YRNA Self-employment Guidelines

YRNA Guidelines

for Self-Employed Nurses

 

 

 

Acknowledgements

The Yukon Registered Nurses Association wishes to thank the Nurses Association of New Brunswick (NANB) and for granting permission to adopt and adapt their publication, Guidelines for Self-Employed Registered Nurses, 2015.

 

Introduction

The Yukon Registered Nurses Association (YRNA) has the legislated authority through the Registered Nurse Professions Act to establish, maintain and promote standards of practice for Registered Nurses (RN) and Nurse Practitioners (NP) within the Yukon. YRNA is responsible for governing and regulating nurses in a manner that protects the public. Regulation makes the profession, and its members, accountable to the public for the delivery of safe, competent and ethical nursing care.

The purpose of this document is to provide guidance to RNs and NPs considering self-employment, and those currently self‐employed, to identify their responsibilities consistent with related legislation, bylaws, standards of practice and guidelines.

The self‐employed RN or NP must practise in accordance with the Registered Nurse Professions Act, YRNA bylaws, the Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses, the YRNA Standards of Practice for Registered Nurses, and when applicable, the YRNA Foundations for Nurse Practitioner Practice in the Yukon.

In addition to professional requirements, each RN or NP seeking to establish a self-employed practice should, for business considerations, contact independent legal counsel, accountants and other resources to ensure compliance with relevant legislation and best practices pertinent to the practice area.

 

Self Employed Nursing Practice

Selfemployed RNs and NPs apply nursing knowledge, skill and judgement in the provision of health services to clients in a variety of settings and roles in the areas of direct care, education, research, administration or consultation. Clients may be individuals, families, groups, communities, educational institutions, corporations or other healthcare agencies. Selfemployed RNs and NPs may provide nursing services themselves, in partnership with other providers, or employ others to do so.

 

The practice of nursing is defined in the Registered Nurse Professions Act (2002) as:

 

Nursing means the application of professional nursing knowledge, skills, and judgement for the purpose of

(a)     Promoting, maintaining, and restoring health;

(b)     Preventing illness, injury, or disability;

(c)      Caring for persons who are sick, injured, disabled, or dying;

(d)     Assisting in pre-natal care, childbirth, and post-natal care;

(e)      Health teaching and health counselling;

(f)       Coordinating health care; or

(g)     Engaging in administration, teaching, or research to implement a matter referred to in paragraphs (a) to (f).

 

Under s.13.1 (1) of the Registered Nurse Professions Act (2002),

A Registered Nurse is entitled to practise nursing within a scope that is determined by the board to be appropriate for a registered nurse based on the requirements under this Act.

 

Under s.13.1 (2) of the Registered Nurse Professions Act (2002),

 

Subject to regulations setting out exceptions, conditions, or restrictions to be placed on the scope of practice of a nurse practitioner, a nurse practitioner is entitled to

(a)     Make diagnoses to identify diseases, disorders, or conditions;

(b)     To communicate a diagnosis;

(c)      Order or interpret screening and diagnostic tests;

(d)     Select, recommend, supply, prescribe, or monitor the effectiveness of drugs and treatments; or

(e)      Perform other procedures authorized by regulations.

 

Selfemployed RNs and NPs are directly accountable to their clients and should develop policies and procedures based on evidence, best practice guidelines, YRNA standards and the CNA Code of Ethics for Registered Nurses. These RNs and NPs have experience and nursing expertise in the practice area related to the nursing services provided. Self-employed RNs and NPs refer to YRNA standards, guidelines and relevant documents as needed. They are responsible at all times for the delivery of safe, competent and ethical care, and to maintain competence related to their area of practice. YRNA does not recommend selfemployed practice for new graduates or RNs and NPs with limited or no recent relevant nursing practice experience.

 

Examples of selfemployed nursing practice could include but are not limited to:

·         Health promotion and prevention services (e.g., health education, smoking cessation programs, health risk screening);

·         Curative, restorative, or palliative care (e.g., home care, foot care, mental health counseling);

·         Serving as a consultant to agencies or organizations on health issues.

 

Legislation and Regulatory Requirements

Selfemployed RNs and NPs must comply with the Registered Nurse Professions Act, the YRNA Bylaws, all YRNA standards and guidelines, including the Standards of Practice for Registered Nurses and/or the Foundations for Nurse Practitioner Practice in the Yukon, and the CNA Code ofEthics for Registered Nurses. RNs and NPs must also be knowledgeable and comply with other relevant healthcare, privacy and business legislation as applicable to their practice.

 

Relevant Legislation to Self-Employed nurses includes but is not limited to:

·         Health Information Privacy and Management Act (2016)

·         Personal Information Protection and Electronic Documents Act (2000) (federal privacy legislation for commercial entities)

·         Yukon Workers Compensation Act (2008)

·         Yukon Human Rights Act (2002)

·         Yukon Occupational Health and Safety Act (2002)

·         Yukon Employment Standards Act (2002)

 

Recognition of Nursing Practice

RNs and NPs may legally offer any service that falls within the practice of nursing, as defined in the Registered Nurse Professions Act. A service that is being provided by an RN or NP does not necessarily constitute nursing practice. Prior to establishing a business, RNs or NPs considering selfemployed nursing practice must contact YRNA to ensure that their work is recognized as nursing.

 

If a service provided by a selfemployed RN or NP is not recognized by YRNA as nursing

practice:

·         the practice hours related to providing that particular service cannot be applied toward annual renewal of registration;

·         the RN or NP cannot use their title in association with the provision of that

particular service; and

·         the RN or NP would not have liability protection through the Canadian Nurses

Protective Society (CNPS) for that particular service.

 

Use of Title (RN, NP)

A selfemployed RN or NP may only use the title ‘Registered Nurse’ or ‘RN’/‘Nurse Practitioner’ or ‘NP’ when engaged in a practice recognized as the practice of nursing by YRNA and while holding current registration with YRNA.

 

If the self-employed practice is not recognized, the YRNA member may identify themselves as a nurse when delivering services, but must not use the above restricted titles.

 

Continuing Competence

Selfemployed RNs and NPs must maintain their competence to practise through on-going participation in continuing education and professional development and utilize a process to systematically reflect and evaluate their nursing practice.

Meeting the YRNA continuing competence requirements is mandatory for all practising RNs and NPs, including those in selfemployed practice.

 

All RNs and NPs are required to:

·         meet annual registration renewal requirements including currency of recognized nursing practice hours and compliance with the YRNA Continuing Competence Program (CCP); and

·         participate in the annual CCP audit if randomly selected.

 

Responsibilities of Self-Employed RNs and NPs

RNs and NPs in self‐employed practice assume full responsibility and accountability for the provision of nursing services. This professional autonomy requires RNs and NPs to:

1.        Hold a current practising membership with the YRNA.

2.        Practise competently in accordance with the Registered Nurse Professions Act, YRNA standards and guidelines and the CNA Code of Ethics for Registered Nurses.

3.        Demonstrate knowledge, skill and judgement in the particular area of practice.

4.        Have a written description of their nursing practice, which is congruent with their knowledge, skill and experience.

5.        Have written policies, procedures and inspection documentation related to their practice and equipment.

6.        Have written policies, procedures and other related documentation pertaining to corporate functions, such as human resources, information management, finance, and IT, where applicable.

7.        Maintain competence to practise through ongoing participation in continuing education and professional development.

8.        Complete the annual YRNA continuing competence requirements (CCP and hours of practice).

9.        Utilize research findings and apply best practices where appropriate.

10.     Utilize a documentation and information management system that conforms to standards and legal principles.

11.     Obtain informed consent for treatment from the client.

12.     Follow business entity registration requirements as required in the Yukon.

Upon contacting the YRNA regarding self-employed practice, the YRNA may require the self-employed nurse to provide any or all of the above documentation as evidence that self-employed responsibilities are being met.

 

Establishment of a Business Entity

In the Yukon, registering as a business entity is managed by Corporate Affairs, Community Services, Yukon Government. An FAQ site dedicated to business registration is located here: http://www.community.gov.yk.ca/corp/faq.html

 

In addition to registering as a business entity with the Yukon Government, a self-employed nurse must also register to operate with the city of Whitehorse if business is being conducted in Whitehorse. Information for how to register a business with the city of Whitehorse is located here: http://www.city.whitehorse.yk.ca/home/showdocument?id=603

 

After registering as a business entity, a self-employed nurse needs Workers Compensation coverage. This will protect the nurse in the event of a work-related injury or illness. Coverage for sole proprietors is available.

In unique circumstances, and depending on the nursing work being provided, additional approval from Environmental Health, Yukon Government may be required.

Upon approval of all permits and legislated requirements, the Employment Standards office has a FAQ on how to implement the Employment Standards Act as a Yukon employer. The FAQ can be accessed here: http://www.community.gov.yk.ca/pdf/es_faq.pdf

 

Information Management

Managing information and maintaining accurate documentation in accordance with federal and provincial legislation is a responsibility of the selfemployed RN and NP. The CNA Code of Ethics for Registered Nurses and federal and territorial legislation should be referenced to ensure information management and documentation requirements are met. Information management must include the following:

·         confidentiality of client information,

·         accurate record of services provided, including all steps of the nursing process,

·         expected and actual outcomes of nursing service,

·         documentation of client consent and/or agreed upon business contract, and

·         appropriate storage, retention and authorized release of client information.

The onus is on the selfemployed RN or NP to become familiar with issues surrounding ownership and access to client records, and requirements arising through territorial and federal information management and privacy legislation as a custodian of client information. All health records are confidential and must be stored and physically secure 24 hours a day. The length of time records must be retained is dependent on the nature of the business and Yukon and federal legislation. Disposal of health information, particularly when a business is terminated, must be done in congruence with territorial and federal legislation. Consultation with a lawyer and accountant for professional advice relating to retention of business records is recommended.

 

The YRNA encourages current and prospective self-employed nurses to consult with the office of the Yukon Ombudsman, Information Privacy Commissioner and Public Interest Disclosure Commissioner regarding questions to the Access to Information and Protection of Privacy Act (ATIPP) and Health Information Privacy and Management Act (HIPMA).

 

The Personal Information Protection and Electronic Documents Act (2002) from the federal government sets out the rules that protect a person’s privacy and confidentiality of personal health information for commercial entities. The Health Information Privacy and Management Act (2016) applies to all custodians of health information which includes individuals, who collect, maintain or use personal health information for providing or assisting in the provision of health care.

 

Quality Improvement and Risk Management

Selfemployed RNs and NPs must be committed to ongoing evaluation to ensure the provision of safe and effective nursing services. Formal and informal evaluation feedback assists selfemployed RNs and NPs to determine what services have been effective and how to meet evolving needs of clients. Some quality improvement and risk management strategies for maintaining quality of practice include:

·         development of and adherence to policies and procedures related to the business,

·         development and regular review and revision of policies and procedures related to the nursing practice,

·         measurement of client care outcomes,

·         regular feedback from clients,

·         consultation with peers and role models,

·         a comprehensive information management system, and

·          knowledge of and adherence to laws related to the business.

 

Professional Liability

Selfemployed RNs and NPs are responsible for investigating the level of liability risk associated with their nursing practice in order to determine the appropriate liability coverage. This includes professional liability, general liability and vicarious liability for employees if applicable. All RNs and NPs who hold a practising registration with the YRNA have professional liability protection through CNPS for their nursing practice. RNs and NPs who own a professional corporation or nursing practice, who operate a clinic or otherwise operate a business providing nursing services may require additional liability protection for their business, in addition to their individual professional liability protection. RNs and NPs considering selfemployed practice should contact CNPS (www.cnps.ca) and/or their lawyer or business consultant to discuss issues related to professional liability and any other forms of insurance.

 

Payment for Services

Selfemployed RNs and NPs in the Yukon are not currently eligible to bill for nursing services through the territorial health care system. Services are provided on a direct feefor service basis, with the fees being paid either by private insurance companies or directly by clients. It is the responsibility of the RN or NP to set reasonable fee structures that are in line with the nursing services being provided, and to make the client aware of the fees at the onset of the professional relationship.

 

Advertising

Selfemployed RNs and NPs must demonstrate ethical decisionmaking in the advertisement of their services. Responsible advertising is done in a manner that serves the interest of the public and pertains to activities within the RN or NP’s nursing practice. Selfemployed RNs and NPs may use the title Registered Nurse or ‘RN’/ ‘Nurse Practitioner’ or ‘NP’ to market nursing services, as this informs the client making choices related to their health care. These titles are not to be used to market services not recognized by YRNA to be nursing practice.

 

Conflict of Interest

Selfemployed RNs and NPs must avoid conflict of interest in their practice. If self-employed are also under the employment of a health care organization, RNs and NPs need to be cognizant of the ethical implications of engaging in both roles. RNs and NPs should inform their employer of their selfemployed practice and know the employers conflict of interest policies /positions. RNs and NPs should not refer clients from their employment related contacts to their selfemployed practice. The RN or NP with an actual or perceived conflict of interest should declare the details of the conflict when discussing health care options with the client.

 

Endorsement

Endorsing or promoting a product or service may be considered a conflict of interest. Selfemployed RNs and NPs may not use their title to promote a personal interest in a commercial product or service. Endorsement occurs when an RN or NP uses their credentials to lend credibility to a commercial product, product line or service. RNs and NPs with vested interests in a specific product cannot use their title to lead the public to believe they know that one product is better than another even if they believe it to be true. The endorsement of a product or service without providing information about other options could mislead the public and compromise trust.

 

Conclusion

All RNs and NPs, including those in selfemployed practice must adhere to standards of practice and a code of ethics as determined by the YRNA. In order to use the protected titles ‘RN’ or ‘NP’, the selfemployed RN or NP must engage in recognized nursing practice and maintain registration with YRNA. Selfemployed RNs and NPs establish and maintain their competence and expertise in their area of practice in order to provide safe, competent and ethical care. For additional information about selfemployed nursing practice please contact the YRNA office.

 

Useful Link:

Canadian Nurses Protective Society (CNPS) Collaborative Practice: Are Nurses Employees or Self-Employed?


 

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