Introduction
Demands on rural health care professionals are increasing. Shortages of skilled registered
nurses and General Practitioners ('GPs') in rural areas mean that health care professionals
need to work together more effectively in order to provide sustainable high quality care for their
communities.
The Rural Collaborative Practice Project ('the Project') has been established to test a new
model of collaborative practice between GPs and registered nurses who provide emergency
care in rural hospitals and health services. The Project involves introducing the Primary Clinical
Care Manual ('PCCM') into selected hospitals and health services in rural Victoria. The PCCM
has been developed and is maintained by the Queensland Government (Queensland Health)
and contains guidelines for the management of patients with low acuity to high acuity
presentations. Introduction of the PCCM will provide a basis for GPs and registered nurses
who provide emergency care in rural hospitals and health services to support each other within
a defined clinical framework.
Bass Coast Regional Health, Cann Valley Bush Nursing Centre, Mansfield District Hospital,
Omeo District Health and Stawell Regional Health will be the first Victorian pilot sites for the
implementation of the PCCM and the associated Rural and Isolated Practice Registered Nurse
training program ('RIPRN'). All pilot sites are rural hospitals and health services that rely on
local GPs to provide medical support to their emergency services.
The Project will facilitate introduction of a new model of emergency care that allows GPs and
registered nurses working in rural areas to work collaboratively and flexibly and involves
strategies to reduce the workload of on-call GPs and advance the clinical practice of registered
nurses to support their management of emergency presentations.
The purpose of this manual
Some participants in the Project have raised questions about the medico-legal implications of
advancing the clinical practice of registered nurses and of a more collaborative, team-based
model of care. Some are concerned that their potential liability may be greater if things go
wrong; others are unsure about who bears legal responsibility for the care of the patient; and all
are interested in how medico-legal risk is best managed.
The provision of emergency care is known to be a relatively higher risk area of practice with
respect to medico-legal claims, but it is neither clear nor inevitable that advancing the clinical
practice of registered nurses who provide emergency care in rural hospitals and health services
will result in a corresponding increase in their medico-legal risk.
The manual recognises that medico-legal risk is a reality for all health care professionals, but
that if it is understood and managed well it can be controlled. Registered nurses who provide
emergency care in rural hospitals and health services will be supported to provide care of an
appropriate standard. The tools and supports provided through the Project to registered nurses
and other health care professionals are designed to support safe practice and reduce medicolegal risk in rural emergency care. The provision of training (through RIPRN); clinical guidelines
(through PCCM); and support for GPs, nurses, hospitals and health services to collaborate and
agree on their roles and how they will manage emergency presentations all are expected to
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assist significantly with the management of medico-legal risk. In particular, the skills-based
application of clinical guidelines and improved documentation and communication which are
supported by the Project are key risk management tools.
The manual outlines some of the legal issues that participants in the pilot programme have
raised. It focuses primarily on the law of negligence and explains the elements of negligence,
the ways in which health care professionals can be liable for negligent acts and the potential
impact of a more collaborative model of care and/or of advancing the clinical practice of
registered nurses in rural hospitals and health services.
The Australian legal system
The legal system in Australia is based on legislation and common law.
Legislation forms the framework of the law and exists in 2 forms:
x statutes, or Acts; these are made by Parliament, both at Commonwealth and State
levels; and
x delegated or subordinate legislation, made under the Acts (i.e. regulations, rules);
these are made by individuals or bodies authorised to do so by Parliament.
Legislation has supremacy over common law. There is a plethora of legislation which is
relevant to health care professionals, some of which will be discussed in this manual.
Common law is essentially judge-made law (case law) and is used to interpret common legal
principles as well as legislation. Case law creates a precedent in the law so findings of the
court will be influenced by similar cases previously decided. The precedent effect of case law
can cross different jurisdictions,
so for example the finding in an English case may have bearing
on a similar Australian case.
The law is fluid, and ever changing. Particularly in the field of medical law, where the law must
keep pace with scientific and socio-political developments, new cases will always be presenting
before the courts. Although it can be difficult to predict with any certainty what decision a court
will make when faced with a novel situation, there are some common principles that apply to the
law of negligence
