Self-Employed Practice

Registered nurses (RNs, RN(AP)s and RN(NP)s) who own a business entity (sole proprietorship, partnership or corporation) that provides registered nursing services or who act as an independent contractor responsible for the collection, use, disclosure, security, retention, destruction and access (trustee) of personal health information are considered self-employed by the College and must disclose their self-employed practice to the College prior to seeing their first client*. Self-employed registered nurses are accountable to all federal, provincial, and municipal laws. This includes being accountable to The Regulated Health Professions Act, Regulations, Practice Directions and the Code of Ethics. 

*AA-17 Opening, Closing, Leaving or Moving a Self-Employed Practice was approved on June 2, 2021. Self-employed registered nurses who did not submit a Recognition of Registered Nursing Practice after the College came under The Regulated Health Professions Act in 2018 will be contacted by the College to submit an Opening Self-employed Practice Notification & Declaration. More information will be sent to impacted registrants in the upcoming months.  

Responsibilities

Open the drop downs below for an overview of responsibilities for self-employed practice. 

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  1. General Responsibilities

    Self-employed RNs must:

    • Hold and maintain a certificate of practice in good standing in either the RN or RN(NP) membership class. 
    • Submit to the College an Opening Self-employed Practice Notification & Declaration prior to seeing their first client and notify the College by emailing selfemployed@crnm.mb.ca if their registered nursing services substantively change anytime thereafter. 
    • Notify the College by emailing selfemployed@crnm.mb.ca when closing, leaving or moving the self-employed practice.
    • Meet the College’s annual continuing competency program (CCP) requirements. 
    • Keep the employer tab on their CRNM profile up to date with the self-employed practice information. 
    • Be able to verify, upon request from the College, RN practice hours through an independent third party such as an accountant, lawyer, tax specialist or designated person in authority (cannot be a family member). 
    • Maintain, and be prepared to submit upon request, up-to-date position descriptions for themselves and any registered nurse employee they may have. A sample position description template can be found here
    • Only perform a reserved act or any other registered nursing service if they are legally permitted and competent to perform it and it is safe and appropriate for the procedure being performed. 
    • Demonstrate the use of the nursing process to assess, make diagnoses, plan, implement and evaluate all care in a holistic manner. 
    • Demonstrate compliance with federal, provincial, and municipal laws. This includes compliance with The Regulated Health Professions Act, Regulations, Practice Directions and the Code of Ethics. 
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  2. Before Starting a Self- Employed Practice 

    Before starting a self-employed practice, registered nurses are expected to: 

    • Identify and document the purpose of their business.
    • Review practice expectations, scope of practice and 2017 Code of Ethics documents to determine if the purpose and work of the business aligns with the information in the documents. Businesses which cannot be considered registered nursing practices include: 
      • Businesses whose service fall outside of RN, RN(AP), RN(NP) scope of practice. 
      • Businesses whose practices or services cannot be compliant with The Regulated Health Professions Act, RN regulations, Practice Directions or the Code of Ethics.
    • Determine an appropriate business structure (sole proprietorship, partnership or corporation).  Registered nurses are encouraged to speak with a lawyer to determine the best business structure.  If the Health Profession Corporation business structure is chosen, the registered nurse must comply with the Health Profession Corporation regulations. The application form for Health Profession Corporations can be found here.   
    • Consult with CNPS to determine liability coverage needs. 
    • Seek appropriate expert advice to ensure they are compliant with all laws and regulations applicable to the service they intend to provide. 
    • Review the self- employed regulations found in the College of Registered Nurses of Manitoba General Regulation. Create policies or processes, at a minimum, to demonstrate compliance with the self- employed regulations: 
      • Accepting and refusing clients
      • Ending client relationships 
      • Notice of required payment 
      • Client record management including storage, disposition, retention and transfer 
    • Create policies and processes to demonstrate compliance with practice expectations including, but not limited to:
      • Infection control
      • Documentation - if using electronic health records ensure the electronic records have comprehensive audit capability including a system which 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.
      • Conflict of interest 
      • Informed consent 
      • Continuity of care/referral  
      • Quality improvement 

    It is recommended that registered nurses contact the college for a practice consultation prior to starting their self- employed practice to obtain feedback about their intended practice and policies. Practice consultation is available by email or telephone 204-774-3477 ext. 301.  

  3. During the Operation of a Self- Employed Practice 

     

    During the operation of a self- employed practice registered nurses are expected to: 

    • Submit to the College, by emailing selfemployed@crnm.mb.ca, an Opening Self-employed Practice Notification & Declaration prior to seeing their first client and notify the College if their registered nursing services substantively change anytime thereafter.  
    • Update the employer section of their CRNM profile by selecting self-employed and entering their business name. 
    • Identify as self-employed on the annual renewal application and answer all questions. 
    • Review their business practices and services on a routine basis to ensure they are compliant with federal, provincial, and municipal laws. This includes compliance with The Regulated Health Professions Act, Regulations, Practice Directions and the Code of Ethics. 
    • Adhere to the Guidelines for Advertising. 
    • Seek expert advice when needed. 
    • Participate in College directed reviews to demonstrate accountability in registered nursing practice. 
    • Maintain their Health Profession Corporation Permit (if applicable).  
  4. Closing, Leaving or Moving a Self-Employed practice 

     

    Self-employed registered nurses are responsible to ensure continuity of care and management of client records when closing, leaving or moving their business. Leaving a business includes situations in which the self- employed registered nurse takes a leave of absence from the business or temporarily ceases to practice. This includes ceasing to practice due to voluntary surrender, suspension or cancellation of a certificate to practice.

    When closing, leaving or moving a self- employed practice registered nurses are expected to: 

    • Provide written notice to their clients (or their representatives) and the College’s self- employed program of this change. 
    • Include in the notification to their clients: 
      • The date they are ceasing practice, taking a leave of absence, moving or closing their business. 
      • Information about how they will communicate their expected return to practice (if applicable). 
      • Information about where client records are to be located and how the records can be transferred to another health care provider or how copies of the records can be obtained (if applicable). 
      • Information about alternative options for care and referral processes in place to support continuity of care (if applicable). 
    • Include in the notification to the College: 
      • A copy of the notification sent to clients and information about how they disseminated this notification to their clients. 
      • Confirmation of where they will be securely storing any health records in their possession for the retention period. If they do not possess client records as part of their business, they must confirm this for the College in their notification. 
      • Their plan for safely disposing medications, laboratory specimens, equipment and supplies (if applicable). 

    Notifications regarding closing, leaving or moving businesses can be sent to selfemployed@crnm.mb.ca

Self-Employed Practice Review 

Self-employed registered nurses may participate in a Quality Practice Review, the Continuing Competency Review or may be requested to have their practice hours verified during the course of their self- employment. Where applicable, these reviews may include an assessment of the self-employed registered nurse’s ability to demonstrate adherence of their business practices to The Regulated Health Professions Act, Regulations, Practice Directions and the Code of Ethics. It is therefore recommended that self- employed registered nurses review their business practices and policies routinely to ensure compliance. 

Health Profession Corporation Permit Registry  

Section 61 of The Regulated Health Professions Act states:  

Except as permitted by the regulations, no corporation, other than a health profession corporation, shall carry on the practice of a regulated health profession. 

The Health Professions Corporations Registry provides the public with information about the current status of corporations that are majority owned by registered nurses. Click here to view the registry. 

More information about the Health Profession Corporations Permit Registry processes can be found in AA-1 and the Health Profession Corporation Permit Application Form

Resources

College of Registered Nurses of Manitoba

 

Canadian Nurses Protective Society (CNPS)