Becoming a self-employed nurse is above all a choice for freedom. You choose your hours, your patients, and how you work. But this autonomy also comes with responsibilities, particularly in terms of administration and accounting. Here is everything you need to know to avoid pitfalls and practise your profession with peace of mind.
Why does a nurse need to keep accounts?
In Belgium, all self-employed activities, including those in the medical sector, must comply with certain tax and accounting obligations. Even if your core business remains patient care, you are also considered a self-employed professional in the eyes of the authorities.
This means that you must keep regular accounts to track your income and expenses. These accounts will serve as the basis for calculating your taxes and social security contributions and for verifying the profitability of your business.
What accounting system should a self-employed nurse use?
The good news is that most self-employed nurses are subject to a simplified tax regime. As long as you do not exceed certain turnover thresholds (which change every year), you can opt for simplified accounting, also known as ‘single-entry accounting’.
This consists of three main registers:
- The income ledger: this records all the amounts you receive for your services.
- The expense ledger: this lists all your professional expenses (purchase of medical equipment, fuel, telephone costs, etc.).
- The VAT register: if you are subject to VAT, you must also record all your VAT-liable transactions in this register.
In some cases, particularly if your turnover exceeds certain thresholds, you will have to switch to double-entry accounting, which is much more cumbersome and complex.
Are you subject to VAT as a self-employed nurse?
In principle, medical services are exempt from VAT in Belgium. This means that you do not charge VAT to your patients and you do not have to pay it to the government.
However, this exemption is not automatic for all activities. If you offer certain additional services, such as the sale of medical equipment or cosmetic services, part of your income may become taxable. It is therefore crucial to thoroughly analyse your activity with a professional.
What are your tax obligations?
Each year, you must:
- File your personal income tax return, including your professional income.
- Pay quarterly social security contributions, which are calculated based on your income.
- Make advance payments to avoid potential tax surcharges.
- Keep your accounting documents up to date in case of an audit.
It is recommended that you keep all your supporting documents for at least seven years. This includes your invoices, bank statements and contracts.
What expenses can you deduct?
One of the major advantages of being self-employed is the ability to deduct your professional expenses. In practical terms, this means that all expenses necessary for your business can be subtracted from your taxable income.
Here are some typical examples for a self-employed nurse:
- The purchase of medical equipment (gloves, syringes, blood pressure monitor, etc.).
- Professional clothing.
- Travel expenses between patients.
- Part of your telephone and internet costs.
- Subscriptions to professional journals or continuing education courses.
- Management fees related to your accountant or invoicing software.
The more accurately you identify and justify your expenses, the more you can reduce your tax bill.
Why seek expert assistance?
Many new nurses choose to manage their own accounting to save money. However, the complexity of the rules and lack of time quickly become obstacles.
A chartered accountant specialising in your sector is fully aware of your obligations and rights. They can guide you through the process, optimise your tax situation and save you valuable time. Above all, they will help you anticipate your payments and avoid unpleasant surprises.
In addition, some modern accounting firms now offer support tailored to nurses, combining digital tools and human contact for smooth and reassuring management.
In short: a well-oiled organisation for peace of mind
Being a self-employed nurse is not just about providing care: it also means becoming a business owner. By complying with your accounting and tax obligations, you secure your business and give yourself the means to grow it with peace of mind.
Always keep in mind that your profession deserves to be practised with peace of mind. Good accounting organisation is your best ally in achieving this.