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You Asked Us

Being a nurse

Accountability & responsibility
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.

I am often asked to volunteer my nursing services at children’s camps, sports events and school field trips. What should I consider before agreeing?

When you volunteer as a nurse, whether on a field trip or in a first aid trailer, you have an obligation to provide safe, competent and ethical care to your clients. Before agreeing, make sure you have the knowledge, skills and judgment to provide the necessary care and are clear about the role expectations. Some factors to consider include:

  • Potential clients and the types of nursing care required
  • Client information necessary for planning or providing care e.g., allergies, health concerns, medications and emergency contact information
  • Responsibilities for medications
  • Maintaining client privacy and information confidentiality
  • Obtaining client consent and when you may act without
  • Documenting services or care provided
  • Available resources e.g., policies, guidelines, clinical supports and equipment

CRNBC's Standards of Practice set out requirements for nurses' practice. The Medication Administration, Privacy and Confidentiality, Consent, Documentation and Boundaries in the Nurse-Client Relationship Practice Standards may be helpful in clarifying the expectations for practice.

The Standards for Acting without an Order (p. 13) in the Scope of Practice for RNs provide additional guidance.

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

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 recommend that nurses 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 CRNBC. What should I do?

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

  • Under the Health Professions Act, you can only call yourself a registered nurse if you are registered with CRNBC. 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 Standard 1 of the Professional Standards for Registered Nurses and Nurse Practitioners.  This standard states that registered nurses maintain current registration. You — not your employer or CRNBC — 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 CRNBC’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 CRNBC’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.

Self-employment
I’ve been asked by a pharmacist/company/doctor to give flu shots. What do I have to consider before doing this?

Ask yourself: Can I meet the Scope of Practice Standards, limits and conditions for giving flu shots? These include practising according to the B.C. Centre for Disease Control competencies and using their decision support tools.   Reviewing the guide for self-employed RNs and NPs will help identify your primary responsibilities as a self-employed registered nurse.

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. You can also check out our self-employment resources.

Can registered nurses and nurse practitioners in B.C. incorporate a business for the purposes of providing nursing services?

Yes. Incorporation is a business decision and nurses making such decisions may wish to seek advice from a business consultant, accountant or lawyer.

Using titles
I work in the community and see nurses signing as PHN and HCN. What is the correct nursing title to use in documentation?

You should use the title that most accurately reflects your registrant class and practice. This might be RN for a registered nurse or RN(C) for a CRNBC-certified registered nurse working in that practice area. Adding your signature and title to your entries on the health record reflects your scope of practice and indicates accountability for your practice. Learn more about titles

I work part-time as an RN and part-time as a real estate agent. Can I put “RN” on my real estate business cards?

No. Selling real estate is not considered nursing practice. To use the title RN you need to have practising registration with CRNBC and be in compliance with CRNBC bylaws. You can’t use the title RN for advertising, marketing or promoting services when the main purpose is sales and/or the product is not used to provide nursing services.

Although you cannot use the title “RN” on your real estate cards, you may use your academic credentials (e.g., BScN).

For more information about using titles, refer to the Appropriate Use of Titles practice standard and the CRNBC Bylaws (section 8.04) and/or contact Practice Support.

Duty to provide care
My client rarely keeps his appointments. When he does, he is impatient, rude and verbally abusive to staff and other clients. Do we have a duty to provide care to this client?

Nurses have an obligation and a legal duty to provide safe, competent and ethical care to their clients. The client has a right to receive care.

Nurses are not expected to tolerate verbal or physical abuse. Other clients can also be vulnerable to this client’s behaviours and may require protection.

An ethical decision-making process may be useful in this situation. Outline the things that affect your ability to provide care. Have a discussion with your colleagues and employer and develop a care plan. It is essential that every effort be made to develop a treatment plan that will meet the client’s needs.

One option is to negotiate a treatment plan with the client that outlines the conditions under which care will be provided. By approaching the situation this way, nurses are not abandoning the client. Another option is to refer this client to another health care provider who may be better suited to manage his care.

Refer to the Duty to Provide Care practice standard for more information.

I want to take on a new role but some aspects of the role go against my personal values and beliefs. What are my options?

If some aspects of the role conflict with your moral or religious beliefs, you may be able to arrange with your employer to refrain from providing that care. Discuss your concerns with your employer before you take on the role. It’s important to make your objection known well before a client requires care.

If your objection can’t be accommodated, you will need to provide the care in question without allowing your moral beliefs to affect your care in any way. If you are not certain you can do this, don’t take on the role.

The Duty to Provide Care Practice Standard provides more information and guidance about circumstances when it may be acceptable to withdraw from or refuse to provide care.

Does the emergency exemption apply if I stop to help at the scene of a traffic accident when I'm off duty?

Generally, yes.

The HPA’s emergency exemption applies if the situation:

  • arises unexpectedly;
  • involves imminent risk of death or serious harm to an individual; and
  • requires urgent action

This assumes you’re providing assistance without gain or reward or hope of the same.

In these situations, you are ethically obligated to provide the best care you can, given the circumstances and your individual competence.

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

My practice takes me into environments that cause me to be concerned for my safety. What can I do to keep myself safe?

Nurses may withdraw from providing care or refuse to provide care if they believe that in doing so would place them at risk. In these situations you can use an ethical decision-making process to decide what to do. When doing so you need to think about your legal, professional and contractual responsibilities.

It is important to work with the client, co-workers, and your employer to develop a plan that allows the client to receive care and you to remain safe.

Some examples:

  • Work with the client to make sure the environment is safe for your arrival. Have them remove any offending material or persons from the area before your visit.
  • One option is to negotiate a treatment plan with the client that outlines the conditions under which care will provide care.
  • Arrange for nurses to partner when doing home visits.
  • Make sure nurses have a way to call for help in an emergency, cell phone.
  • Have the client come to the clinic for treatment.

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

CPR is not a requirement of my employment. What is my responsibility in an emergency?

Given the circumstances and your competence, provide the best care you can. See Duty to Provide Care for more information.

I do a lot of volunteer work in my community. Does the emergency exemption apply if I'm acting in a volunteer capacity?

This depends on the circumstances.

The HPA’s emergency exemption applies to situations that:

  • arise unexpectedly;
  • involve imminent risk of death or serious harm to an individual; and
  • require urgent action

Unexpected situations may occur when working or volunteering as a nurse. However, you should not rely on the emergency exemption to allow you to carry out activities considered an expectation of practice in your setting, even if you are working as a volunteer.

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

Nurse practitioner
As a family nurse practitioner, when do I have to transfer care for a pregnant client to a physician or midwife?

You can transfer care for a pregnant client to a physician or midwife at any agreed upon time during the pregnancy - before delivery. This is a professional decision influenced by several factors, such as maternal/fetal complexity and risk, your individual competence in providing prenatal care and care provider preference. Typically, NPs consult with a physician or midwife when they first learn a client is pregnant.

If you are caring for a prenatal client, make sure you inform your client that another provider will be involved in their care, including performing the delivery. You’ll need to consult with the midwife or physician at the outset to determine the best approach for your client’s care. Possibilities include:

  • You assume primary responsibility for prenatal care until an agreed upon gestation, then transfer care to the physician/midwife
  • You and physician/midwife mutually agree to share care. Together you clarify responsibility for various aspects of care, with the physician/midwife assuming responsibility of some aspects of prenatal care
  • You immediately transfer care to the physician /midwife
If the client does not have a physician or midwife, you would, in consultation with the client, refer to an appropriate physician/midwife.

See Standards of Physician Consultation and Referral.

I am a nurse practitioner working in a physician’s private fee-for-service office. The physician is submitting MSP billings for services I provide. Is CRNBC concerned about these billing practices in this care model?

It's not CRNBC's role to comment on physician billing practices. Physician billing practices are regulated under legislation managed by the Medical Services Commission (MSC). Contact the MSC directly if you have questions or concerns.

I'm an NP employed by a physician. Am I obligated to report concerns about physician billing practices to CRNBC or the College of Physicians and Surgeons of BC?

No. If you wish to pursue concerns about a physician's billing practices, contact the Medical Services Commission directly.

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

As an NP, you are responsible for ending relationships with clients in an appropriate way that both considers their needs and ensures continuity of care. You should avoid any actions that could be seen as abandonment of care.   Recommendations for nurse practitioners leaving practice include:

  • Communicate your decision to end the relationship in writing and discuss your decision in person with as many clients as possible, when appropriate.
  • Allow reasonable time for clients to find a new nurse practitioner or other primary care provider. A reasonable amount of time will depend on the circumstances.
  • Document the reason for ending the professional relationship in the client record, include a copy of any communications you have with the client, and clearly convey to the client that they should seek ongoing care.
  • Ensure all outstanding reports or test results are reviewed and acted upon.
  • Transfer the care of any client under acute, active treatment directly to an alternative care provider. Make sure you and the alternate provider agree when and how they will assume responsibility for the client’s care.
  • Make arrangements for client records to be appropriately stored and accessible to clients.
  • Advise other health care providers and support staff (e.g. office receptionists) that you will no longer be providing services.
  • Notify relevant organizations such as CRNBC, MSP, BCCA or private labs of your departure date and change in your practice address.

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

Employed student nurses
Can I work as a camp nurse while I’m a student?

In order to work as a nursing student in a health care setting, you must be registered with CRNBC as an employed student registrant.

Your employer would need to designate a manager or RN/NP supervisor for you to report to and make sure an RN or NP was physically present to provide regulatory supervision when you were working.

As an employed student nurse, you would need to meet the requirements set out in the Employed Student Registrant Practice Standard.

Do I have to be registered with CRNBC if I want to work as a health care aide or a medical office assistant?

No, you are only required to register when you are working in an employed student nurse role.

 Need help?

For further information on the Standards of Practice or professional practice matters, contact us:

  • Telephone 604.736.7331 ext. 332
  • Toll-free in Canada 1.800.565.6505
  • Email practice@crnbc.ca
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