Ask a lawyer: Working with unregulated care providers

Question: 

What are the liability risks for nurses who work with unregulated care providers in collaborative care teams?

Answer:

New and evolving models for health-care delivery have increased the opportunity for collaborative practice between physicians, nurses and other health-care providers, some of whom may not be regulated. Unlike regulated health-care professionals, unregulated care providers (“UCPs”) are not governed by legislation, have no legally defined scope of practice, and are not answerable to an external nursing regulator that sets standards of practice and monitors the quality of care provided by these health-care providers. Typically, UCPs have a scope of employment defined by their job description and are accountable to their employer. UCPs include, but are not limited to, nursing aides and assistants, personal support workers, home support workers, etc.

While health-care professionals are generally entitled to assume, and rely upon, the competence of other regulated health-care professionals in the team, with respect to matters that fall within their scope of practice and area of competence, they cannot always do so when working with UCPs. Indeed, nurses who work with UCPs are often expected to delegate tasks and supervise those tasks assigned to UCPs. The delegating nurse should be confident that the UCP is competent to perform the task safely prior to assigning the particular task. The delegating nurse must also ensure they appropriately monitor and supervise the specific activities assigned to the UCP. Supervision involves initial direction, periodic inspection and corrective action when needed. Various nursing regulators have developed practice standards or guidelines for nurses working with UCPs.1 Nurses should be aware of and abide by any relevant practice standards or guidelines in their jurisdiction. Nurses may also wish to consult the CNPS infoLAW on Delegation to Other Health-Care Workers.

In the event of litigation, the supervising nurse, the UCP and the employer could potentially be held liable for any harm caused by the UCP to the patient. In this regard, the supervising nurse could be held liable if a court decides that they have inappropriately delegated the task or did not properly supervise the UCP during the performance of the task. The UCP may be found liable for accepting delegation for an act they are not competent to perform, unsafely carrying out a task or failing to report important information to the supervising nurse. The employer may also be held liable in certain circumstances, for instance, if it was found that they failed to provide and ensure adequate education, training, assessment and supervision of the competence of the UCP.

Safe patient care is the common goal of all care providers, whether regulated or unregulated. Proper assessment of the care needs, effective care planning and implementation, and good communication between all members of the care team are key to achieving this common goal.

1.For example, Nova Scotia College of Nursing’s Assignment and Delegation to Unregulated Care Providers; College of Nurses of Ontario’s Practice Guideline on Working with Unregulated Care Providers; British Columbia College of Nursing Professionals’ Practice Standard on Assigning and Delegating to Unregulated Care Providers.

Published June 2015

THIS PUBLICATION IS FOR INFORMATION PURPOSES ONLY. NOTHING IN THIS PUBLICATION SHOULD BE CONSTRUED AS LEGAL ADVICE FROM ANY LAWYER, CONTRIBUTOR OR THE CNPS. READERS SHOULD CONSULT LEGAL COUNSEL FOR SPECIFIC ADVICE.