In Fall 2025, BCCNM conducted a registrant survey and hosted four virtual focus groups to better understand how care providers navigate complex situations in client care, particularly around care requests that fall outside standards, termination of care, and the duty to provide care.
This work supports the
Provider Responsibilities in Client Care and Access policy project, which reviews three key BCCNM documents:
The project aims to align standards with the
Health Professions and Occupations Act (HPOA) and address registrant concerns about unclear or ethically complex expectations.
We’re deeply grateful to the more than 200 registrants who participated in the survey and focus groups, sharing their time and experiences. Their insights are helping shape clearer, more supportive standards that reflect the realities of practice and promote safe, equitable care for all clients.
What we heard
- Care requests outside scope or standards
- Over 60% of survey respondents reported encountering client requests that fall outside their scope of practice, professional standards, or clinical recommendations. Common strategies used to manage these situations included:
- Providing education and explaining evidence-based care options
- Clearly communicating boundaries of their scope
- Referring clients to appropriate providers or services
- Focus groups emphasized navigating requests for care outside clinical scope or clinical recommendations, often balancing professional responsibilities with client autonomy and harm reduction approaches.
- Ending care relationships
- A similar proportion of registrants had experiences with early termination or transfer of care. To ensure safe and respectful transitions, providers emphasized:
- Maintaining continuity of care through thorough handovers
- Communicating clearly and empathetically with clients
- Documenting decisions and involving leadership when appropriate
- Focus groups raised concerns that fear of complaints and disciplinary action often influenced decision-making, particularly among midwives, leading to moral distress and, in some cases, early termination of care.
- Safety in practice
- Many registrants described feeling physically or psychologically unsafe in certain care situations. To manage these risks, they most often relied on:
- Support from colleagues and team members
- Escalation to supervisors or managers
- Ensuring they are not alone with clients and setting clear boundaries
- Focus groups highlighted that “safety” is subjective and context-dependent, requiring the need for standards that support both client and provider safety, especially in high-risk or unpredictable situations.
- Conscientious objection
- While many registrants noted they had not encountered situations requiring conscientious objection, those who had emphasized the importance of maintaining client safety and continuity of care. Common approaches included:
- Transferring care to another provider when possible
- Consulting with supervisors or team members
- Ensuring client safety and continuity of care
- Communicating respectfully and documenting decisions, even in situations where personal values may differ.
- Cultural safety and equity
- Focus groups stressed the need for culturally safe environments and standards that address discrimination and systemic barriers.
- Survey respondents identified several priority populations for future public engagement on these topics:
- People facing socioeconomic barriers
- Older adults and youth
- Individuals with mental health or substance use challenges
- Indigenous Peoples
- People with disabilities or complex health needs
- Perinatal and birthing populations
What happens next
BCCNM will be seeking public input on these topics through a public survey and key informant interviews. Insights from the registrant survey, focus groups, and public engagement will inform any revisions to the standards and guide the development of learning resources.