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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

Case studies



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.

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 our team by completing the Standards Support intake form.

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 our team by completing the Standards Support intake form.

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 our team by completing the Standards Support intake form.​​​​​

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We acknowledge the rights and title of the First Nations on whose collective unceded territories encompass the land base colonially known as British Columbia. We give specific thanks to the hən̓q̓əmin̓əm̓ speaking peoples the xʷməθkʷəy̓əm (Musqueam) and sel̓íl̓witulh (Tsleil-Waututh) Nations and the Sḵwx̱wú7mesh-ulh Sníchim speaking Peoples the Sḵwx̱wú7mesh Úxwumixw (Squamish Nation), on whose unceded territories BCCNM’s office is located. We also give thanks for the medicines of these territories and recognize that laws, governance, and health systems tied to these lands and waters have existed here for over 9000 years.

We also acknowledge the unique and distinct rights, including rights to health and wellness, of First Nations, Métis, and Inuit peoples from elsewhere in Canada who now live in British Columbia. As leaders in the settler health system, we acknowledge our responsibilities to these rights under international, national, and provincial law.​