Ending the Therapeutic Nurse Practitioner Client Relationship

Nurse Practitioners (NPs) have a professional obligation to provide safe, competent, and ethical care for clients and to establish therapeutic nurse client relationships (TNCRs) that are culturally safe and equitable. TNCRs are foundational to the practice of an NP, however, situations may arise (e.g., planned or unplanned) that may lead to the discontinuation of the NP-client relationship. These circumstances require careful consideration and reflection and require the NP to fulfill certain legislative, regulatory, and, if applicable, employer requirements.

As NPs will need to evaluate their unique situations and context, this document is purposely presented as a regulatory guideline to help NPs make decisions in the best interest of the public they serve. Ending an TNCR is not simple, and NPs are encouraged to follow their Standards of Practice, applicable evidence-informed best practices, and consider seeking legal advice before proceeding.

Ending the NP-Client Relationship

Have Reasonable Grounds to End the NP-Client Relationship

There may be situations where the NP (using critical reflection and judgment) has reasonable grounds (consider on a case-by-case basis) to end the NP-client relationship. The NP may discontinue their professional relationship with a client in certain circumstances, including but not limited to:

• the NP-client relationship has eroded to the point where the NP can no longer meet their professional obligations toward the client (i.e., provide safe, competent, and ethical care)
  • the client and/or the client’s family pose a genuine risk of harm or exhibits inappropriate behavior such as threatening or abusive behavior toward the NP, including comments of a sexualized or racist nature
  • in situations that pose a safety risk to the NP or others (e.g., staff, members of the healthcare team, other clients), the NP may end the NP-client relationship immediately and is not obligated to engage directly with the client
• the client requests discontinuation of the professional relationship
• NP’s therapeutic relationship with the client reaches its natural or expected conclusion
• a planned leave from practice
• the NP licence is not in good standing, preventing the NP from meeting their professional responsibilities for aspects of client care (e.g., licensure restrictions)
• the client makes a clear declaration of non-confidence in the NP’s ability to provide care
• the client engaged in prescription or requisition-related fraud dependent upon the context. The NP must use their professional judgment to determine if it constitutes an immediate end to the relationship. The NP may choose to have a frank discussion with the client to set boundaries and clear direction to prevent reoccurrence
• the client has been absent from the practice for an extended period of time (e.g., missed appointments without appropriate cause or notice) and the employer’s/organization’s policy on ending the relationship on this basis has been communicated ahead of time to the client
• the NP is aware that the client has relocated and/or that another physician/NP has assumed the care of the client
• the client requests care outside the NP’s scope of practice and care may be transferred to another healthcare professional with that expertise (e.g., NP may not have prescriptive authority for opioid agonist therapy (OAT for Opioid Use Disorder).

Before ending the NP-client relationship, the NP is encouraged to seek legal advice. For NPs within an organization, the NP should consult with their manager, Professional Practice, and/or employer and, if appropriate, with the employer’s legal and/or risk management teams. In addition, the NP is encouraged to seek legal advice from the Canadian Nurses Protective Society (CNPS).

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