Your accountabilities when deciding to discontinue or decline care

Nurse Practitioners’ (NPs) are responsible for applying the accountabilities outlined in the Discontinuing or Declining to Provide Care practice standard. You must apply your knowledge, skill and judgment when you are faced with decisions about discontinuing care.

Your accountability extends beyond clinical considerations to include your ethical duty to prioritize the nurse-client relationship. By understanding and integrating the accountabilities outlined in the standard, you can navigate complex situations with professionalism, ensuring safe and client-centred care remains at the forefront of your practice.

Your role and responsibility within your employment setting informs your accountabilities and duties to provide care. The therapeutic NP-client relationship is the foundation of the quality of care received. It is based on mutual trust, respect, professional intimacy and empathy. It requires proper use of the power inherent in the care provider’s role. NPs have a responsibility to establish and maintain professional relationships.

Whenever possible, you should try to resolve conflicts and disagreements before deciding to discontinue care. This includes addressing differences of opinion with the client, health care team or employer to try to preserve the therapeutic relationship and offer the best care. However, there may be situations where you have reasonable grounds to end the therapeutic relationship.

When you may discontinue care

You may discontinue the NP-client relationship in certain circumstances, which might include these situations or others:

  • the NP-client relationship has broken down to the point where you cannot provide safe, competent or ethical care (for example, the client or their family exhibits threatening or abusive behaviour toward you, staff or others, posing a risk of violence or harm, including comments of a sexualized or racist nature)
  • the client requests an end to the professional relationship
  • the client has relocated and/or another provider has assumed the client’s care
  • you take a planned leave from practice
  • the client is discharged because the terms of the service agreement have been met
  • you are no longer registered to practice as an NP in Ontario or you have restrictions on your registration that mean you can no longer care for the client
  • you have not had contact with the client for an extended period (for example, they have missed appointments without proper cause or notice)
  • a real or potential conflict of interest emerges (for example, change in familial status)

What to do when you are discontinuing care

You should do the following when you discontinue care of a client:

  • demonstrate professionalism in all interactions when discontinuing or declining care
  • act with integrity and ensure your decisions are well-communicated, well-reasoned and ethically sound
  • make reasonable efforts to resolve or repair issues to ensure the client care is not jeopardized
  • notify or consult your employer or the broader health care team (if applicable) of the intent to end the NP-client relationship
  • comply with employer policies or your service agreement about discontinuing care as required and seek legal advice as needed
  • communicate clearly with the client about the situation, and the reason for discontinuing care
    • communicate to the client, in writing, the reason the relationship has ended and the date the relationship will conclude, even if you have notified the client verbally during an appointment
    • document the reasons for discontinuing care, including any actions taken to resolve the issue and the client's referral or transition to other services
  • continue to provide essential health care services (for example, renewing prescriptions) whenever feasible until another health care professional has been identified and an effective referral has been made
  • provide client information on how to access urgent or emergency services, if needed
  • understand accountabilities within the health care team; for example,
    • if you are serving in an allied health provider role where you are not the most responsible provider [MRP]), communicate with the employer and other team members to ensure continuity of care
    • if you are acting as the MRP, transfer care to another health provider or ensure the client has continued access to primary care
      • transfer the client’s medical records with consent, complying with the Personal Health Information Protection Act, 2004 (PHIPA)
      • arrange coverage and follow up on pending laboratory or diagnostic tests; if coverage is not possible, inform clients how best to follow up on results (such as using walk-in clinics or the emergency department)
      • provide or allow the client a reasonable amount of time to find an alternate care provider (the timeframe will vary based on circumstances, including the client's mental well-being and condition)

Strategies for resolving issues before discontinuing care

Before discontinuing care, you should make reasonable efforts to resolve issues to ensure that client care is not jeopardized and document these efforts. Review this table for some examples.

This resource was adapted from Nurse Practitioners Closing or Leaving Practice – Temporarily or Permanently (2024) and from Ending the Therapeutic Nurse Practitioner Client Relationship (2024), with the permission of the College of Registered Nurses of Newfoundland and Labrador.