CASE RNs provides follow-up article on independent practice
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Nurses often start their business to address a gap in care they identified while working within traditional places of employment. Their self-employment is designed to provide better care because they are applying their nursing skills and knowledge to the gap they found.
Editor’s note: On February 8, 2025, the Canadian Association of Self-Employed Regulated Nurses will hold its second virtual conference, entitled Nurses in Independent Practice: A Paradigm Shift. Visit their conference website for more information.
Nurses in independent practice apply nursing knowledge, skills, judgment and business skills to their own entrepreneurial venture. The Canadian Association of Self-Employed Regulated Nurses (CASE RNs) is the only association in Canada prepared to represent those nurses who are thinking of starting a business, are self-employed or are in independent practice and/or running their own nursing business. They may see clients spanning from pre-birth to death according to their expertise.
Some businesses that nurses run include care management, advocacy, consultancy, education, legal nurse consultancy, psychotherapy, palliative and end-of-life care, podcasting, researching, speaking and device innovation, from technology to tangible devices.
Nurses can be authors, franchisee owners and providers of nursing services, including not-for-profit patient and/or nursing organizations. Nurses often begin as sole proprietors and decide to incorporate their business as it grows.
CASE RNs wants to take this opportunity to provide an update to our 2020 article for Canadian Nurse, beginning with the growth we’ve seen over the past few years.
Growth in self-employed nursing workforce
According to recent numbers analyzed by the Canadian Institute for Health Information (CIHI), Ontario, Manitoba and British Columbia have seen the highest rise of registered nurses (RNs) in independent practice over the past four to five years (B. Li, personal communication, October 30, 2024).
Ontario (CIHI, 2024):
- Number of RNs in independent practice:
- Number of nurse practitioners (NPs) in independent practice:
- As of November 22, 2024, there were 79 active health professional corporations registered with the College of Nurses of Ontario (F. Bonechi, personal communication, November 22, 2024).
Manitoba (College of Registered Nurses of Manitoba, 2023):
- Number of nurses who registered as self-employed or running a business:
- Number of health professional corporation permits:
- 2020: 3 permits
- 2023: 30 permits
British Columbia (CIHI, 2024):
- Number of RNs in independent practice:
- Number of NPs in independent practice:
Challenges for nurses exploring independent practice
Despite this growth in interest, challenges remain for nurses exploring independent practice, and CASE RNs has been working to address these issues.
The difficulty of starting a business
Nurses often start their business to address a gap in care they identified while working within traditional places of employment. Their self-employment is designed to provide better care because they are applying their nursing skills and knowledge to the gap they found. Unfortunately, many business owners very quickly realize that developing and growing their business model is daunting, such as creating the patient record program mentioned below. CASE RNs seeks to address this lack of knowledge through education on business-related matters. Nurses in business must know the legalities of contracts and ensure that they have the appropriate business liability coverage, professional liability protection, cyber insurance and cyber security training. They need help with so much more than just risk management. There are few role models and resources for entrepreneurial nurses to tap into. CASE RNs is well equipped to provide guidance regarding this unique requirement of a health-care professional.
Patient records
Keeping patient records creates barriers as hard copies need to be stored a number of years and accessing provincial electronic health records when working outside the public health system is not happening easily. Innovative nurses have developed their own secure and customized electronic health record systems, which is a difficult yet achievable solution to this problem.
No national standard
The fact that each province has different expectations for independent practice creates boundaries to expanding a good idea. It simply creates confusion when developing business plans. Creating national standards for self-employed nurses will benefit nurses, especially those with successful businesses looking to expand into other jurisdictions (Thiessen, Leslie, & Stephens, 2023). CASE RNs works to assist nurses with identifying these types of barriers.
Private health insurance providers
Nurses who are self-employed or work as independent consultants are contractors directly paid by their clients, often known as “family-funded” care. Some clients have insurance for private nursing coverage in their home through organizations such as Canada Life, Manulife and Sun Life. However, the dollar amount reimbursed to clients by insurance companies is highly variable, and the subsidy provided is not aligned with today’s nursing fees for service. In addition, insurance companies often require a doctor’s referral note for independent nursing care, creating an extra step for families securing coverage for the nursing care. Realistically, for a nursing business to be financially sustainable, the demand for services and ability for clients and families to pay for support must be carefully evaluated.
About the Canadian Association of Self-Employed Regulated Nurses
CASE RNs is a business for nurses in business, and membership has privileges. CASE RNs is a registered not-for-profit organization that was officially launched in 2019 with a board of directors spanning across Canada. In 2024, CASE RNs went through an official registered name change to represent all “regulated” nurses across Canada. We learn from our peers. We share with our peers. If you are a nurse who is considering entering independent practice, you will benefit by joining CASE RNs. Check out our website for more information. For example, did you know that nurses in Ontario should incorporate the Business Corporations Act and the Regulated Health Professions Act, specifically, Ontario Regulation 39/02 Certificates of Authorization, into their planning (College of Nurses of Ontario, n.d.)? Looking to the future opportunities for independent practice has CASE RNs tracking the new RN prescribing programs (College of Nurses of Ontario, n.d.).
References
Canadian Institute for Health Information. (2024). Number of nurse practitioners and registered nurses workforce by jurisdictions and nurse type in 2023 [Excel file received by author].
College of Nurses of Ontario. (n.d.). RN prescribing practice. Retrieved from https://cno.org/standards-learning/rn-prescribing/rn-prescribing-practice
College of Registered Nurses of Manitoba. (2023). Defining a path forward: 2023 annual report. Retrieved from https://www.crnm.mb.ca/wp-content/uploads/2024/04/CRNM-2023-Report-2.pdf
Thiessen, N. J., Leslie, K., & Stephens, J. M. L. (2023). An examination of self-employed nursing regulation in three Canadian provinces. Policy, Politics, & Nursing Practice, 24(4), 265–277. doi:10.1177/15271544231175472
Gigi van den Hoef, MHS, BSc, RN, CCRP, is a medical science liaison and RN consultant. She is executive director of the Canadian Association of Self-Employed Regulated Nurses.
Kirk Nyquist, RN, BSN, MA, is the secretary for CASE RNs. He is a self-employed nurse producing Reefer MEDness - The Podcast, which explores integrating cannabis into nursing practice.
Susan Hagar, RN, BCPA, is founder and CEO of Nurse On Board, Ottawa, and vice-president of the Canadian Holistic Nurses Association.
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