A really good question and lets start the conversation

 This is my current deep dive, and I look forward to finding an answer. A young person in my life asked an innocent question, and it sent me on a profound path, resharpening my research skills. The question was: if a community nurse comes into a Supported Independent Living (SIL) home and trains the staff to perform a medical task, say injections or simple wound care, and the client is harmed by a support worker carrying out that task, who is to blame?

This seemingly simple question raises a host of ethical and practical issues:

• Was the training adequate?
• Were the staff paying attention during training?
• Was the nurse qualified to train others, or were they a registered nurse rather than a nurse educator?
• Were there enough resources, like time and hygiene, to safely perform the task?
• What role do the overall cleanliness of the house and the behaviour of other residents play in this?

But then the bigger questions arise:

• Where does one go to report harm?
• Whose code of ethics applies?
• Are the support staff in general abiding by policies, procedures, and medication guidelines?
• Are the SIL house ratios being maintained, or are other clients being added without consent?

These questions open up broader issues about the behaviour and suitability of support workers:

• Are they the right match for the clients?
• Do they understand the importance of reading case notes, care plans, feeding management protocols, and behaviour management plans?
• Are they being asked to do tasks outside their scope of practice?

Reporting harm involves multiple professional and regulatory bodies. The first point of contact would be the NDIS Commission. From there, it could extend to:

• AHPRA (Australian Health Practitioner Regulation Agency)
• The Health Department
• Professional organizations like the Pharmacy Guild, FRANZCP, OT Australia, and others

Then there’s the question of systemic harm caused by the NDIA itself. As public servants, NDIA staff are bound by the APS Code of Ethics, yet funding cuts and legislative decisions often shift the burden to other departments, such as health and education. This creates gaps in early intervention, individualized education plans, and therapeutic facilities for those with mental health issues that cannot be managed in the community.

When we talk about "causing harm," it’s important to define what we mean. Is it asking untrained support staff to perform tasks they’re not equipped for? Or is it failing to provide the funding needed for qualified clinical staff to perform those tasks?

Good organizations understand their policies and procedures, but too often, support staff are scapegoated. While it’s easy to find people willing to enter the industry, retaining well-trained and experienced workers is the real challenge.

This rabbit hole raises yet more questions about care, support, and the intersection of ethics, legality, and duty of care. For example:

• When does saying "no" to a task become a legal issue?
• Should harm minimization take precedence over client choice and control?
• What happens when WorkSafe gets involved due to safety concerns?
• If a client is on a weight-reduction plan, what happens when staff undermine it by making decisions without clinical approval?

This isn’t just a wormhole—it’s a rip in the space-time continuum of support work and training. Yet, this question has reignited my passion for content creation and advocacy.

Do we need to rewrite training for support workers to be more clinically focused? Or would that bring us back to the days of block funding, abandoning person-centred care? What happens when a support worker is unfit for a role due to injury or recovery, but no replacement can be found, and harm minimization is prioritized over appropriate staffing?

Ultimately, we need to evaluate whether policies are working, whether staff understand their roles, and whether performance reviews should emphasize supporting more than one person without favouritism.

This journey is one I’m bringing you along for, and while I hope to find answers, I suspect it will raise more questions. This situation is so common it could happen to anyone. I have my own thoughts, but I’ll keep them to myself for now to avoid muddying the waters.