Skip to main content

Nursing professional responsibility includes professional, legal, and ethical responsibilities and cultural safety. Nurses have a professional responsibility to demonstrate knowledge and judgment and be accountable for their actions and decisions. Nurses must also be aware of how their actions and decisions reflect on their reputation, their employer’s/organization’s reputation and the nursing profession in general.

Case studies

Resources

FAQs

As an NP, what should I consider when building my panel of primary care clients?

NPs accepting clients onto their panels are responsible to ensure clients have access to a primary care provider by:

  • ensuring systems are in place to provide continuity and follow up of care and diagnostic tests
  • advising their clients how to access care after hours and in their absence
  • working with their Primary Care Network to ensure their clients are covered if the NP is going to be unavailable for any extended absences

NPs decide to accept or decline new clients in good faith and not on personal judgments about the client or the client’s lifestyle. Under the BC Human Rights Code it may be considered discrimination to refuse clients for reasons of race, colour, ancestry, place of origin, religion, marital status, family status, physical or mental disability, sex, sexual orientation, gender identity or expression, or age.

NPs consistently apply and document their client selection process. If NPs choose to limit their practice based on legitimate reasons (e.g., at practice capacity, competence, work-life balance) these limitations should be clearly and publicly available (e.g., by a sign in the office, on a practice’s website), and communicated to persons seeking care.

If NPs have introductory meetings to get to know new clients and learn of their health concerns and histories, the decisions to accept or decline clients should be made on the basis of the nature and scope of their practice and composition of their panel, not on the simplicity or complexity of the clients.

NPs convey decisions to decline someone as a client honestly and respectfully, and offer assistance to find an alternative health care provider as appropriate.

I am an NP employed in an HA elder care program. I gave 4 months’ notice I was leaving, but they can’t recruit a new NP before I go. What are my pr​ofessional obligations to my patients? After I leave, can I follow-up on the diagnostic tests I’ve ordered?

Once you have given reasonable notice, you are responsible and accountable for working with the Health Authority to facilitate continuity and transfer of client care. For example, notifying clients and giving them information about how their health care needs will be met; prioritizing high-risk clients for appointments; ensuring the clinic is aware of pending diagnostic test or lab results. You may also have other obligations to the Health Authority based on your employment contract with them.

The clinic is responsible for addressing client-care needs while they recruit your replacement.

You cannot access client health records, including diagnostic test results, when you are no longer employed at the clinic. You can only remain involved in the care of these clients if you are retained by the Health Authority in some other way

(e.g., contract), to provide health services to these clients.

Thank you to the College of Nurses of Ontario for allowing us to adapt this Q & A from their NP Practice Q & A tab.

I am a nurse practitioner leaving my practice. What do I need to consider?

You are responsible and accountable for ending relationships in a way that considers the clients needs and ensures continuity of care. Avoid actions that could be seen as abandonment of care.  

  • Where possible communicate your decision to your clients in person. You may also end the relationship  with a letter, secure email or by telephone. A minimum of three months is generally considered reasonable time to allow clients to make alternate care arrangements. And  if you are in an employment situation, notify your employer as soon as possible to give them sufficient time to replace you.
  • Document the reason for ending the relationship in the client record, including a copy of any communications you have with the client.
  • Ensure there is a process for all outstanding reports or test results to be reviewed and acted upon.
  • Be aware that if you convert to non-practicing or do not renew your registration, all written unfilled prescriptions, including refills, are void. Plan accordingly.
  • Contact BCCNM to return your duplicate prescription pads.
  • Make a reasonable effort to transfer the care of clients you are actively caring for to another care provider. Agree upon when and how the alternate provider will assume responsibility for the clients’ care.  If an alternate provider is not found to take over care, clients must be advised of contingency plans. Document these plans in the client record.
  • Arrange for client records to be stored or transferred – provide the college a written summary of the steps you have taken to dispose of those records as per section 357 of the BCCNM bylaws. (s. 187 BCCNM Bylaws September 1, 2020) Advise clients how they can access copies of their medical records.
  • Advise other health care providers and support staff that you will no longer be providing services.
  • Notify relevant organizations involved in the management of clients -  such as BCCNM, MSP, WorkSafeBC, ICBC, CNPS, BCCA, providers you regularly refer and/or receive referrals,  diagnostic facilities (laboratory and imaging,) private labs -  of your departure date and change in practice address.
  • Seek legal advice from the Canadian Nurses Protective Society.

The Duty to Provide Care practice standard provides more information and guidance about your legal and professional obligations to clients.

As an NP what should I consider related to ending my contract in a primary care network?

NPs are independent contractors, not Health Authority employees when contracted to provide health services in primary care networks. You are responsible and accountable for ending relationships in a way that considers the clients’ needs, ensures continuity of care, and meets your obligations to the Health Authority based on your employment contract with them.

Recommendations:

  • Notify the appropriate contract manager within the Health Authority as soon as possible and as per your contract obligations.
  • Notify clients and give them information about how their health care needs will be met, prioritizing high-risk clients for appointments. Ensure the clinic is aware of pending diagnostic test or lab results, prescription refills.
  • Clients may wish to follow you if you intend to maintain an ongoing attachment relationship with them. If you do not intend to maintain an ongoing attachment relationship with your clients, work with the PCN, the Health Authority you contracted with and any other appropriate health system partners to collaboratively maintain primary care access for the clients and re-attach them to another primary care practice where possible. The Duty to Provide Care practice standard provides more information and guidance about your legal and professional obligations to clients.
  • Complete and submit all reports as set out in your contract.
  • Be aware that you may be considered a custodian of personal health information for the purposes of FIPPA and PIPA. Contact the contract manager or health authority privacy office regarding your obligations.

    Please refer to the next FAQ in this section “What are some key considerations related to client records for NPs in primary care networks?” for additional information.
  • If appropriate, contact BCCNP to return your duplicate prescription pads.
  • Notify relevant organizations involved in the management of clients—such as MSP, WorkSafeBC, ICBC or BCAA, providers you regularly refer and/or receive referrals, diagnostic facilities (laboratory and imaging,) private labs—of your departure date and change in practice address.
  • Seek legal advice from the Canadian Nurses Protective Society.
Do my clients have the right to know my name?

As a general rule, clients have a right to know who is caring for them. One way of demonstrating accountability is sharing your name and title with your clients.

All nurses have the right to be safe. Health care agencies need to balance clients' interests with staff safety. Agencies should have policies on staff identification, documentation and releasing employee names.

If I am charged with a criminal offence, do I need to tell BCCNM?

Yes. The college requires nurses to report criminal charges. Under the Criminal Records Review Act, nurses charged with a relevant or specified criminal offence must promptly report it to the college.

Report as soon as a charge is laid

We require nurses to contact us as soon as a criminal charge has been laid, before the information is disclosed to us by law enforcement or other third parties. We have an obligation to deal with such information in a transparent and fair manner while pursuing our public protection mandate.

Registered nurses are also required to disclose any outstanding or recently concluded charges every year when renewing registration. Failing to do so is considered to be misconduct under the Health Professions Act and will result in an investigation by our Professional Conduct Review department.

When we learn of a new charge or conviction for a criminal offence listed in the Criminal Records Review Act, we (a) require you to authorize a new criminal record check, and (b) notify your employer that we are requesting a criminal record check because you have disclosed an offence listed in the Act. All nurses must consent to a criminal record check every five years.

Requirements under legislation

The Criminal Records Review Act, helps protect children and vulnerable adults from physical, sexual or financial abuse. Under the Act, convictions include "conditional discharges," ""alternative measures" and "peace bonds" ordered under sections 717 and 810 of the Criminal Code.

Applicants must also disclose charges and convictions

Applicants to the college are required to disclose all outstanding charges and concluded criminal matters when applying for registration.

I forgot to renew my registration. Yesterday my employer told me to stop working and call BCCNM. What should I do?

There are several important reasons why you cannot work as a registered nurse unless you have current practising registration with BCCNM.

  • Under the Health Professions Act, you can only call yourself a registered nurse if you are registered with BCCNM. This assures the public that anyone using one of the protected nursing titles is legally entitled to practise nursing.
  • If you practise nursing without being registered, you are violating your Professional Standards. This standard states that registered nurses maintain current registration. You — not your employer or BCCNM — must ensure that your registration is current.

If you have been practising nursing without being registered, you must stop immediately, inform your employer and contact BCCNM’s Registration, Inquiry and Discipline Department for direction. If you have worked for more than 60 days without practising registration, you will be referred to BCCNM’s Professional Conduct Review Process.

In the meantime, your employer may determine that there is other work you can do that is not considered the practice of nursing and assign this work to you.

When we have to work over census or short-staffed, I’m concerned that client care may be compromised. What should I do?

Situations where the need for health care is greater than the available resources require your professional judgment and ethical decision making. You are responsible for providing safe, appropriate and ethical care to the best of your ability.

The following strategies may help you:

  • Work with the care team to assess client needs, staff capacity and available resources. Be sure to consider environment safety needs such as oxygen, suction, and access to call bells.
  • Set priorities, adjust client plans of care and care delivery as needed. This may include moving clients to ensure appropriate access to equipment or monitoring.
  • Identify and communicate any immediate safety concerns to the appropriate person, such as your supervisor or manager.
  • Explore whether discharging or transferring clients is an option. Include physicians in the discussion when appropriate.
  • Check in with the care team regularly throughout the shift to reassess and adjust care plans as needed.
  • Document the situation and communicate any concerns to your manager.

Working with limited resources and 10 tips may provide further information and guidance for these situations.  For further assistance contact practice@bccnm.ca

When we work short-staffed, we’re not always able to meet all our clients’ care needs. Can we be reported for not meeting standards?

In this type of situation it is very unlikely that you would be reported to BCCNM. For BCCNM to become involved, a formal written complaint must be received, describing how a nurse’s unethical, impaired or incompetent practice puts clients’ at risk.

 

It’s important to remember that even in situations where you cannot provide optimal client care, you can still meet the Professional Standards. These situations are usually beyond your individual control and often require a systems approach for resolution. You are responsible for providing the best care possible under the circumstances. In these situations:

  • Start by assessing client needs, available staff and mix.
  • Communicate any immediate safety concerns to your manager or supervisor.
  • Work with the care team, set priorities, and adjust client plans of care and care delivery as needed.
  • Check in with the care team frequently during the shift. Reassess and adjust client plans of care as appropriate.
  • At the end of your workday, document the situation and your concerns and share with your manager.

By following these steps, you are likely meeting your Professional Standards and your obligation to provide clients with safe, competent, ethical care.

You’ll find more information and guidance in in the resource Working with limited resources.

For further assistance contact practice@bccnm.ca.

I’m expected to work in an unfamiliar practice area. Can I refuse?

Your employer has a right to reassign you to another area. You were likely hired by an agency or health authority and cannot refuse to be reassigned.

Consider what care you can safely provide, while practicing within your level of competence. Clearly communicate this to the most appropriate person such as your immediate supervisor and discuss any concerns about your reassignment.  Refusing a reassignment is generally justified only when the risk of harm to clients is greater if you accept than if you refuse. If you don’t have the competence to work in the assigned area, collaborate with others to determine the best option and follow up in writing.

Working in an unfamiliar practice area can be challenging and anxiety provoking. Using these strategies may help:

  • Ask for an orientation to the clients, environment and resources.
  • Review your assignment with the charge nurse and discuss the care requirements for your assigned clients.
  • Outline your competencies as they relate to the client care required, indicating what care you can safely provide and what you cannot.
  • Communicate regularly with the charge nurse/team leader about changes to your clients and their plan of care.
  •  Ask for nurse to be assigned as your resource person.

Working with limited resources may provide further information and guidance for these situations.  For further assistance contact practice@bccnm.ca​​​​