Hi,
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I am writing to bring a recent decision of AHPRA to the attention of podiatrists working in the public sector in Australia, as I feel it has much wider implications.
I am a Qld Health podiatrist and last year I was working alongside a diabetes educator (Registered Nurse). On this particular day I was treating patients at a nursing home but unbeknown to me an outpatient appointment had been made for one of my patients in the community clinic. I did not know about this appt until somebody rang me to tell me that the patient was waiting. I was therefore late for the patient c 1 hour but the appt letter said a 2 hour wait was considered normal.
I had previously assessed this patient and my care plan involved managing her painful ingrown nails. I had planned to discuss nail surgery with her at our next appointment. However, on my arrival for her appointment at the community clinic the diabetes educator (Nurse) had given herself authority to step in without my permission or knowledge and treat or rather cut this patient's nails. On enquiring why she had treated my patient without even advising me beforehand she responded by saying treating podiatry patients was within her scope of practice. In addition, she had not even seen the patient's chart or care plan as I had collected the patient's chart myself on my way back to the clinic.
I put in a notification complaining to Qld AHPRA about what had happened as I felt this nurse was well out of her scope of practice, without authorisation. I subsequently received the following decision from AHPRA:
"The Committee does not consider the practitioner's performance to be unsatisfactory as:
i. The Committee notes that nurses are required to provide treatment to outpatients in a broad range of clinics. As such, the patient being a podiatry outpatient does not necessarily mean treatment carried out by a nurse should be considered beyond their scope of practice.
ii In her submission the practitioner indicated she advised the patient she was not a podiatrist, furthermore the treatment provided was limited to cutting the patient's nails, providing limited/general advice and providing a foot massage. The Committee does not consider this treatment to be beyond the practitioner's scope of practice having considered the practitioner's training and experience.
iii You identified the patient had presented for treatment for ingrown toe nails and the practitioner had cut the patients nails. However, the Committee considers the practitioner's submission that the patient had cut the corners of the nails, prior to the consultation, and her cutting of the nails was to 'straighten them' demonstrates satisfactory performance.
iv The Committee also considered that the practitioner's reason for initiating treatment on the patient was reasonable in the circumstances. The patient had been waiting for a number of hours (Note to Podiatry Arena readers - this is completely wrong, the nurse's own patient notes stated the patient had been waiting for less than an hour and the Nursing & Midwifery Board came to this conclusion even though I and the diabetes educator had put the patient had been waiting for about an hour) and the practitioner had been advised you had been further delayed".
I am absolutely flabbergasted by this decision.
This decision suggests that AHPRA thinks it is entirely acceptable for a nurse to come into any podiatry clinic and treat a podiatry patient (who has been referred to the podiatrist, not to the nurse) without benefit of the clinical notes or care plan, and without any authorization or delegation from the podiatrist, and that this action is "within their scope of practice"??? I found out after the situation that the diabetes educator nurse had done a basic foot care course many years ago, but have no evidence of its currency or syllabus.
This response has implications for all podiatrists working in the public sector and I am interested in hearing whether any other podiatrists (especially those working in Australia) find this decision problematic?
Thanks
Helen
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