COVID-19: Six considerations for independent practice during a pandemic

During extraordinary circumstances like a global pandemic, nurses who operate their own nursing businesses may have questions regarding the ever-changing nature of their practice. Below is a list of some important risk management considerations when operating an independent nursing practice during a global pandemic.

1. Update yourself frequently.  In the event of a crisis, all levels of government have established legislation to respond to emergency management planning and public health. In response to COVID-19, many provincial and territorial governments have used their powers to issue emergency orders, such as those requiring the closure of non-essential services. Nursing regulatory bodies are also an important source for nurses to obtain updated information regarding their nursing practice during this unprecedented time. In light of the fast-paced and constantly evolving nature of this pandemic and the continual flow of new information, it is important for nurses to consult reliable sources, such as their local government websites, their local public health departments, and their nursing regulatory bodies, frequently to ensure that they are practicing with the most updated information. Nurses may consider developing a standard practice of checking the information at the same time each day to establish a daily routine of keeping themselves up-to-date.

2. Understand what constitutes essential services and emergency services. In an effort to control the spread of a disease during a pandemic, governments may issue emergency orders or directives limiting the provision of some services. It is important to be familiar with the emergency order or directive posted in your specific jurisdiction along with any specific directives applicable to your practice. The health-care provider is usually in the best position to determine which services are classified as essential or emergency services and should consider seeking guidance directly from the written directive or emergency order and their nursing regulatory body to assist in their decision-making exercise. However, a nurse in a position to make the decision may also consider the following:

  • Will discontinuing that specific patient’s care put that patient at a greater risk of harm or at greater risk of requiring emergency services?
  • Are the risks of discontinuing the patient’s care greater than the risks of the patient receiving care?

It would be prudent to review all patient records and make this determination on a case-by-case basis, as some patients will require ongoing essential services based on their specific underlying conditions and clinical presentations, while others will not.  How can these decisions be effectively recorded?  In addition to documenting the rationale for either continuing or temporarily suspending care in the patient’s chart, consider referencing and retaining any relevant orders or declarations consulted in making these decisions.

3. Understand the screening, infection control & other precautions that have been implemented by authorities. Nurses who continue to operate their businesses during a pandemic would be prudent to familiarize themselves with and regularly review the direction or recommendations provided by their local public health departments concerning:

  • the screening of patients prior to providing care;
  • the use of personal protective equipment;
  • infection control measures; and
  • when their own patients should be referred for COVID-19 testing.

Nurses who have employees may be required or advised to take additional steps to protect the health and wellbeing of their employees by local authorities.

When considering whether a nurse met their standard of care in a legal proceeding, the court or adjudicating body will rely heavily on authoritative statements, such as directives from regulatory bodies and government institutions, including Public Health departments, along with best practices available at the time of the incident.

4. Communicate with your patients. Consider communicating your decision to continue or temporally suspend services directly to the patient, or the patient’s substitute decision maker if the patient is incapable.  When communicating with the patient, it is prudent to consider any reported changes in the patient’s condition, to outline what they should do in the event of an emergency, and thoroughly and accurately document the communication. If services are suspended for the patient on a temporary basis, it would also be prudent to advise the patient to notify you if their condition changes so that you may re-evaluate the decision to continue or temporarily suspend care. In the face of COVID-19, some patients may be fearful of attending an in-person appointment, and like all treatments, the nurse should have an informed consent discussion with the patient which includes the risks of not attending the appointment, but remembering that the decision to attend ultimately rests on the patient, or the substitute-decision maker, if the patient is incapable of making their own medical decisions.

You may also consider whether alternatives to direct patient care, such as virtual care, may be safely used as an alternative to providing direct patient care.

5. Document. Given the constant and frequent changes arising from this global pandemic, frequent and contemporaneous nursing documentation is especially important to not only capture the nursing care and discussions with your patients, but also to capture your decision-making process as it relates to the continuation of services or temporary suspension of care.

6. Do you have business insurance? Some nurses may have purchased business insurance to cover some aspects of their business. Consider contacting your business insurance provider for questions concerning how COVID-19 may impact your coverage or for questions regarding additional business insurance you may require during this time.