Self-Employed Practice
Self-employed nursing practice (non-agency) can take many forms, including working as
- an independent contractor with one or more businesses,
- operating a non-registered business, or
- running a registered business as a sole proprietor or Health Profession Corporation.
This page guides you through important considerations from concept to the operations, ensuring you are well-prepared for each step of your self-employment journey.
Along with the below information, please refer to the Self-Employed Practice Handbook for more detail.
This roadmap and below information is designed to help you identify considerations specific to your self-employed practice. It encompasses a broad range of self-employed practice settings; therefore, not all the information may be applicable to your situation. Please review and select the information relevant to your specific practice and setting.
Self-Reflection
Before transitioning to self-employed practice, take time to reflect on whether your planned practice aligns with the nursing profession and can meet regulations, practice expectations, entry level competencies and Code of Ethical Conduct.
- You must be in good standing with the College, which means you are not undergoing an investigation or have conditions on your certificate of practice that would exclude you from being self-employed.
- Is your practice considered nursing practice?
- Does legislation give nurses the authority to perform the activity? See Education.
- Does the nursing practice fit within the nursing scope of practice?
- In Manitoba, the scope of practice for registered nurses (RNs) includes a range of activities defined by The Regulated Health Professions Act (RHPA). It encompasses applying nursing knowledge, skills, and judgment to help individuals and populations achieve and maintain optimal health. This includes assessing, diagnosing, planning, treating, evaluating care, making referrals, teaching, counseling, advocating, coordinating, supervising, and managing healthcare services.
- Is the nursing practice supported by rigorous evidence for the client’s clinical indication?
- An RN may have the legal authority to perform a practice within their scope, but if there is no scholarly evidence supporting its use for the identified clinical indication, the practice is no longer appropriate for the RN to perform.
- Will the practice allow the nurse to meet Practice Expectations?
- Will the practice allow the nurse to meet the Code of Ethical Conduct allowing the nurse to provide high-quality nursing care and maintain the public’s trust in the nursing profession.
- Will the practice a promote client centered care?
- All registered nurses play a crucial role in prioritizing client care and ensuring that clients are actively involved in their health care decisions.
- Does the practice support the nursing process and use of nursing knowledge, skill, and judgement?
To determine if nursing practice is effectively using the nursing process, knowledge, skill and judgment, you can refer to the following indicators…
- Systematic Assessment: Nurses gather comprehensive data about the patient’s health status through interviews, physical exams, and reviewing medical records ensuring all relevant information is collected to understand the patient’s needs.
- Accurate Diagnosis: Nurses use critical thinking to identify health problems based on the assessment data.
- Individualized Planning: Nurses develop a care plan tailored to the patient’s specific needs.
- Implementation of Interventions: Nurses execute the planned interventions, which may involve administering medications, offering education, or performing procedures. Successful implementation demands a combination of technical expertise, nursing knowledge and judgment.
- Ongoing Evaluation: Nurses consistently evaluate the patient’s reaction to interventions and modify the care plan accordingly. This process guarantees that the care remains effective and adapts to the patient’s changing needs.
- Documentation: Thorough and precise documentation of every step in the nursing process is essential. It not only creates a comprehensive record of care but also enhances communication among the healthcare team.
Preparation
Once you have identified that your practice qualifies as nursing practice and aligns with the Practice Expectations, Practice Directions, and the Code of Ethical Conduct, you can proceed with actively preparing for your self-employed journey.
See here for a few things to consider during this phase:
- Review the College’s Self-Employed Practice Direction and the Self-Employed Practice Handbook.
- Review the following documents to ensure familiarity with nursing requirements:
- Identify if additional education is required for your practice.
- Identify a plan for continuing competence in your field of practice.
- Contact CNPS regarding additional liability coverage for your practice.
- If applicable, identify requirements for home-based or store-front based business insurance.
- If applicable, contact the City of Winnipeg, or appropriate municipality regarding permitting and licensing (even if home-based). Here are a few sites that may assist with starting this process:
- Outline every step within your business to ensure compliance with College Regulations with the goal of maintaining a high standard of practice. Your business plan outline should include but is not limited to:
- your mission,
- services,
- target market,
- positions, roles and responsibilities,
- operational procedures, from client intake and assessment to service delivery and follow-up,
- necessary resources, such as equipment, technology, and personnel, and ensure they meet regulatory standards, and
- protocols and policies for maintaining client records, handling confidential information, and obtaining informed consent.
Action
You have gathered all the necessary information and understand the requirements for starting your self-employed practice. It is time to implement this knowledge and take action.
Develop the resources identified in the planning stage. For example:
- Position description for yourself and any employee(s)/independent contractor(s) within your business.
- Review the position description(s) to ensure that what is identified is nursing practice.
- Standard Work
- Standard work ensures the delivery of consistent, high-quality patient care. By adhering to established protocols and procedures, nurses can minimize variability in care, reduce the risk of errors, and enhance patient safety. Additionally, it provides a reliable framework for training new nurses, helping them quickly adapt to their roles and maintain the same high standards. Ultimately, standard work supports continuous improvement and compliance with regulatory requirements, fostering a culture of excellence in nursing practice.
- Policies and procedures for all aspects of your business, such as
- Informed Consent
- Information management
- Monitoring and maintenance of equipment
- Patient care
- Infection prevention and control
- Supply handling and management
- Management of emergent situations
- Safe storage of medications and substances
- Quality assurance
At a minimum you must have the following policies
- Accepting and refusing clients
- Ending client relationships
- Notice of required payment
- Client record management, including storage, disposition, retention, and transfer.
- Electronic records must have a comprehensive audit capability including a system that enters all access onto a permanent file log, identifying and recording where the access originated and by whom, and if alterations are made to the record, identifying whom, what was altered, and when the alteration was made.
- Request by the client to view their personal health information documented in the client record.
BEFORE INITIATING YOUR SELF-EMPLOYED PRACTICE
Submit the Self-employed Nursing Practice Notification & Declaration form.
- Ensure the summary section clearly identifies all types of nursing services you will be providing. Include any additional services offered within your business, specifying who will provide these services and the locations where they will be delivered.
If you are considering incorporating your business, please visit the Incorporation page before beginning the process. There are specific requirements under the Regulated Health Professions Act that you need to be aware of and follow.
Operations
Awareness of your business and ongoing assessment are crucial for maintaining smooth operations. These practices enable you to build a strong reputation, foster trust, and ensure stability.
Regularly review and update your documentation to reflect changes in regulations and best practices. This comprehensive approach will help you stay organized, ensure quality care, and demonstrate your commitment to professional standards.
Other items to consider include:
- Advertising: Be familiar with the College’s Guidelines for Advertising as there is information from the Regulated Health Professions Act, and disclosures that must be included on any online promotion or advertising.
- For legal reasons, CNPS advises keeping copies of all advertisements, including their published dates.
- Selling of products in accordance with regulatory guidelines
- Transparency about the benefits and limitations of products
- Sales practices cannot be exploitive
- Inform clients where else products can be purchased
- Products can only be sold at cost, and can include shipping cost, cost of storage, and professional time in placing order, etc.
- Retention and storage of client records
- To ensure patient information is available for ongoing care, legal purposes, and regulatory compliance, patient records must be retained for at least 10 years from the date of the last entry into the record. For minors, records must be kept for at least 10 years after the client turns 18.
- Maintaining your Health Profession Corporation (HPC), if applicable
- As with any corporation, an HPC requires an annual renewal. See here for information on this process.
- Establish a process to independently verify your annual practice hours
- Each year, nurses are required to self-report their practice hours. Additionally, the College selects a number of nurses annually to provide verified practice hours for the past five years. For nurses employed by an organization, the verification form would be submitted to their employer, who will then complete the form and forward it to the College. For self-employed registrants, it is necessary to establish a system with a third party, such as an accountant, to verify and submit their practice hours to the College on their behalf should this request be made.
- Maintain an updated CRNM profile
- If you own a business and work through that business, this is your employer.
- If your business has contracts through other businesses, identify these businesses as your employer. When contracts have ended ensure that your CRNM profile reflects that your employment relationship with the organization has ended.
Before transitioning to self-employed practice, take time to reflect on whether your planned practice aligns with the nursing profession and can meet regulations, practice expectations, entry level competencies and Code of Ethical Conduct.
- You must be in good standing with the College, which means you are not undergoing an investigation or have conditions on your certificate of practice that would exclude you from being self-employed.
- Is your practice considered nursing practice?
- Does legislation give nurses the authority to perform the activity? See Education.
- Does the nursing practice fit within the nursing scope of practice?
- In Manitoba, the scope of practice for registered nurses (RNs) includes a range of activities defined by The Regulated Health Professions Act (RHPA). It encompasses applying nursing knowledge, skills, and judgment to help individuals and populations achieve and maintain optimal health. This includes assessing, diagnosing, planning, treating, evaluating care, making referrals, teaching, counseling, advocating, coordinating, supervising, and managing healthcare services.
- Is the nursing practice supported by rigorous evidence for the client’s clinical indication?
- An RN may have the legal authority to perform a practice within their scope, but if there is no scholarly evidence supporting its use for the identified clinical indication, the practice is no longer appropriate for the RN to perform.
- Will the practice allow the nurse to meet Practice Expectations?
- Will the practice allow the nurse to meet the Code of Ethical Conduct allowing the nurse to provide high-quality nursing care and maintain the public’s trust in the nursing profession.
- Will the practice a promote client centered care?
- All registered nurses play a crucial role in prioritizing client care and ensuring that clients are actively involved in their health care decisions.
- Does the practice support the nursing process and use of nursing knowledge, skill, and judgement?
To determine if nursing practice is effectively using the nursing process, knowledge, skill and judgment, you can refer to the following indicators…
- Systematic Assessment: Nurses gather comprehensive data about the patient’s health status through interviews, physical exams, and reviewing medical records ensuring all relevant information is collected to understand the patient’s needs.
- Accurate Diagnosis: Nurses use critical thinking to identify health problems based on the assessment data.
- Individualized Planning: Nurses develop a care plan tailored to the patient’s specific needs.
- Implementation of Interventions: Nurses execute the planned interventions, which may involve administering medications, offering education, or performing procedures. Successful implementation demands a combination of technical expertise, nursing knowledge and judgment.
- Ongoing Evaluation: Nurses consistently evaluate the patient’s reaction to interventions and modify the care plan accordingly. This process guarantees that the care remains effective and adapts to the patient’s changing needs.
- Documentation: Thorough and precise documentation of every step in the nursing process is essential. It not only creates a comprehensive record of care but also enhances communication among the healthcare team.
Once you have identified that your practice qualifies as nursing practice and aligns with the Practice Expectations, Practice Directions, and the Code of Ethical Conduct, you can proceed with actively preparing for your self-employed journey.
See here for a few things to consider during this phase:
- Review the College’s Self-Employed Practice Direction and the Self-Employed Practice Handbook.
- Review the following documents to ensure familiarity with nursing requirements:
- Identify if additional education is required for your practice.
- Identify a plan for continuing competence in your field of practice.
- Contact CNPS regarding additional liability coverage for your practice.
- If applicable, identify requirements for home-based or store-front based business insurance.
- If applicable, contact the City of Winnipeg, or appropriate municipality regarding permitting and licensing (even if home-based). Here are a few sites that may assist with starting this process:
- Outline every step within your business to ensure compliance with College Regulations with the goal of maintaining a high standard of practice. Your business plan outline should include but is not limited to:
- your mission,
- services,
- target market,
- positions, roles and responsibilities,
- operational procedures, from client intake and assessment to service delivery and follow-up,
- necessary resources, such as equipment, technology, and personnel, and ensure they meet regulatory standards, and
- protocols and policies for maintaining client records, handling confidential information, and obtaining informed consent.
You have gathered all the necessary information and understand the requirements for starting your self-employed practice. It is time to implement this knowledge and take action.
Develop the resources identified in the planning stage. For example:
- Position description for yourself and any employee(s)/independent contractor(s) within your business.
- Review the position description(s) to ensure that what is identified is nursing practice.
- Standard Work
- Standard work ensures the delivery of consistent, high-quality patient care. By adhering to established protocols and procedures, nurses can minimize variability in care, reduce the risk of errors, and enhance patient safety. Additionally, it provides a reliable framework for training new nurses, helping them quickly adapt to their roles and maintain the same high standards. Ultimately, standard work supports continuous improvement and compliance with regulatory requirements, fostering a culture of excellence in nursing practice.
- Policies and procedures for all aspects of your business, such as
- Informed Consent
- Information management
- Monitoring and maintenance of equipment
- Patient care
- Infection prevention and control
- Supply handling and management
- Management of emergent situations
- Safe storage of medications and substances
- Quality assurance
At a minimum you must have the following policies
- Accepting and refusing clients
- Ending client relationships
- Notice of required payment
- Client record management, including storage, disposition, retention, and transfer.
- Electronic records must have a comprehensive audit capability including a system that enters all access onto a permanent file log, identifying and recording where the access originated and by whom, and if alterations are made to the record, identifying whom, what was altered, and when the alteration was made.
- Request by the client to view their personal health information documented in the client record.
BEFORE INITIATING YOUR SELF-EMPLOYED PRACTICE
Submit the Self-employed Nursing Practice Notification & Declaration form.
- Ensure the summary section clearly identifies all types of nursing services you will be providing. Include any additional services offered within your business, specifying who will provide these services and the locations where they will be delivered.
If you are considering incorporating your business, please visit the Incorporation page before beginning the process. There are specific requirements under the Regulated Health Professions Act that you need to be aware of and follow.
Awareness of your business and ongoing assessment are crucial for maintaining smooth operations. These practices enable you to build a strong reputation, foster trust, and ensure stability.
Regularly review and update your documentation to reflect changes in regulations and best practices. This comprehensive approach will help you stay organized, ensure quality care, and demonstrate your commitment to professional standards.
Other items to consider include:
- Advertising: Be familiar with the College’s Guidelines for Advertising as there is information from the Regulated Health Professions Act, and disclosures that must be included on any online promotion or advertising.
- For legal reasons, CNPS advises keeping copies of all advertisements, including their published dates.
- Selling of products in accordance with regulatory guidelines
- Transparency about the benefits and limitations of products
- Sales practices cannot be exploitive
- Inform clients where else products can be purchased
- Products can only be sold at cost, and can include shipping cost, cost of storage, and professional time in placing order, etc.
- Retention and storage of client records
- To ensure patient information is available for ongoing care, legal purposes, and regulatory compliance, patient records must be retained for at least 10 years from the date of the last entry into the record. For minors, records must be kept for at least 10 years after the client turns 18.
- Maintaining your Health Profession Corporation (HPC), if applicable
- As with any corporation, an HPC requires an annual renewal. See here for information on this process.
- Establish a process to independently verify your annual practice hours
- Each year, nurses are required to self-report their practice hours. Additionally, the College selects a number of nurses annually to provide verified practice hours for the past five years. For nurses employed by an organization, the verification form would be submitted to their employer, who will then complete the form and forward it to the College. For self-employed registrants, it is necessary to establish a system with a third party, such as an accountant, to verify and submit their practice hours to the College on their behalf should this request be made.
- Maintain an updated CRNM profile
- If you own a business and work through that business, this is your employer.
- If your business has contracts through other businesses, identify these businesses as your employer. When contracts have ended ensure that your CRNM profile reflects that your employment relationship with the organization has ended.