Nurses have an obligation to provide safe, competent and ethical care to their clients, in accordance with BCCNM’s Standards of Practice and relevant legislation.
You can transfer care for a pregnant client to a physician or midwife at any agreed upon time during the pregnancy and before delivery. This is a decision influenced by factors such as maternal/fetal complexity and risk, your individual competence providing prenatal care, and care provider preference.
Make sure you inform your prenatal client early on that another provider will be involved in their care, including performing the delivery. You’ll need to consult with the midwife or physician at an appropriate time to determine the best approach for your client’s care. Possibilities include:
If the client does not have a physician or midwife, discuss with the client and refer to an appropriate physician/midwife.
Consultation and referral standards in the Scope of Practice for NPs.
NPs have a
Duty to Provide Care and should avoid any actions that could be seen as abandonment of care. However, NPs may be required to discontinue their professional relationship with clients when the NP-client relationship is eroded to the point where NPs can no longer meet their professional obligations toward the client. Ending the professional relationship when a client has not requested it and still requires care, is generally a measure of last resort.
If the NP-client relationship no longer seems therapeutic, you may need to discontinue that relationship. When this occurs, consider the following:
Provide your client with:
While you are not obligated to continue to care for a client indefinitely, you must not abandon a client in an emergency where harm may be imminent. In the event of a complaint to BCCNP, abrupt discontinuation of necessary medical care and treatment may constitute unprofessional conduct. The following are examples of situations where ending the NP-client relationship may be appropriate:
The following are examples where ending the NP-client relationship is not appropriate:
Review CNPS information on
ending the NP client relationship.
Thank you to the College of Physicians and Surgeons of BC for permission to adapt their content.
If you think providing care would put you at risk, you may withdraw from providing care or refuse to provide care. Think about your legal, professional, and contractual responsibilities and use an ethical decision-making process to help you make the decision. The
Duty to Provide Care practice standard provides more information and guidance about your legal and professional obligations to clients.
It's important to work with the client, co-workers, and your employer to develop a plan that allows for client care and for your safety.
Nurses have a professional and legal duty to provide clients with safe, competent and ethical care, and the client has a right to receive care. Do not allow your personal judgments about a client, or the client's lifestyle, to compromise the client's care by withdrawing care or refusing to provide care.
While you cannot abandon your clients, do not put yourself or clients in situations where giving care might be a danger to personal safety - violence; communicable disease; physical, verbal, or sexual abuse.