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.
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:
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 in the Scope of Practice for RNs provide additional guidance.
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.
There are several important reasons why you cannot work as a registered nurse unless you have current practising registration with CRNBC.
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.
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.
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.
Yes. Incorporation is a business decision and nurses making such decisions may wish to seek advice from a business consultant, accountant or lawyer.
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
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).
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.
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 HPA’s emergency exemption applies if the situation:
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.
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.
Given the circumstances and your competence, provide the best care you can. See Duty to Provide Care for more information.
This depends on the circumstances.
The HPA’s emergency exemption applies to situations that:
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.
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:
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.
No. If you wish to pursue concerns about a physician's billing practices, contact the Medical Services Commission directly.
NPs can prescribe Zopiclone – it’s a schedule 1 drug and there are no limits or conditions placed on it by the College.
NPs cannot prescribe Sublinox (Zolpidem) at this time – it is a drug subject to control under the Federal Controlled Drugs and Substances Act.
NPs do not yet have authority to initiate or continue prescriptions for controlled drugs and substances, or order another professional to administer, compound or dispense them.
In some situations, however, it may be appropriate for NPs to advise a client to stop taking a controlled drug or substance when no prescribing, ordering or adjusting is required (for example, if a client is having a significant adverse reaction or unwanted side effects that present safety concerns) or advise a client about dosages within PRN ranges in a prescription or order written by another provider (for example, if a client has a prescription for PRN Tylenol #3 and the NP is advising the client about transitioning to plain Tylenol).
NPs use their clinical judgement, in accordance with the applicable CRNBC standards, when advising clients on medication therapy initiated by other providers. NPs consult with and/or refer to the appropriate provider, as needed to ensure appropriate follow up for the client.
Neither RNs nor NPs are allowed to issue these medical documents in BC.
Federal laws have changed to allow individuals to legally possess dried leaf marijuana if it was obtained, under the new Medical Marijuana for Medical Purposes Regulations from a licenced producer, with a supporting medical document from an authorized health care practitioner (either a physician or nurse practitioner). However, these changes for NPs have not been adopted by the provincial government in BC and are not included in the scope of practice of NPs at this time.
NPs in BC are not allowed to prescribe controlled drugs and substances at this time - including those containing synthetic cannabinoids. See CRNBC limits in the NP prescribing standards.
For more information on this or other scope of practice matters, contact firstname.lastname@example.org.
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:
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.
No, you are only required to register when you are working in an employed student nurse role.
For further information on the Standards of Practice or professional practice matters, contact us: