Yes, nurses in independent practice can charge a fee for the services they offer in their practice. Currently in Ontario, there are no remuneration systems or billing models for the health services provided by nurses (i.e., Registered Nurses (RNs), Registered Practical Nurses (RPNs), Nurse Practitioners (NPs)) who are self-employed for the purpose of providing nursing services, and/or operating their own nursing business.

As nurses are not able to charge or bill the Ontario Health Insurance Plan (OHIP) for any services they provide, nurses in independent practice should set fees comparable to that of other nursing and/or health care providers who provide similar services. Although Nurse Practitioners (NPs) are assigned an OHIP billing number, this is to facilitate referrals to physicians (e.g. consultation or procedural requests); NPs cannot bill OHIP directly on a per service basis.

Charging fees to a client may not be appropriate in all settings. When determining fees, nurses must follow the accountabilities around setting fees in the Independent Practice guideline and refrain from inappropriate business practices as outlined in the Professional Misconduct reference document.

If you cannot find a comparable service in your community, consider comparable jurisdictions or areas (such as other provinces), and use your professional judgment to determine if your proposed fees are reasonable.  It is unacceptable for a nurse to charge a fee that is excessive for the nursing services rendered.

When calculating a fee, the nurse should consider the nature and complexity of the matter, the time spent with or on behalf of the client, and the cost of the materials. Nurses must inform the client of the cost of the service before it is performed, and it is advisable to explain the considerations used to determine the fee prior to performing a service.

No, nurses cannot charge a fee to be available or be on call to provide services to a particular client, as it creates a risk that the client is being charged for a service that has not been provided and may never be rendered. Nurses must ensure they can itemize the services they have provided to the client.

Nurses in independent practice may charge a fee in advance for providing nursing services, but it must relate to the services they intend to provide to a client. For example, a nurse providing psychotherapy may offer the client a fee for a treatment plan that includes ten therapy sessions. In this case, the fee is for the planned treatment and is subject to reasonable policies for refunds, missed appointments and cancellations.

CNO does not regulate employers. CNO regulates nurses and can only speak to nursing accountabilities. While employers who are nurses remain accountable to CNO’s standards and guidelines, it is beyond CNO’s purview to comment on employers’ business practices or provide legal or business advice.