Self-employed nurses (LPNs, NPs, RNs, and RPNs) play an important role in expanding access to quality healthcare.
Scope of practice standards
Acting within autonomous scope of practice standard
Self-employed practice can be a big change from practising under an employer. In this resource, we will look at what to consider if you are thinking about self-employed practice.
Self-employed practice, also called independent practice, is when a nurse provides nursing services independent of another health professional, employer, or health-care agency. Examples of self-employed practice include:
Health promotion and prevention services such as smoking cessation, health education, and risk screening.
Curative, restorative, or palliative care such as home care, foot care, and mental health services.
Acting as a consultant to agencies on health care-related issues.
Self-employed nurses are legally accountable and responsible for both nursing services provided and the business matters of the self-employed practice. Many of the decisions and responsibilities that are generally taken by an employer are now your responsibility as a self-employed practitioner—you will be accountable for developing policies and procedures to guide your practice.
If you are thinking about self-employed practice, we recommend you:
Review BCCNM standards of practice and bylaws.
Contact your liability insurance provider.
Contact a lawyer, accountant, and/or business consultant about business matters.
As a self-employed nurse you:
Know your scope of practice and practising within it.
Have the knowledge, skills, judgment, and resources to safely perform all services you will provide.
Know and follow BCCNM's standards.
Apply all standards to the
controls on practice framework for the services you will be providing.
Know if the hours spent in your self-employed practice can count toward the hours needed to maintain nursing registration. If in doubt, check with BCCNM's registration department.
Have in place continuity of care processes: consultation, referral, and transfer of care pathways applicable to the type of business you are providing.
As a self-employed nurse, you become the "employer" both for yourself and any others who work for you. It is therefore your responsibility to comply with relevant healthcare, privacy, and business legislation. This may include setting policies and adopting decision support tools (DSTs). You are responsible for knowing if any of the services you will provide are governed by legislation or regulatory requirements.
Regardless of the work setting, all BCCNM registrants practise according to legislation and regulations, BCCNM bylaws, and standards.
Did you know? Registrants must immediately notify the registrar of any change in their information previously provided to the college (bylaw 83 (2)). For example, if your place of work changes because you are now self-employed, you must update this information in the BCCNM registrant portal.
BCCNM's standards of practice include professional, scope of practice, and practice standards. These three sets of standards set out practice requirements for all nurses, including those in self-employed practice.
Self-employed nurses act as the health information custodian of the client's health records and have legal responsibilities concerning the collection, use, disclosure, retention, and disposal of a client's personal health information. This responsibility may not end when the nurse-client relationship does, and you may be responsible for the retention of records for several years.
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.
Information management in nursing practice refers to collecting, organizing, analyzing, and using information to support clinical decision-making and improve client outcomes. It is your responsibility to know how to manage client information and records.
Client records are confidential and must be safely stored and physically secure at all times—do NOT leave them in your car or any other non-secure location.
Develop policies and procedures for information management, including the type and frequency of documentation, storage, destruction, and access to records. Follow the legal requirements under the
Limitation Act for the retention and destruction of health records.
If you are away from your practice for a long period or close your business, ensure safe storage of records and have a way for clients to access their personal records.
BCCNM bylaws (Division 5) which provide direction when collecting client information.
Privacy and confidentiality practice standard
BC Personal Information Protection Act governs the use, collection, storage and disclosure of personal information
BC Freedom of Information and Protection of Privacy Act allows for the disclosure of personal information for health and safety reasons
Personal Information Protection and Electronic Documents Act (PIPEDA) applies to the use or disclosure of personal information when using technology
Marketing and advertising nursing services can help raise awareness about your services and reach potential clients. It is important to do this in a way that is truthful, accurate, and professional. Be clear about the services you offer and the qualifications you hold (such as education or any certifications you have).
Market services so they align with BCCNM bylaws and advertise services in a factual manner. Do not exaggerate, mislead, or guarantee results.
Did you know? BCCNM's bylaws do not allow you to use the BCCNM logo in connection with your business or imply that your self-employed practice is connected/endorsed by the college or that you are speaking on behalf of or in any way representing BCCNM.
BCCNM bylaws (Division 2) for the marketing of your professional services
Use of title practice standard
Quality improvement is the continuous process of monitoring and improving the quality of care provided to clients, while risk management involves identifying, assessing, and mitigating potential risks to client safety.
Some strategies include:
Develop, review, revise business-related policies and procedures.
Measure client care outcomes.
Seek regular feedback from clients.
Set up a system to identify risk management issues and to make changes to practice to ensure safe care. Develop a professional support system to discuss personal and professional challenges and to share ideas related to care delivery.
BCCNM does not provide any advice or guidance about the business aspect of self-employed practice. Therefore, before beginning self-employed practice, talk to someone about the business part of your self-employed practice (business lawyer, accountant, and/or financial advisor). We recommend seeking legal advice before entering into a contract to provide nursing services.
Did you know? Self-employed nurses cannot use incorporation to avoid professional liability. Incorporation is a legal process that creates a separate legal entity known as a corporation. By incorporating a business, you can limit personal liability for the company's debts and obligations. Incorporation does not provide absolute protection against professional liability, especially for certain professions where personal liability cannot be fully eliminated. Note, your nursing personal liability protection only covers you when providing professional nursing services. It does not generally cover your incorporated company, partnership, or employees.
All practising BCCNM registrants are required by BCCNM bylaws to have professional liability protection. Self-employed nurses need to determine the level of liability risk of their nursing practice to determine if they require additional personal, professional, or business liability insurance. Consult with your PLP provider about your insurance requirements.
Did you know? Self-employed nurses who also work for someone else (for example, work as a nurse in a clinic/hospital) are not covered by their employer's insurance when working in their self-employed practice. Talk to your PLP provider to understand your liability protection.
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 your business name (or something sounding like a reserved title) B.C. Registry Services requires you to get our consent.
Legislation Relevant to Nursing Practice
Review the following consent agreements to see how not meeting BCCNM's standards of practice can impact your nursing practice.