Nurse practitioners
Nurse practitioners are highly skilled registered nurses endorsed by the Nursing and Midwifery Board of Australia (NMBA).
In the ACT, nurse practitioners are autonomous practitioners who can work independently in private practice or as part of a treating team within the public health system. Nurse practitioners are able to:
- assess and diagnose medical conditions
- prescribe medicines
- order and interpret tests such as x-rays, ultrasounds and blood tests
- provide referrals to medical or allied health specialists.
The Nurse Practitioner's Journey.
Obtaining endorsement as a nurse practitioner
The Nursing and Midwifery Board of Australia (NMBA) endorse registered nurses as nurse practitioners. To obtain endorsement, you must be a registered nurse and have additional qualifications and specific expertise that meet the nurse practitioner endorsement standards .
Practice authority and scope of practice
‘Practice authority’ refers to what a profession is legally allowed to do by law. ‘Scope of practice’ covers activities that the individual professional (ie. Nurse Practitioner) is legally allowed to do and competent to perform.
As a nurse practitioner, you’re fully responsible and accountable for your actions and decisions in practice.
Upon gaining employment as a Nurse Practitioner, you and your employer agree jointly on your scope of practice, aligning with the requirements of your role.
The public sector authorisation process
If you’re a nurse practitioner working in the private sector, you must go through a formal credentialing process. This process enables your specific work responsibilities (your employed scope of practice) to be approved.
In the ACT public sector, the Minister for Health, using the Health Act 1993, gives credentialing committees the authority to do this.
The main reason for credentialing is to keep the public safe and to allow you, as a nurse practitioner, to use the full range of your skills and knowledge within your specific role.
The private sector authorisation process
Follow professional rules
As a nurse practitioner, you must follow professional standards and guidelines for practice set by the NMBA, as well as obey local legislation and regulations.
Private employers should consider credentialing
The ACT Government recommends that private sector employers create their own credentialing processes. These processes should be fit for your specific situation, the health practitioners you hire, and the kind of work you do.
Rules for standalone clinics
Like other private sector employers in the health industry, nurse practitioners working in standalone clinics must follow local requirements, such as work health and safety laws.
Australian Business Licence and Information Service
The ACT Government recommends you use the Australian Business Licence and Information Service (ABLIS) when setting up a clinic to understand requirements.
Licence for skin procedures
Standalone nurse practitioner clinics in the ACT must apply for an infection control licence if any procedures are undertaken that break the skin. This requirement doesn't apply to general practices that have medical practitioners.
Guides for nurse practitioners
To find out more about nurse practitioners’ scope of practice and how to gain endorsement, review the following resources from the Nursing and Midwifery Board of Australia:
- Nurse practitioner standards for practice
- Safety and quality guidelines for nurse practitioners
- Fact sheet: advanced nursing practice and specialty areas within nursing
- Useful documents: endorsement as a nurse practitioner
- Fact sheet: endorsement as a nurse practitioner
What nurse practitioners can do in the ACT
Sick certificates and medical certificates are different documents.
As a nurse practitioner in the ACT, you can issue a sick certificate for people who are unwell and can't go to work.
A sick certificate serves as a statutory declaration for the patient’s employer.
Only registered medical practitioners can provide medical certificates – nurse practitioners can't. This is set out in the Fair Work Act 2009 (Cth) and Workers Compensation Act 1951.
It’s an offence for you to provide a medical certificate. This is known as ‘holding out’ under sections 116 and 118 of the Health Practitioner Regulation National Law 2010 (Cth).
You can issue a sick certificate for any number of days as there is no set limit. It depends on the patient’s situation and employer policy.
As a nurse practitioner, you can also sign off attendance and carers’ certificates for employers of patients through the statutory declaration process.
You can provide these certificates when an employee misses work for a medical appointment, or if they are well but caring for an unwell family member.
Nurse practitioners in the ACT can assess, diagnose, and treat work-related injuries within their employed scope of practice.
However, under the Workers Compensation Act 1951 (ACT) and Work Health and Safety Act 2011 (Commonwealth) you can't authorise workers’ compensation or Comcare certificates. A medical practitioner must complete this.
Nurse practitioners in the ACT can assess a person’s fitness to drive within their employed scope of practice.
However, under the Road Transport (Driver Licensing) Act 1999, you can't authorise the paperwork required as evidence by the ACT Road Transport Authority. This paperwork must be completed by a medical practitioner.
If you identify a patient as unfit to drive, it’s not compulsory to report it.
You're not civilly or criminally liable for:
- assessing a patient
- reporting a patient who may be unfit to drive.
Under the Medical Treatment (Health Directions) Act 2006 (ACT), nurse practitioners and other health professionals can witness non-written health directions, but one of the 2 witnessing professionals must be a medical practitioner.
You can't substitute for a medical practitioner for this purpose.
As a nurse practitioner, you can request any diagnostic pathology or imaging examination within your scope of practice.
Like medical practitioners, you may interpret any diagnostic pathology or imaging examination within your scope of practice.
Subsidy of diagnostic pathology or imaging through the Medicare Benefits Schedule (MBS) or other funding mechanisms doesn’t relate to your practice authority.
However, your employed scope of practice may limit which diagnostic examinations you can request and interpret.
As a nurse practitioner, you can prescribe any S2, S3, S4 or S8 medicine within your scope of practice for your role. When you prescribe controlled medicines in the ACT, you must comply with Controlled Medicines Prescribing Standards.
However, you can’t prescribe medicines listed in Appendix D Medicines in the Medicines, Poisons and Therapeutic Goods Regulation 2008.
Authority to practice on patients living outside the ACT
Authorisation to practice isn’t required for patients living in different states or territories, as long as you provide care within ACT borders.
For telehealth services, you must follow the law in the state or territory where the patient lives.
This is important for acts relating to:
- medicines
- poisons
- therapeutic goods.
Concerns about care a nurse practitioner provides
If you have a concern about the care a fellow nurse practitioner has provided, raise your concerns with the practitioner involved. If you don’t feel comfortable doing so, contact either:
- the nurse practitioner's employer
- ACT Human Rights Commission
- Australian Health Practitioner Regulation Agency.