Ask a Lawyer: Ending the NP-Client Relationship

Question: 

I am a nurse practitioner and I want to end my professional relationship with a client. What do I need to consider before doing so?

Answer:

Ending the nurse-client relationship is not simple, and you may wish to seek legal advice from the CNPS before proceeding. If the relationship ends in unwarranted circumstances, it may be considered professional misconduct. As a result, discontinuing the professional relationship when the client still requires nursing services is generally a measure of last resort.

There are several issues you need to consider before ending a nurse-client relationship:

• • Is the relationship ending based on a prohibited ground under legislation?
  • Is the client vulnerable in terms of the ongoing care required?
  • Is trust an issue, as trust is considered one of the foundational elements of a professional relationship?
  • Have you entered into a discussion with the client about the issues that are impacting the relationship?
  • Have you created a plan with the client to help resolve the issues that are impacting the relationship
  • Does the status of the relationship enable you to meet your professional obligations?
  • Are there employer policies in place about ending the relationship?
  • Can you identify an alternate care provider for the client or, if given a reasonable amount of notice, could the client identify an appropriate alternate care provider?
  • Are there alternate primary-care providers and community-health resources available?
  • If ending the relationship is recommended, have you determined the necessary services that you should provide in the interim while the client is locating a new care provider?
  • How best to communicate and document the concerns about the nurse-client relationship, and, if ending the relationship is recommended, letting the client know about the reasons for the decision and actions taken?

This list of issues is not exhaustive and the specific circumstances regarding the client and the NP will need to be considered.

As a health care professional, terminating nursing services should be viewed as a last resort. Yet you may still be faced with a difficult situation where you feel it would be best for both you and the patient to discontinue the nursing services you are providing. This may include boundary violations, aggressive or threatening behaviour, or the patient’s lack of response. However, a nurse may wonder if they are discontinuing services for a suitable reason. If faced with this situation, it would be prudent to consult the nursing regulator’s guidelines and employer policies on patient abandonment and the duty to provide care in order to be fully informed about your rights and responsibilities.

Nurses have a professional and legal duty to provide clients with safe, competent and ethical care, while the client has a right to receive care.¹ The CNA Code of Ethics and many nursing regulators explain that nurses should “respect the decisions a person makes, including choice of lifestyles or treatment that are not conducive to good health, and continue to provide care in a non-judgmental manner.” Nevertheless, this would not include putting yourself at an unacceptable level of risk.²

Generally, discontinuing professional services after you have accepted an assignment or established a therapeutic relationship with the client may be considered professional misconduct, unless:

1. 1. The client requests the discontinuation,
   2. Alternative or replacement services are arranged, or
   3. The client or the nurse’s work provider is given reasonable opportunity to arrange alternative or replacement services.³

Refusing to care for a patient after accepting responsibility without transferring care to another provider or informing the appropriate supervisors so they can find a replacement could be considered a form of patient abandonment.⁴ You may also be required to negotiate with the patient or employer to “develop a mutually acceptable plan for withdrawal of service.”⁵

It is important to carefully document the factors that lead to the decision to terminate a client relationship, including all communication with the patient. In addition, if you choose to terminate the services, it would be prudent to ensure that the patient’s immediate follow up needs have been met. As such, you may wish to consider continuing to provide interim services until the patient has found a new care provider.

CNPS beneficiaries can contact CNPS at 1-800-267-3390 to speak with a member of CNPS legal counsel. All calls are confidential.

1. British Columbia College of Nurses and Midwives, Duty to Provide Care.
2. BCCNM, Defining client abandonment.
3. College of Nurses of Ontario, Discontinuing or Declining to Provide Care, 2024; BCCNM, Defining client abandonment; Nova Scotia College of Nursing, Abandonment Practice Guideline, July 2022.
4. Ibid.
5. Nova Scotia College of Nursing, Abandonment Practice Guideline, July 2022.

September 2017, Revised November 2024

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.