Independent Contracting and Protecting Your License

[nightingale, RN]

Here is an interesting question and answer posed on the Nursing Spectrum website I subscribe to that is a general nursing website. The question posed is regarding independent contracting:

http://65.54.246.250/cgi-bin/linkrd?_lang=EN&lah=f997f95c834f38b080e63ecd5e693621&lat=1050240554&hm___action=http%3a%2f%2fwww%2enursingspectrum%2ecom%2fCareerManagement%2fAskTheExperts%2fLaw%2fdetail%2ecfm%3fID%3d248

(I am not sure it will be donloadable from my MSN start page)

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As an independent contractor, what concerns should I have regarding protecting my license? - by Vanessa on March 14, 2003

Dear Nancy,

I have been self-appointed as an independent contractor and visit clients in adult foster homes. Being that I am not an employee of Aging Services, I have no "supervisor" to report to or consult with. I am a bit uncomfortable with this role as it seems so unmonitored and "risky." Because I work for myself, I'm perplexed and without answers as to rules and regulations for my nursing practice.

I visit clients in adult foster homes. These homes are required to have an RN (apparently of their choice) assess the client every 60 days. I have reported some problems to the foster home licensure such as medication errors and lack of follow through on nursing orders (to resident care manager or non certified caregiver), but they are not medically oriented.

Is my license in any kind of jeopardy here?

Signed, Vanessa

Nancy replies:

Dear Vanessa:

Your independent contractor practice sounds interesting and challenging. Because it is somewhat "unique," the concerns raised in the question are valid, but not insurmountable. Knowing about the many laws that impact upon your practice can help avoid potential legal pitfalls.

First and foremost, the state nurse practice act and its rules will govern how the business must be molded to your allowable nursing practice. For example, unless you have a license to practice as an advanced practice nurse, some of the responsibilities in your nursing business may not be possible. Moreover, any requirements for collaboration with a licensed physician must also be met. Generally speaking, an RN cannot practice nursing without some type of order from a licensed physician, dentist, advanced practice nurse, or other healthcare provider included in the act and/or rules. Additionally, the RN must conform his or her practice to the scope of practice defined in the act, any standards of practice adopted in its rules, and to standards of practice adhered to by nurse colleagues across the country.

A second area of concern that must be evaluated are the state laws in effect that deal with care provided in adult foster homes. For example, what requirements exist, if any, for an RN in your position in terms of credentials, number of hours that must be met in the home per week, and documentation mandates? What does the same law say about medication administration? Who is authorized to do so? What types of policies must be in place before medication administration to residents can occur?

Luckily, there are a wealth of resources for nurses in an independent practice so that answers to these, and other, questions can be obtained. Consulting with a nurse attorney or attorney in your state is essential to be certain your practice is consistent with the many laws that apply to such a practice.

A second resource is your nurse colleagues who have established their own independent consulting business. For example, the National Nurses in Business Association provides support, information, seminars, and other member benefits to nurse entrepreneurs. Its website is http://www.nnba.net.

On a final note, it is essential that your professional Liability Insurance policy covers practicing in an independent manner. A frank discussion with your insurance representative can help provide the coverage necessary for such a practice. It would be a grave legal mistake to rely on a "standard" professional liability insurance policy.

Best wishes,

Nancy