INDEPENDENT

PRACTICE ISSUES
INTRODUCTION :
Self employed
nurses
still bound by all
nursing
legislation and
standards
face some unique
challenges
KEY PRACTICES COMPONENTS TO
CONSIDER THE SCOPE OF SERVICES :
a nurse needs to clearly
identify that he or she is
providing nursing services,
the extent of those nursing
services and under what
conditions he or she will refer
clients to other health care
professionals.
must maintain the high
standards of nursing and
uphold the public trust that
has been bestowed on the
nursing profession
CONFLICT OF INTEREST
primary obligation is
providing professional
care to his or her
clients
In a position of trust
and cannot use their
position to influence
their clients for
financial gain of non-
financial benefit
CONFLICT OF INTEREST CONT

Avoid selling products

or services to clients
they are treating
avoid conflict of
interest situations in
their practice,
particularly when it
comes to the
endorsement and
advertising of
products.
ENDORSEMENT
Endorsing or
promoting a product
or services is closely
linked to conflict of
interest
Endorsement occurs
when a nurse uses her
credentials to lend
credibility to a
commercial product
line or service.
ENDORSEMENT CONT
The endorsement of a
product or service
without providing
information about other
options could mislead
the public and
compromise trust.
For example, a nurse in
independent practice
who provides foot care
services should not sell
any foot care products
for her clients.
ADVERTISING
There are limitations on how a
nurse can advertise his or her
services.
Advertising may take various
forms, such as business cards,
listing in telephone directories,
announcements in newspapers
and periodicals, and
promotional materials.
It can include information such
as a description of services and
nursing credentials, practice
experience, fees, address and
phone number.
PRACTICE GUIDELINE INDEPENDENT
PRACTICE FEES

The college does not

determine or approve specific
service fees. According to
Nursing Act 1991 and the
accompanying regulations,
the following activities
related to fees are considered
professional misconduct.
A). Submitting an account or
change for services that the
member knows is false or
misleading.
PRACTICE GUIDELINE INDEPENDENT
PRACTICE FEES CONT
B)Failing to fulfill the terms of
an agreement for professional
services.
C). Charging a fee that is
excessive in relation to the
service for which it is charged
and/or
D). Offering or giving a
reduction for prompt payment of
an account. Before setting fees, a
nurse should research the fees of
other nurses who have similar
qualifications and experience
and who provide comparable
services.
INFORMED CONSENT
Nurses in independent practice
are expected to obtain informed
consent before performing any
treatment.
For consent to be valid, it must
relate directly to the treatment.
Treatment is defined as anything
that is performed for a
therapeutic, preventive,
palliative, diagnostic, cosmetic or
other health related purposes,
and includes a course or plan of
treatment.
DOCUMENTATION
An integral part
of service that a
nurse provides
is creating and
maintaining
accurate and
complete health
records and
documentation.
DOCUMENTATION CONT
Health records are the
means by which
information about the
client is communicated
to the health care team
and how continuity of
care is maintained.
They also demonstrate
the nurses
accountability and
answer questions about
the type of care
provided
CONFIDENTIALITY
Nurses in independent
practice are required to
maintain the
confidentiality of the
client information and
cannot communicate
the information to
another person unless
the client or clients
representative gives
consent or it is required
by law.
OTHER ISSUES AND RESOURCES
INCORPORATION

Regulated
professionals may
incorporate their
independent
practice under
legislation.
BUSINESS OR LEGAL COUNCIL

Nurses may want to seek legal

advice before starting an
independent nursing practice.
LIABILITY PROTECTION
The college
recommends that
nurses in
independent
practice purchase
liability protection
to enable public
redress if any
problem occurs.
NETWORKING

Entrepreneurial support groups for self

employed nurses offer assistance with
peer feedback, idea and issue sharing,
planning for vacation and sickness etc.
VARIOUS AREAS OF INDEPENDENT
NURSE PRACTICE :
Adult nurse practitioner
Family nurse practitioner
Pediatric nurse practitioner
Acute care nurse practitioner
Geriatric nurse practitioner
Psychiatric and mental health
nurse practitioner
Midwifery or womens health
nurse practitioner
School health nurse
practitioner
Family nurse practitioner
INDEPENDENT NURSE
MIDWIFERY
PRACTITIONER
INTRODUCTION :
Activitiesof health care
providers who are experts
in the women health care
including prenatal care to
expectant mothers,
attending at birth and
providing post partum care
to mother and infant.
Practitioners of midwifery
are known as midwives.
 Independent midwifery
practice enables registered
nurse midwives to utilize
their knowledge skills,
judgment and authority in
the provision of midwifery
practice package and
primary womens health
services while maintaining
accountability for the
management of patient care
in accordance with
midwifery standards laid
down by the midwifery or
nursing council of their
country.
 Independent should
not interpreted to
mean alone, as there
are clinical
situations when any
prudent practitioner
would seek the
assistance of other
qualified.
MIDWIFERY PRACTICE PACKAGE FOR
INDEPENDENT PRACTICE :
1. Access to a midwife 24 hours a
day, 7 days a week.
2. Two midwives available
alternatively and provide
women centered antenatal,
intrapartum and postnatal
midwifery care.
3. Antenatal care in privacy.
4. Continuity of care throughout
labour.
5. Postnatal care up to 6 weeks.
6. Knowledgeable breast feeding
support.
 STANDARDS REQUIRED FOR THE
PRACTICE OF MIDWIFERY :
Midwifery practice as
conducted by midwife is the
independent management of
womens health care, focusing
particularly on pregnancy,
child birth the postpartum
period care of newborn, family
planning and gynecological
needs of women.
Midwives provide consultation,
management, collaborative
management or referral as
indicated according to
standards of midwifery
practice.
 InIndia as such
standards of midwifery
practice act are not
developed to do
independent midwifery
practices which are one
of the essential
requirements.
American college of
nursing midwives has
defined eight
standards of practice.
STANDARD- I :
Midwifery care is provided by
qualified practitioners.
Midwifery should be
registered.
Shows evidence of continuing
competency as required by
certification agency by
council.
It is in compliance with the
legal requirements of the
jurisdiction where the
midwifery practice occurs.
STANDARD- II :
Midwifery care occurs in a
safe environment within the
context of the family,
community and a system of
health care.
Demonstrate a safe
mechanism for obtaining
medical consultation,
collaboration and referral.
Uses community services as
needed.
Demonstrates knowledge
of the medical,
psychological, economical,
cultural and family factors
that affect care.
Demonstrates appropriate
techniques for emergency
management including
arrangements for
emergency transportation.
Promotes involvement of
support persons in the
practice settings.
STANDARD- III :
The midwives practices in
accordance with the
philosophy and the code of
ethics of the professional
body provides clients with
a description of the scope
of midwifery services and
information regarding the
clients rights and
responsibilities.
Provides clients with
information regarding services
when requested or when care
required is not within the
midwifes scope of practice.
Provides client with
information regarding health
care decisions and the state of
science regarding these
choices to allow for informed
decision making.
STANDARD- IV :
Midwifery care is comprised
of knowledge, skills and
judgment that foster the
delivery of safe satisfying and
culturally competent care.
The midwife collects and
assesses client care data,
develops and implement
individualized plan of
management and evaluates
outcome of care.
Demonstrates the clinical skills and judgments
described in the basic midwifery practice.
Practices in accordance with standards.
Practices in accordance with service or practice
guidelines that meet the requirements of the
particular institution or practice settings.
STANDARD- V :
Midwifery care is based upon
knowledge, skills and judgment
which are reflected in written
practice guidelines.
Midwife describes the
parameters of services for
independent and collaborative
midwifery management and
transfer of care when needed.
Establish practice guidelines for
each specialty area which may
include, but is not care of the
child bearing family and
newborn care.
 Includes the following
information in each specialty
area :
Client selection criteria.

Parameters and methods for

assessing health status.
Parameters for risk
assessment.
Parameters for consultation,
collaboration and referral.
Appropriate interventions
including treatment,
medications and or devices.
STANDARD- VI :
Midwifery care is documented in
a format that is accessible and
competent.
The midwife uses records that
facilitate communications and
institutions.
Provides prompt and complete
documentation of evaluation,
course of management and
outcome of care.
Promotes documentation system
that provides for confidentiality
and transmissibility of health
records.
Maintain confidentiality in
verbal and written
communications.
STANDARD- VII :
Midwifery care is evaluated
according to an established
programme for quality management
that includes a plan to identify and
resolve problems.
The midwife participates in
programme of quality management
for the evaluation of practice within
the setting in which it occurs.
Provides for a systemic collection of
practice data as a part of a
programme of quality, management.
Seeks consultation to review
problems, including peer review of
care.
Acts to resolve problems identified.
STANDARD- VIII :
Midwifery practice may be
extended beyond the set
competencies to incorporate
new procedure that improve
care for women and their
fames.
The midwife identifies the need
for new procedure taking into
consideration consumer
demand, standards for safe
practice and availability of
other qualified personnel.
 Ensures that there are no
institutional state or council
statures, regulations or laws that
would constrain the midwife from
incorporation of the procedure into
practice.
Reports the incorporation of this
procedure to the authority. In
respect to provide standardized
practice independently, the nurse
midwife has to meet required
education, experience, advanced
skills and competency.