Self-employed nurses: what do you need to consider?

​All BCCNM registrants are required to practice according to the college's Standards of Practice. This guide is to help you identify your responsibilities as a self-employed nurse (LPN, RN, RPN, NP) so that you practise according to related legislation, regulations, bylaws and standards.

While BCCNM Standards of Practice, bylaws, policies and guidelines apply to nurses in all practice settings, there are some aspects of these that have particular importance for those who practise in a self-employed role.

Note

Each BCCNM registrant is accountable for the practice they provide to the public. BCCNM has developed resources to assist nurses to provide safe and ethical care. These resources are intended to support, not replace, your professional judgment. 

It is strongly recommended that persons interested in self-employed practice contact their liability insurance provider as well as consult a lawyer, accountant and/ or business consultant regarding contracts and business processes. ​

Legislation and Regulatory Requirements

• Review the Health Professions Act, your nursing regulation and BCCNM's Legislation Overview to ensure that your practice is within the defined scope of practice and is recognized as the practice of nursing.
• Review BCCNM's Legislation Relevant to Nurses’ Practice to learn about federal and provincial legislation relevant to the practice of nursing.
• Become familiar with the BCCNM Bylaws (Parts 8 & 9), which provide direction for the collection of client information and for the marketing of professional services.
• Ensure compliance with other relevant health-care, privacy and business legislation.

Standards of Practice

BCCNM’s Standards of Practice set out practice requirements for all nurses and must be met by those in independent 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 set out the standards, limits and conditions for nurses. Scope of Practice Standards for NPs is further specified for family, adult and pediatric NP practice. The BCCNM standards for Acting within Autonomous Scope and Acting with Client-specific Orders in the Scope of Practice Standards provide direction for independent practice and decision making.

Quality Assurance

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

• Self assessment
• Peer feedback
• Professional development plan

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

Use of Title

• Review the BCCNM Use of Titlepractice standard. 
• Ensure that you are practising nursing according to the definition of “nursing” in your applicable nursing regulation.
• Use your title in a way that does not damage the integrity of nursing or mislead clients in any way.

Conflict of Interest

• Review the BCCNM Conflict of Interest practice standard. 
• 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 BCCNM Bylaws on marketing/sale of products.

Boundaries in The Nurse – Client Relationship

• The nurse-client relationship is the foundation of nursing practice across all populations and cultures and in all practice settings. It is therapeutic and focuses on the needs of the client. Review BCCNM's Boundaries in the Nurse-Client Relationship practice standard to understand how to protect a client’s dignity, autonomy and privacy.

Communicable Diseases: Preventing Nurse-To-Client Transmission

• A communicable disease is caused by an infectious agent that is spread from person to person, either directly or indirectly. Review BCCNM's applicable Communicable Diseases: Preventing Nurse-to-Client Transmission practice standard to understand your responsibility on preventing, detecting, and controlling the spread of infectious agents from nurse to client.

Information Management/Documentation

• BCCNM 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 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 BCCNM Consent practice standard  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 BCCNM Duty to Provide Care practice standard which sets out professional obligations related to a legal duty to provide safe, competent and ethical care.
• Negotiate a mutually acceptable withdrawal of service or arrange for suitable alternative services if care cannot continue to be provided.
• Use an ethical decision-making framework when there is concern that providing care puts the nurse 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 BCCNM Bylaws.
• Advertise services in a factual manner.
• Do not exaggerate or mislead regarding the nature of services to be provided.
• Avoid 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.

Professional liability protection

• ​All practicing BCCNM registrants are required by BCCNM bylaws to have professional liability protection
• Seek legal advice prior to entering into a contract to provide nursing services. Consult with your PLP provider regarding PLP specific to your self-employed practice.

FAQs

What experience/competency do I need to be self-employed?

Before becoming self-employed, ensure you have the competencies required for the services you will be providing. When self-employed, you assume the responsibility of an employer both for yourself, and any others that you employ. This may involve setting policies, adopting decision support tools (DSTs), and following relevant legislation. You must also consider the controls on nursing practice, which are defined in your scope of practice standard.

I’m thinking of setting up a private practice and want to incorporate. Do I need to get BCCNM’s permission to incorporate?

BCCNM has no regulatory requirements specific to incorporation and you don’t need to get our permission. Incorporating is solely a business decision that you can discuss with an accountant and/or lawyer to determine your options. However, if you do incorporate and want to use a reserved title in you business name (or something sounding like a reserved title – see Use of Title) BC Registry Services will require you to get our consent. If you have questions about our consent process contact practice@bccnm.ca.

Are there specific requirements around record keeping for self-employed nurses?

Nurses, like other health care professionals, can be sued by clients, former clients, their families, or their legal representative(s). If a claim is made against a nurse, it can be helpful for the nurse to have access to the client health record.

Record retention practices are affected by the time within which a legal claim can be made against a nurse. The Limitation Act sets out the time periods within which a lawsuit can be commenced in the civil justice system.

We recommend that nurses who are storing health records consult a lawyer for advice regarding the retention of records.​

I have my own foot care business but still work in home care. Is it alright to give my business card to my home care clients?

No, it is not appropriate to refer clients from your employment to your private business. Your personal interests could interfere with your professional judgment or your clients’ best interests. For example, your clients may think by hiring you as a foot care nurse, they will receive better home care services.

Refer to the Conflict of Interest and Boundaries in the Nurse-Client Relationship practice standards for more information.

Can I use the BCCNM name or logo in connection with my business?

No, you may not use the BCCNM logo in connection with your business.

In addition, you may not make any other representation implying your self-employed practice is connected to or endorsed by the college, or that you are speaking on behalf of or in any way representing BCCNM​.

Do I need to inform BCCNM if I'm self employed?

Yes, you must inform BCCNM as soon as you become self-employed.

Every time you renew your registration or request a change in status you will be asked on the relevant form whether you are self-employed. If you are self-employed you must answer “yes” to this question and provide the additional information requested, even if you have previously informed BCCNM of your self-employment.​