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​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.

Practice Standard

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FAQs

As a family nurse practitioner, when do I have to transfer care of a pregnant client to a physician or midwife?

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:

  • You assume primary responsibility for prenatal care until an agreed upon gestation, then transfer care to the physician/midwife, or
  • You and physician/midwife agree to share care. Clarify with the physician/midwife who will assume responsibility for various aspects of prenatal care, or
  • You immediately transfer care to the physician /midwife.

If the client does not have a physician or midwife, discuss with the client and refer to an appropriate physician/midwife.

See the Consultation and referral standards in the Scope of Practice for NPs.

Can I end an NP-Client relationship when it becomes non-therapeutic?

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:

  • Work with the client and others to develop and implement strategies to resolve issues impacting the NP-client relationship wherever feasible. Make reasonable attempts to resolve the situation first as this decision may have negative consequences for the client, such as limiting their access to medical care. 
  • Do not allow personal judgments about a client or the client’s lifestyle to compromise the client’s care by withdrawing or refusing to provide care.
  • Do not base your decisions on reasons that are discriminatory under the BC Human Rights Code, including:  race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental disability, sex, sexual orientation, gender identity or expression, and age.
  • Document the reasons for the decision to discontinue services in the client’s medical record, including a description of actions taken to resolve issues prior to ending the relationship, and accommodations made to ensure continuity of care.
  • Where possible, assist the client to find an alternate provider or allow the client a reasonable amount of time to find an alternate provider.
  • Continue to provide essential health care services such as renewing prescription medication and arranging for appropriate follow-up on any diagnostic tests ordered whenever feasible until another provider has been identified .
  • Seek legal/risk management advice from the Canadian Nurses Protective Society.

Provide your client with:

  • written notification of the decision to discontinue care and discuss the reason for this decision, unless meeting with the client is a safety risk.
  • a copy of their medical record, or transfer the client’s medical record to another NP, physician or clinic in a timely manner.
  • a time frame to find another NP, physician, or clinic. This varies depending on the circumstances of the situation, including the client’s medical condition.

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:

  • client exhibits threatening or abusive behaviour towards the NP and/or staff, including behaviour or comments of a sexualized nature
  • client makes a declaration of non-confidence in the NP
  • client’s behaviour is such that the primary care practice is not being utilized as the primary medical home by the client (e.g. attending other clinics unnecessarily)

The following are examples where ending the NP-client relationship is not appropriate:

  • prohibited by the BC Human Rights Code
  • client’s objectionable behaviour is reasonably attributable to cognitive impairment, unless it is determined that the client poses a significant safety risk to the NP and/or staff
  • client respectfully declines to follow the NP’s advice
  • client seeks treatment to which the NP objects based on scientific, conscience or religious beliefs

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.

Sometimes I’m concerned about my safety when my practice takes me into certain environments. What can I do to keep myself safe?

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.  

For example:

  • Make sure the environment is safe by having the client remove any offending material or persons before your visit.
  • Negotiate a treatment plan with the client that states the terms under which care will be provided.
  • Arrange for another nurse to partner with you when doing home visits.
  • Make sure you have a way to call for help in an emergency (i.e. cell phone)​.
  • Have the client come to the clinic for treatment. ​
My client rarely keeps his appointments. When he does he is rude and verbally abusive to staff and other clients. Do we have a duty to provide care to this client?

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.