The Employer's Notification About a New Graduate
A regional ambulance service employs Ms Nguyen, a newly registered paramedic who graduated 7 months ago. Over 3 months, three separate incidents are logged: (1) she administered adrenaline by the wrong route to an anaphylaxis patient, who recovered; (2) she failed to recognise a deteriorating head-injury patient and delayed transport by 25 minutes; (3) a colleague reports she 'freezes' during high-acuity jobs and has twice asked others to lead. No patient has died. Her clinical team manager believes she is 'unsafe' and wants to notify the Board. The service's education lead believes she is a competent new graduate who needs support and that notification would be punitive. Ms Nguyen has not been told a notification is being considered. She has completed her CPD and has no health or criminal history issues. The service is an employer for the purposes of the National Law.
1. Advise the service on whether it has a mandatory notification obligation, and distinguish mandatory notification from a voluntary notification.
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The service must ask two separate questions.
Is this a mandatory notification? As an employer of a registered health practitioner, the service must notify the Board if it reasonably believes the practitioner has behaved in a way that departs significantly from accepted professional standards or that the practitioner's health or performance places the public at risk. The threshold is a reasonable belief, not proof, and the test is significant departure - not any error.
On these facts: three incidents in 3 months, including a wrong-route administration and a delayed transport in a deteriorating patient, plus reported freezing in high-acuity situations, could support a reasonable belief of a significant departure from accepted standards, particularly the failure to recognise deterioration. That is enough to make notification arguably mandatory. The employer should not decide the question solely on the manager's or educator's personal view; it should apply the statutory test and document its reasoning.
Mandatory vs voluntary. A mandatory notification is required by law when the threshold is met; failing to notify can itself be an offence. A voluntary notification is a report made where the threshold is not met but the notifier still has concerns. The service can make a voluntary notification even if it concludes the mandatory threshold is not met, but it cannot use 'we chose to support her instead' to avoid a mandatory notification if the threshold is met.
Practical point. The service should also consider whether its own response (supervision, remediation) is adequate to manage risk in the meantime; notification and support are not mutually exclusive.
2. What process should the service follow before and after notifying, including its obligations to Ms Nguyen?
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Before notifying:
- Gather the facts: incident reports, patient care records, statements from crew and the receiving hospital, and any performance reviews.
- Put the concerns to Ms Nguyen and give her an opportunity to respond; natural justice applies, and she should not learn of a notification from the Board.
- Consider whether there is an immediate risk requiring a change in duties (for example, not rostering her as the sole clinician on high-acuity cases) pending resolution.
- Decide and record whether the mandatory threshold is met.
Notifying:
- Notify promptly; delay can itself be a breach. Include the facts, not conclusions, and identify the patients and incidents.
- Tell Ms Nguyen that a notification has been made, what it contains, and what happens next.
After notifying:
- Cooperate with the Board, provide records on request, and keep the Board informed of any change in circumstances.
- Continue appropriate supervision and support; a notification does not suspend the employment relationship automatically.
- Do not treat her as guilty; the Board's process is protective and investigative, and many notifications result in no further action or in conditions.
The educator's concern about punitiveness is addressed by support, not by suppressing a notification. The manager's concern is addressed by evidence, not by assertion.
3. How would the Board likely categorise this matter - performance, health, or conduct - and what pathways follow?
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The facts point primarily to performance, not health or conduct.
- Performance concerns competence and skill: wrong-route administration, failure to recognise deterioration, and difficulty leading high-acuity jobs are classic performance indicators. The pathway is usually a performance assessment, possibly followed by conditions such as supervised practice, a structured education plan, and review.
- Health would be indicated if there were evidence of impairment, illness, or fatigue-related incapacity. There is none on these facts.
- Conduct would be indicated by deliberate departures - practising outside scope, dishonesty, or refusing to follow protocols. Errors by an inexperienced practitioner are usually performance, not misconduct.
The Board's triage would consider the seriousness and recency of the incidents, the practitioner's insight, and whether the employer has already put remediation in place. Because she is a new graduate, the Board would weigh the transition from student to independent practice and the level of supervision she received. Possible outcomes: no further action with a recommendation for employer support; conditions requiring supervision and education; or a performance assessment. Immediate action (suspension) is unlikely unless there is evidence of ongoing serious risk that supervision cannot manage. The key exam point is that the pathway should match the problem: performance concerns call for assessment and remediation, not punishment, and not silence.