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Self-employed RNs and NPs

What do you need to consider?

​All CRNBC registrants are required to practice in accordance with the College's Standards of Practice (Professional Standards, Practice Standards, Scope of Practice Standards). The intention of this guide is to provide a checklist to help identify your primary responsibilities as a self-employed registered nurse or nurse practitioner so that you practise according to related legislation, regulations, bylaws and standards. While CRNBC Standards of Practice, bylaws, policies and guidelines apply to RNs and NPs in all practice settings, there are some aspects of these that have particular importance for RNs and NPs who practise in a self-employed role.

Note

Each CRNBC registrant is accountable for the practice she or he provides to the public. CRNBC has developed resources to assist RNs and NPs to provide safe and ethical care. These resources are intended to support, not replace, the exercise of professional judgment of RNs and NPs.

It is strongly recommended that persons interested in self-employed practice consult a lawyer, accountant and/ or business consultant regarding contracts and business processes. ​

Legislation and Regulatory Requirements

CRNBC is the self-governing body empowered under the Health Professions Act to regulate the practice of B.C.'s registered nurses and nurse practitioners.

  • Review the Health Professions Act, Nurses (Registered) and Nurse Practitioners Regulation and CRNBC’s Legislation Overview to ensure that your practice is within the defined scope of practice for RNs and NPs and is recognized as the practice of nursing.
  • Review CRNBC’s Legislation Relevant to Nurses’ Practice to learn about federal and provincial legislation relevant to the practice of nursing.
  • Become familiar with the CRNBC Bylaws, which provides direction for the collection of patient information and for the marketing of professional services.
  • Ensure compliance with other relevant health-care, privacy and business legislation.
Standards of Practice

CRNBC’s Standards of Practice set out practice requirements for all registered nurses and nurse practitioners and must be met by those in private practice.

  • Professional Standards provide an overall framework for the practice of nursing in B.C.
  • Practice Standards set out the requirements related to specific aspects of nursing practice. Practice Standards of particular significance to self-employed practice include:, Consent, Documentation, Duty to Provide Care, Privacy and Confidentiality, Boundaries in the Nurse-Client Relationship, Conflict of Interest, and Appropriate Use of Titles by Nurses.
  • Scope of Practice Standards articulate the standards, limits and conditions for RN and NP practice in separate documents. Scope of Practice Standards for NPs is further specified for family, adult and pediatric NP practice. For RNs, the CRNBC Standards for Acting Without an Order in the Scope of Practice Standards for Registered Nurses provide direction for independent practice and decision making.
Quality Assurance

Quality Assurance requirements are set out for RNs and NPs for their annual renewal of practising registration. These include:

  • Self Assessment
  • Practice Hours Requirements
  • Reporting (Personal Practice Review) Requirement

Nurse practitioners must meet additional quality assurance requirements stemming from the legislated scope of nurse practitioner practice, which exceed those required for registered nurse practice. These include an on-site peer review and chart audit for quality assurance purposes.

Use of Title
Conflict of Interest
  • Review the CRNBC Practice Standard Conflict of Interest.
  • Avoid any actual or perceived conflict of interest by maintaining a practice of transparency with all clients and with current employers regarding your self-employed practice.
  • Adhere to the CRNBC Bylaws on marketing/sale of products
Information Management/Documentation

Information management policies for self-employed RNs and NPs are guided by:

  • CRNBC Bylaws
  • Documentation Practice Standard
  • Privacy and Confidentiality Practice Standard
  • Develop policies and procedures for all aspects of information management, including the type and frequency of documentation, storage, destruction and access to records.
  • Documentation is expected to be timely and to include appropriate reports of assessments, decisions about client status, plans, interventions and client outcomes as well as consultations with other health care providers.
  • The principles underlying documentation are the same for paper or electronically generated documentation.
  • Client records are to be treated as confidential and must be stored and physically secure 24 hours a day.
  • There are legal requirements regarding the retention and destruction of health records. Please refer to the Limitation Act.
  • If you are away from your practice for a lengthy period or close your business, you must ensure safe storage of records and provide a way for individual clients to have access to their personal records.
  • Review the B.C. Personal Information Protection Act which governs the use, collection, storage and disclosure of personal information.
  • The Personal Information Protection and Electronic Documents Act (PIPEDA) applies to federally regulated undertakings.
Consent
  • Review the CRNBC Practice Standard Consent for legal and ethical obligations regarding client consent for care.
  • Develop policies related to client consent and determine when a written, signed consent may be useful.
  • Assess each client’s understanding of the nursing care or treatment to be provided and document the understanding.
Duty to Provide Care
  • Review the CRNBC Practice Standard Duty to Provide Care, which sets out professional obligations related to a legal duty to provide safe, competent and ethical care.
  • NPs have an ethical obligation to be available to provide care for their established clients on a 24 hours basis either personally or through ongoing call schedules. See Standard B3 in the Scope of Practice for Nurse Practitioners (Adult, Family Pediatric).
  • Negotiate a mutually acceptable withdrawal of service or arrange for suitable alternative or replacement services if care cannot continue to be provided.
  • Use an ethical decision-making framework when there is concern that provision of care puts the care provider or their clients at risk.
Quality Improvement and Risk Management
  • Establish a system to identify risk management issues and to make changes to practice to ensure safe care.
  • Develop a professional support system to allow for discussion of personal and professional challenges and to facilitate sharing of ideas related to care delivery.
Marketing/Advertising
  • Have a written description of how your nursing services will be marketed.
  • Market services in a way that is congruent with CRNBC Bylaws.
  • Advertise services in a factual manner.
  • Do not exaggerate or mislead regarding the nature of services to be provided.
  • Avoid making reference to guarantees of services or results and comparatives or superlatives.
  • Understand the difference between soliciting business from members of the public and potential referral sources.
Business/Financial Records
  • Keep business/financial records separate from client records. Retain business records as required by the Canada Revenue Agency.
  • Keep financial records for every client to whom you have charged a fee. Itemize the service provided, the cost of the service, the date care was provided and the money received.
Business Plan
  • Have a written description of your intended nursing practice and how services will be provided.
  • Consider such elements as: business structure; registering your business; financing; business records; business insurance; Employment Standards Act; WorksafeBC coverage; GST payments; and income tax.
  • Seek out resources to assist you with setting up and maintaining your business. Consult a lawyer, accountant and /or business consultant. Online resources include:
    - Canada Business: Starting a Business
    - Small Business BC: Starting a Business
Professional liability protection

​All individual practicing CRNBC registrants are required by CRNBC bylaws to have Professional Liability Protection (PLP). 

CRNBC registrants automatically become beneficiaries of the Canadian Nurses Protective Society (CNPS) upon initial registration, and that status is renewed annually at registration renewal.

Seek legal advice prior to entering into a contract to provide nursing services. 

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 Need help?

For further information on the Standards of Practice or professional practice matters, contact us:

  • Telephone 604.736.7331 ext. 332
  • Toll-free in Canada 1.800.565.6505
  • Email practice@crnbc.ca
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