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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.

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.

  • Only nurses with CRNBC practising registration are provided with liability insurance through Captive Insurance Corporation.

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.

Does CRNBC require CPR certification?

No, you do not need CPR certification for registration. However your employer may require it. Check your agency policy to see if you are responsible for obtaining and maintaining the necessary competencies.

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.

A private medical clinic has offered me a part-time nursing job. Will the liability insurance I have through CRNBC cover me?

Your insurance, as a CRNBC practicing registrant, could cover you in a private clinic, depending on the circumstances. Discuss the specifics of insurance coverage with your employer and contact Captive Insurance Corporation if you have questions.

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.

I'm starting my own private practice. Do I need additional liability insurance?

The amount of liability insurance you may want depends on the nature of your practice and risks associated with it. We recommend you contact Captive Insurance Corporation to discuss your specific circumstances.

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.

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.

My client has difficulty swallowing and chokes easily while eating, but refuses to have his food pureed or a feeding tube inserted. As a result he needs frequent suctioning. Can we insist he have a feeding tube?

The Duty to Provide Care Practice Standard states: Nurses have a professional obligation and a legal duty to provide their clients with safe, competent and ethical care. Informed and capable clients have the right to be independent, live at risk and direct their own care. The Canadian Nurses Association Code of Ethics for Registered Nurses also reflects this.

By respecting the client’s choices it validates his personal beliefs and supports his quality of life as he defines it.

One way to deal with the ethical distress is to talk with others about this and ask how they may have handled similar situations. This can provide ongoing support in addressing this difficult situation.

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.

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 Nurse-Client Relationships Practice Standards may be helpful in clarifying the expectations for practice.

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

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.

Nurse Practitioner
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.

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.

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.

Employed Student Nurses
When I work as an employed student nurse, am I covered by liability insurance?

Yes, you are covered by the professional liability insurance for your professional nursing practice, as long as you as you are practicing in accordance with the Nurses (Registered) and Nurse Practitioners Regulation under the Health Professions Act and the CRNBC Standards of Practice.   If you are concerned about possible legal action because of something that happened while you were practising as an ESN, report the situation to the appropriate person within your workplace as soon as possible.

I'm a nursing student and have been hired as an employed student nurse. How should I sign my name when charting?

Use the title "employed student nurse" or "ESN" after your name. This title clarifies that you are not a fully qualified professional. Using "employed student nurse" when charting or describing your role to clients also differentiates you from a student in an education situation.

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.

Using Titles
I'm a new grad waiting to write the Canadian Registered Nurse Examination. I have provisional registration. How do I sign my name? How should I introduce myself to clients?

Use the title RN (Provisional) when you document nursing care. This tells others you have provisional registration as a registered nurse with CRNBC. Refer to yourself as a nurse with provisional registration or a provisional nurse in general conversation.

During registration renewal, I received an email from CRNBC saying my registration is “Provisional” because I have not met my Quality Assurance requirements. What title should I use?

When you have Provisional Registration, use one of the following titles: 1. Registered Nurse, Provisional 2. Provisional Nurse 3. RN (P)

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).

Certified Practice
Do I need to be certified by CRNBC to give immunizations?

No. Providing immunizations is within the scope of practice for all registered nurses. If you're providing immunizations without an order, you’ll need to meet the Standards for Acting Without an Order (p. 10), including the relevant limits and conditions (p. 19).

I have Canadian Nurses Association (CNA) certification in gerontology. Does this mean I'm CRNBC-certified?

No. CRNBC-certified practice and CNA certification are different.

A CRNBC-certified practice designation allows you to autonomously diagnose and treat some diseases and disorders, following CRNBC decision support tools. This includes activities that otherwise require an order, such as administering, compounding or dispensing Schedule I (prescription level) medications. You’ll find more information on the CRNBC Certified Practice page.

Your CNA certification indicates you’ve met specific nursing practice, continuous learning and exam requirements. You can find more information about CNA certification on the CNA website.

Do I need to be certified by CRNBC to start IVs?

No. Starting IVs within the scope of practice for all RNs. If you’re starting an IV without an order (p. 13), you’ll need to meet the Standards for Acting Without an Order (p. 11).

I'm certified in contraceptive management. Can I use my MSP practitioner number to order tests to screen for STIs?

Check with the Ministry of Health—they are best able to answer this question. Check the Information for RNs (Certified) on their website or call the MSP toll-free 1.866.456.6950 or 604.456.6950 for information about using your MSP practitioner number.

Is diagnosing or treating asthma part of CRNBC-certified practice?

Diagnosing asthma is outside a registered nurse's scope of practice. Nurse Practitioners are the only nurses who may diagnose asthma. Treating respiratory distress in known asthmatics with a Schedule I medication (e.g., salbutamol or ipratropium bromide) is within the scope of practice for all RNs. If you’re carrying out this activity, you’ll need to meet the CRNBC Standards for Acting Without an Order (p.11) including completing additional education and following an established decision support tool (p. 20).

Is advanced cardiac life support (ACLS) part of CRNBC-certified practice for remote nursing?

No, carrying out most ACLS-related activities without an order (e.g., defibrillation, administering epinephrine, atropine and amiodarone) is within the scope of practice for all RNs. If you’re carrying out these activities, you’ll need to meet the Standards for Acting Without an Order, including having the competencies and following the decision support tools established by Providence Health Care (p. 20).

Can CRNBC-certified practice nurses prescribe?

No. Prescribing is outside the scope of CRNBC-certified practice nurses. Nurse practitioners are the only nurses in B.C. who may prescribe.

My employer recently certified me to provide procedural sedation. Is this CRNBC-certified practice?

No. Administering procedural sedation is within the scope of practice for all RNs (p. 23). You’ll need to meet the Standards for Acting with an Order (p. 22), including having the necessary competencies.

What if there is part of CNRBC-certified practice I don’t do often enough to maintain my competence?

As with all nursing practice, you’re responsible for practicing competently. If there are areas of certified practice you don’t feel competent in, be proactive and work with your colleagues and employer to develop strategies to attain and maintain the necessary competence. If you find you’re expected to do things you’re not competent to do, communicate your concerns to your manager and always practice within your own level of competence.

 Need help?

For further information on the Standards of Practice or any nursing practice issue, contact us: 

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