Published: April 24, 2024
Practising through a nursing agency can bring many benefits but can also introduce unique practice challenges and questions about professional accountability.
To help Manitoba’s practical nurses understand how to apply their professional standards when practising through a nursing agency, the CLPNM published an Agency Nursing Guidance Document in 2022, which was most recently updated in 2024. The CLPNM has also published a Fact Sheet for Nursing Agencies to help agencies understand their responsibilities in professional legislation and professional standards.
The CLPNM has become aware that there may still be some confusion about which professional expectations apply when practising through a nursing agency. In response, the CLPNM wishes to provide its registrants with the following reminder.
Your professional responsibilities outlined in legislation, the Code of Ethics, the Standards of Practice and Conduct, and the CLPNM Practice Directions apply equally to you in your agency practice as they would in any other practice environment.
These responsibilities are not solely tied to your employment or employment relationship; they are tied to your status as a member of the LPN profession. As such, these responsibilities apply to you in your practice as long as you hold registration with the CLPNM.
Here are a few specific examples.
Professional Responsibility: The Duty to Provide Care
When you practise through a nursing agency, your professional duty to provide care applies in the same way it would if you were a member of a facility’s regular staff. The duty to provide care refers to a nurse’s professional and ethical responsibility to provide safe and competent nursing care to a client for the time-period that the nurse is required to provide service. 1
When health human resources are less than optimal, all nurses assigned to provide client care in the environment — regardless of employment relationship — have a responsibility to adjust priorities to meet client care needs, and to collaborate with the team and with management to find solutions that support safe client care within available resources. 1, 2
Professional Responsibility: Identify Yourself and Accept Accountability for Your Practice
As a nurse who practises through an agency, you must at all times be transparent about your identity.
It is not acceptable for an LPN to practise in any environment where their identity is not known to the management, team, and clients.
- If you are an owner/operator/employee of nursing agency, and assign an LPN to attend a shift previously assigned to another nurse, you have a responsibility to make sure the facility is aware of the identity of the replacement nurse.
- As an LPN, when you attend an agency nursing shift, you must ensure that the management, team and clients are aware of your identity, and if there is any mistake about your identity, you have a responsibility to immediately and clearly correct the mistake.
Practising under the name of another nurse is both a violation of professional standards and potentially a legal matter.
Professional Responsibility: Choosing Nursing Roles That Match Your Competence
When you practise through a nursing agency, you are choosing to practise in a context where you may be required to work highly independently, in a wide range of unfamiliar environments, and with clients across a wide range of acuity levels. You may be faced with circumstances where you do not have access to clear guidance and are unfamiliar with the expectations in that setting. You may often need to problem-solve quickly in complex situations. Before taking on a role as an agency nurse, be sure to self-reflect and ask yourself if you are prepared for these circumstances.
If you are a graduate practical nurse or novice LPN, you may be putting yourself and your clients at risk if you choose to work through a nursing agency, unless you have assurances from the agency that you will only be assigned to work in practice areas that are an appropriate match for your level of competence and experience.
Professional Responsibility: Ethical Behaviour
All LPNs regardless of their employment relationship, have an obligation per their professional standards to:
- Conduct themselves in a manner that upholds the public’s trust in the profession. 4
- Act honestly, transparently, respectfully and with integrity in all professional interactions. 4
- Represent services provided [including expenses such as mileage and accommodations] accurately and honestly when billing. 5
- Place the interests of the client above the nurse’s own in his or her professional nursing practice. 5
For most LPNs, these professional expectations are so obvious as to not bear repeating. However, the CLPNM has become aware of circumstances in which some LPNs, who practise through agencies, may not be upholding these ethical standards. Through this article, the CLPNM is providing clear notice that the following actions will be considered professional misconduct:
- Misrepresenting expenses, including travel and/or accommodations, when billing the client, the client’s insurer, or any other payer. This applies if you are an LPN who provides clinical care through the agency, or an LPN who has an administrative role in the agency which includes responsibilities for billing the service delivery organization.
- Double billing for expenses.
- Accepting sick leave pay from one employer while simultaneously accepting pay for a nursing shift elsewhere.
- Calling in sick or cancelling a shift on short notice in one practice setting in order to accept a more favourable / higher paid shift at another.
- Using the identity of another nurse, or holding yourself out to be an individual you are not.
- Allowing or colluding with another person for the purposes of enabling that person to use the identity of another nurse or hold themselves out as an individual they are not.
- Knowingly and willfully misrepresenting your current nursing competence, skills, and experiences.
Depending on the circumstances, these actions may also be legal matters (fraud).
Professional Responsibility: Mentorship and Leadership in Practice
Even as an agency nurse you have mentorship and leadership responsibilities, because these are professional responsibilities which follow you to any environment or context in which you practice.
All LPNs regardless of their employment relationship, have an obligation per their professional standards to:
- Act as a role model, resource, and mentor to those who are learning within the practice environment.
- Advocate for and contribute to practice environments, which support the mental, physical, and psychological well-being of other registrants and all members of the health care team.
- Advocate for and contribute to practice environments that promote safety, support, and respect for all persons in the practice setting.
- Collaborate with colleagues to evaluate the quality of your practice and that of the health care team. 4
While employers are responsible for ensuring that facility orientations occur, all nurses, regardless of their employment relationship to the facility, play a role in leading and mentoring others. This may include student nurses, new graduates, or nurses new to a unit you are familiar with for any reason. Failure to uphold the standards in relation to this professional responsibility may be considered professional misconduct.
Conclusion
The CLPNM is aware that the vast majority of LPNs — including the vast majority of those who practise through agencies — are compassionate, competent and ethical professionals.
The purpose of this article is to ensure there can be no confusion about the applicability of professional standards to the context of agency practice. We hope to be fully transparent with our registrants about circumstances which could lead to a finding of professional misconduct. This will assist LPNs, who practise through agencies, in making decisions that align with the standards and values of their chosen profession.
Please contact the CLPNM Practice Department if you have questions.
References
1 CLPNM, CRNM, CRPNM (2019). Duty to Provide Care Guidance Document. Accessible online at:
https://www.clpnm.ca/wp-content/uploads/2022/07/Duty-to-Provide-Care-Final.pdf
2 CLPNM (2022). Duty to Provide Care Practice Direction. Accessible online at:
https://www.clpnm.ca/wp-content/uploads/2022/07/PD-Duty-to-Provide-Care.pdf
3 CLPNM (2024). Guidance Document on Agency Nursing. Accessible online at:
https://www.clpnm.ca/wp-content/uploads/2022/07/Agency-Nursing-Guidance-Document.pdf
4 CLPNM (2021). Standards of Practice and Conduct. Accessible online at: https://www.clpnm.ca/wp-content/uploads/2022/07/CLPNM-Standards-of-Practice-and-Conduct-2021.pdf
5 CLPNM (2014). Code of Ethics. Accessible online at: https://www.clpnm.ca/wp-content/uploads/2022/07/CLPNM-Code-of-Ethics-Approved-June-2-2014.pdf
