a nursing shortage, and we have to work within that as well.

But giving support workers high intensity tasks, we’re not just doing tasks when we’re looking after someone with high intensity needs. Suctioning a tracheostomy isn’t just about the task, or even something as simple as just doing a turn on that person. When it’s a nurse, we’re not just turning the client. Every interaction with the client is an opportunity for an assessment. Whether that be informal or formal, we’re always looking what’s their color of their skin like? What’s the color of their nails and lips like? Do they look like they’re breathing okay? Have they got any pressure areas when we’re turning them? Is there any red areas that need intervention?

It’s constantly assessing it. We’re not just doing tasks, and I think it’s really disrespectful to the nursing profession to insinuate that our work is just task-based, because it’s not. It’s comprehensive and it’s holistic, and we’re always looking at everything, even when we’re doing something as simple as suctioning a tracheostomy. I think that you can’t teach that to someone on an online course and basic training without any education in pathophysiology and anatomy. You just can’t. Otherwise, why would we bother to have all of this education training for registered nurses?

Patrik Hutzel:  That’s right, and just to highlight here, once again, the NDIS is basically asking CCRNs (critical care registered nurses) to delegate to support workers. They’re not even asking us to delegate to a general registered nurse, even that we couldn’t do without them having done some two years in ICU. We’re basically falling from sky high all the way down to bottom, without any checks and balances here. It is absolutely dangerous.

Like I said, a word to the NDIS here, the NDIS is treating some of their participants as almost second-class participants saying, “Well, if you were in hospital, you get gold standard care, but if you’re going into the community, you don’t get gold standard care,” and that is just wrong.

The other thing that I want to mention on that is, it’s also not evidence based. When you look on our website at intensivecareathome.com, there is a section, the Mechanical Home Ventilation Guidelines. They are actually evidence-based. It’s a result of nearly 25 years of Intensive Care at Home nursing in Germany, but also, we’ve provided enough evidence here in Australia now, that this model of care is clearly working, and that exclusively ICU nurses with a minimum of two years intensive care experience, ideally with the postgraduate critical care qualification, are safe to keep ventilated/tracheostomy clients at home safely and predictably. So, there’s evidence, there’s research has gone into that.

Where’s the research for support workers? Well, the research for support workers is people have died.

Kristi Gilbert: Yeah, and that’s the thing. In investigating this delegated model of care, I couldn’t actually find any evidence that this is a safe model of care. Whereas we know that having a critical care RN looking after a ventilated client in the home, they’re not waiting until things go wrong to call for help. They’re always assessing and they’re picking things up early before they become a crisis point.

That’s how we’re able to keep those clients at home safely, is that we’re always looking at what’s trending in the wrong direction? What needs addressing right now? Before it gets to the point where the client is unwell and needs to be back in hospital, or you’re needing to be calling an ambulance to manage something that’s an emergency. Because with the right care, it often never gets to that point because we’re constantly intervening, because we know how to treat those things as they arise, not wait until the client’s clearly unwell.

Patrik Hutzel:  Yeah, and I also want to highlight here, I know you’ve heard me saying this before, providing care in the community for our clients with support workers is like flying the airplane with cabin crew but not with the pilot. That’s the best comparison that I’ve come up with.

Kristi Gilbert:  Absolutely.

Patrik Hutzel: There’s another thing in the community, Kristi, that I’ve picked up, and I’m sure you’ve picked it up too. There are some clients in the community, they don’t want extensive monitoring, which is something we need to respect. Now, as critical care nurses, I argue, okay, we would prefer monitor, but if that’s the client’s preference, we respect that of course. But that’s also where critical thinking comes in and where your ICU nursing skills come in. What else do I need to look for when I don’t have a monitor?

Kristi Gilbert: Well, that’s just it, and that’s what I mean when all those interactions are an opportunity for an assessment and is that we often pick things up before the numbers change on the monitor. I’m sure you’ve seen, and I’ve seen Patrik, where we see somebody deteriorating before the sats ever drop. We know that their breathing doesn’t look right, their color of their nail beds might’ve changed and be a little dusky or it’s all those things. We don’t have to have a monitor on all the time. Often, we’re checking saturations after we’ve seen a clinical change because we are picking up on those subtle changes that occur, because we know what we’re looking for.

Whereas a lot of the time with support workers, they might put the monitoring on, but they don’t understand what they’re seeing. So, unless they understand what those physiological changes mean, and just because somebody’s blood pressure remains within a normal range, but it might’ve dropped from 140 to 105, and they’re like, “Oh, 105 is still okay.” Well, it’s not if their normal blood pressure is normally 140 and they’re showing other signs of being unwell, like their temperature might be going up or their saturations might be dropping there. Especially Resperate, which is something that I don’t think most support workers would understand the significance of. I argue that some nurses don’t understand the significance of Resperate, but it’s one of the key indicators to clinical deterioration.

We have sets of national standards that we work by that have clear guidelines on things like responding to deterioration, and making sure that the care that we’re providing is high quality and safe. But those standards don’t apply, they still apply, but they’re not as understood by the support workers because it’s not part of their training, whereas it is part of our training. We have a code of conduct that we have to practice by. We have professional standards that we have to follow as part of our registration. If we don’t follow them and we breach them, we lose our job, we lose our career, we lose our registration. There’s no oversight with support workers. It’s not the same level of oversight. It’s not the same level of education.

Patrik Hutzel:  Yeah. Another thing, Kristi, that I found out in the last few weeks, and I haven’t actually shared with you, I am talking to NDIS accreditation bodies. They are well aware of the issue. My understanding from some of these accreditation bodies is that they are now stopping to accredit support worker agencies and tick them off for ventilation, tracheostomy, medication management. They stop accrediting them for it, which is a good sign to me. Which means it’s not only up to the NDIS to say, “I want you to provide this.” Now, there’s also hopefully another level of oversight coming in from the accreditation bodies where an RN being employed by an accrediting body’s saying, “Hang on a second, this is just wrong.” We can’t go down that track, unless you have X number of nurses in your organization that are critical care nurses, you can’t provide this service.

But it also sounds to me like in the past, many organizations have been accredited in the support worker agency world. I don’t know how. Again, I don’t know what the exact regulations there are from the NDIS, but hopefully there is more oversight coming in from accrediting bodies as well.

Kristi Gilbert:  I hope so. Look, I hope a lot of lessons have been learned out of the Aged Care Royal Commission, because I think we went down this track with aged care as well. These are complex clients who are probably some of the sickest people most of us will ever look after, is our elderly population. They’ve got not only the changes that come with ageing, but they’ve got a lot of comorbidities. They’re often frail. Then you add in things like dementia and Alzheimer’s and all of those things. For a long time, we took the nursing out of nursing homes, and it took a Royal Commission to highlight the problems that that created and the poor care, poor outcomes, people dying in pain, lack of palliative care, falls prevention, treatment after falls, there were so many problems, like so many problems, that the Royal Commission’s findings were to put nurses back into aged care.

So, we really have to repeat the mistakes that we made in aged care to then say we’re doing the same to people with disabilities. Because a lot of them have got overlap with severe health issues, whether that be from head injuries or cerebral palsy, or there’s a multitude of things where health overlaps with disability. I feel like we’re heading down the same track, is that we’re putting untrained workers or suboptimally trained people to predominantly care for these people. We’re just going to end up in the same boat because these are people with higher intensity needs. They’ve got complex needs. Health overlaps with disability, it just does. You can’t separate the two.

You can’t then just say, “Well, just because they’re under disability services, that they don’t then need a nurse,” because they do. Some of them do. Not everybody does, but some of them do. Where they do, and a nurse has decided because that’s who is in charge, and responsible for the delegation. If a nurse has decided the only safe delegation is to another nurse, then I don’t understand how the NDIS can overrule that, because who’s deciding that? Based on what? Because we’re providing evidence-based rationales for our decision to have to have a nurse, but they’re not providing the same level of evidence when they’re saying that they don’t need a nurse.

Patrik Hutzel: Yeah. What I also want to say on that note is for anyone watching this that might be in a similar situation with a family member, or you might be watching this, and you are yourself in a situation like that, there’s never been an issue with funding from the NDIS with the right evidence, but also with the right NDIS Support Coordinator. So, your NDIS Support Coordinator will make all the difference by gathering the right evidence, by asking the professionals what is required to get the right level of funding for a particular client or for your situation. This is not a rant on what isn’t working. It’s also to highlight what is working because..

Kristi Gilbert: Yes, absolutely.

Patrik Hutzel:  … clearly working. You can look up our job ads on Seek. We are employing critical care nurses for the type of work that we say we do, which is Intensive Care at Home.

But Kristi, where can you see this going in the long run? You’ve already alluded to, we don’t want to go down the track of another Royal Commission because the warning signs are already there…

Kristi Gilbert:  Look, I think they are, and I think that there’s already been a lot of issues with clients. It’s sad that it takes a client’s death to make the media, and a lot of them don’t because a lot of people with severe disabilities, when they do pass away and there may have been complications, they’re often not highlighted to the coroner or through any kind of reporting body because people go, “Well, they were deteriorating and they were going to die anyway.” I think that’s a lot of the time, I certainly know of cases where that’s happened where they’ve said, “Oh, they were deteriorating anyway, so this is just part of the journey.” Whereas they haven’t really highlighted, well, could that have been prevented if they’d have had better care, or more involvement with nursing care?

I worry that we’re heading down that same path of that there’s just going to be more and more people who have serious complications because they’re not being provided with the right level of care, because clients have either been misled to think that they’re not going to get nursing care funded, or they haven’t got the right advocates who are advocating on their behalf to say, “Well, actually, you can get funding for nursing care”, and you just need the right evidence and the right rationale to say that, “This is why you need it.”

We’re certainly not advocating for nurses for everybody because not everybody needs it. But where they do and there’s evidence that it makes a difference to their life and their goals, because that’s what’s important. People with disabilities have goals for their life. If having nursing care involvement means that they get to fulfil those goals and make their life better and improve their health and wellbeing, then that’s what we should be advocating for.

I worry that we’re going to head down the same path where we have these people dying unnecessarily, or having serious consequences unnecessarily, and that we end up in another Royal Commission when we know that this is happening. We know that it really is not a hard fix.

Patrik Hutzel:  No, it’s not a hard fix. It’s certainly not a hard fix, no, no. On a much bigger picture level, we need to move more and more care of people, whenever appropriate, into the community to improve their quality of life, but also take the pressure off the hospitals. It’s not only about what level of care is someone getting in the community, it’s also about looking at the bigger picture. At hospitals, there’s backlogs everywhere. There’s bed blocks everywhere. From my perspective, we are providing a win-win situation here by taking people home, taking pressure off the health system, and more importantly, improving the quality of life for the people.

Kristi Gilbert:  Oh, a hundred percent. Nobody wants to be in hospital. When people with disabilities are in hospital, they miss out on all of the community engagement and all of the things that make their life more fulfilling. So, we want to keep them at home as much as we can because that’s their goal as well. Providing them with the right care means that they have all of those opportunities, which they don’t get once they’re in hospital, just through the nature of why they’re there.

Patrik Hutzel:  Absolutely. Absolutely. Kristi, can you talk lastly, the other thing we haven’t touched on in much detail is, can you talk a little bit about AHPRA, our overseas RN and our AHPRA guidelines? How do they impact on or interact with what we’ve been talking about today?

Kristi Gilbert: Yeah, look, I think that’s really important is that as registered nurses, we are accountable to AHPRA and the nurses’ board. They are who govern our registration and set the standards for our professional care that we deliver. Every year when we redo our registration and we tick all those boxes and sign off at the bottom that we will maintain our CPD and that we’ll practice in accordance with the code of conduct, and the international code of ethics, and the professional standards for whether you’re an RN, or an EN, or a midwife, that we understand what we’re actually signing. And that we have read those documents because they do form the basis for our practice.

A lot of them are guidelines, and they’re not specific to everybody’s role, but they are involved in everybody’s role. No matter what level of education you’ve got, whether you’re a RUSON (Registered Undergraduate Student of Nursing) or a grad, or you’ve got 30 years of experience, they are appropriate and applicable to every level of nursing care, in every environment that we work in. Whether it be community, in somebody’s home, whether it be in a hospital, aged care, it doesn’t matter. We have to make sure that we’re practicing in accordance with those guidelines. So, the delegation is part of that as well, and just understanding what governs our practice is really important.

Patrik Hutzel:  Yeah, yeah, absolutely. That’s also where insurance is coming in, that if we do go against our AHPRA guidelines and we do delegate against AHPRA guidelines, no one is going to insure us as part of our professional indemnity.

Kristi Gilbert:  Well, that’s right. I mean, you risk being reported if you’re breaching those guidelines, those codes of conduct and the professional standards, you risk being reported to AHPRA. If you have done the wrong thing, then you will face consequences. One of those consequences can be that you end up in VCAT (Victorian Civil and Administrative Tribunal), having to argue your case, and potentially facing your registration being suspended or removed. It’s certainly happened before.

Patrik Hutzel:  Yeah, absolutely. Absolutely. Kristi, what would be your advice if, let’s just say an NDIS Support Coordinator comes to a provider and says, “Hey, you’ve got registered nurses on your books. Can your registered nurses train those support workers on ventilation, tracheostomy? Can you show them the hands-on stuff?” What would be your advice to an RN or a CCRN in a situation like that?

Kristi Gilbert:  I would be looking really seriously at reading the delegation guidelines, for starters. They’re really clearly outlined on the nurses’ board website. There’s also a position statement from the ANMF (Australian Nursing and Midwifery Federation) on delegation, which explains it quite clearly in layman’s terms, which I think is quite good if you’re not used to reading those other documents, which can sometimes be a little wordy. But it is really on you to understand what that delegation requirements are.

If you don’t feel like that is a safe thing and that it’s within your own scope of practice, or the person that you’re potentially having to train, most nurses are not educators, unless you’ve got a qualification to educate people, you really shouldn’t be put in that position where you’re having to train someone without understanding what you’re doing and what responsibility falls back on you.

My advice would be, if that’s the position that you’re finding yourself in, is to seek some legal advice. Everybody is entitled to that through their professional indemnity insurance, which every registered nurse has to have, and to really clarify what that role is for you, and whether or not it’s appropriate for you to be doing that. If you don’t feel like it is, you need to speak up because it’s your registration on the line, it’s your career that you’ve worked hard for, why would you risk that for anybody?

Patrik Hutzel:  Yeah, absolutely. Absolutely. No, thank you. Thank you.

Well, Kristi, thank you so much for sharing all your wisdom and your insights there. Also, thank you for all the work that you’ve done for us so far.

Kristi Gilbert:   Thanks for having me.

Patrik Hutzel:  Kristi, where can people find you if they want to engage you or continue the conversation on another level, where can people find you?

Kristi Gilbert:  Yeah, So I’ve got a website. It’s at Unity LNC for Unity Legal Nurse Consulting. So unitylnc.com.au. There’s a contact me button on there, or my phone number’s there if anyone wants to have a chat about it or wants to contact me through the website.

Patrik Hutzel:  That’s great. Okay. Well, thank you again, Kristi. We’ll wrap this up here.

Now, if you need help with Intensive Care at Home, go to intensivecareathome.com and contact us on one of the numbers on the top of our website, or send us an email to [email protected].

We also provide Level 2 and Level 3 NDIS Support Coordination. We do provide specialist NDIS nursing assessments.

We do currently have jobs for CCRNs, predominantly in Melbourne, Sydney, Brisbane, but also in Albury, Wodonga, Port Macquarie, Bendigo, and in Warragul in Victoria.

If you are an intensive care specialist watching this and you have bed blocks in your ICU, I would encourage you to reach out to us. The same if you’re a hospital executive watching this, you should contact us to help you eliminate your bed blocks.

We have also sent our critical care nurses to provide an emergency department bypass services, so there’s a number of services we can help you with.

Thanks again, Kristi, for coming on to this podcast.

Kristi Gilbert:  Thanks Patrik.

Patrik Hutzel: If you like my videos, subscribe to my YouTube channel, click the like button, click the notification bell, and share the video with your friends and families. Thanks again for watching.

This is Patrik Hutzel from intensivecareathome.com.

Thanks again, Kristi. Take care.

Kristi Gilbert:  Thank you.