CNO Discipline Decisions: Everything You Need to Know

Nurses working in Ontario must follow regulations and patient care standards set by the College of Nurses of Ontario (CNO). If an employer or someone from the public complains about the care a nurse provided, the CNO will investigate the incident, which could lead to a referral to the Discipline Committee. This is a frightening situation for any Ontario nurse to find themselves in, but you don’t have to face this ordeal alone.

At Posner Craig Stein, our Ontario professional discipline lawyers understand the stress and fear that comes with these proceedings. We have extensive experience with these cases, know the regulations involved, and can help protect your professional reputation. We treat these cases with the seriousness they deserve and make the process as easy on you as we can. Below you’ll find everything you need to know about CNO discipline decisions in Ontario.

What Cases Does the CNO Investigate?

The CNO typically investigates three kinds of complaints against nurses: professional misconduct, incompetence, or incapacity.

Professional Misconduct

Professional misconduct involves behaviour that breaches the Nursing Act of 1991, the Regulated Health Professions Act of 1991, the CNO by-laws, or the CNO’s practice standards. This could include a wide range of activities such as:

• Violating patient confidentiality by sharing sensitive patient information without consent
• Acting disrespectfully or abusively towards a patient, colleague, or anyone else in a professional capacity
• Practicing while impaired, either through the use of alcohol or drugs or due to a physical or mental condition
• Neglecting to provide appropriate care or failing to document the care provided
• Practicing the profession while in a conflict of interest

Incompetence

Incompetence occurs when a nurse’s professional performance demonstrates a lack of knowledge, skill, or judgment to such an extent that it could endanger a patient’s life or health. Instances of incompetence might include:

• Incorrectly administering medication or treatments
• Failing to recognize and respond appropriately to a change in a patient’s condition
• Insufficient or incorrect use of nursing equipment
• Inadequate assessment of a patient’s health status

Incapacity

Incapacity relates to circumstances when a nurse’s physical or mental condition affects their ability to safely practice nursing. This could include a range of circumstances, such as:

• Mental health disorders that impair the nurse’s judgment or ability to perform their duties
• Physical conditions or disabilities that prevent the safe practice of nursing
• Substance abuse issues that interfere with the nurse’s ability to provide safe and effective care

How the CNO Discipline Process Works

The CNO’s disciplinary process begins when someone files a complaint about a nurse’s care or potential breach of ethical standards. Some complaints come from the public, while others come from nurses’ employers. However, just because someone files a complaint does not mean that a nurse will necessarily face disciplinary action.

In Ontario, the CNO’s Inquiries, Complaints and Reports Committee (ICRC) typically investigates professional misconduct complaints against nurses. The ICRC may recommend an education and remediation program, or they might issue a verbal caution. It’s crucial to remember that a complaint against a nurse does not automatically trigger disciplinary action. The ICRC does not have the authority to discipline nurses. Instead, they’ll review the complaint and the available evidence to determine whether a referral to the Discipline Committee is warranted.

After the Discipline Committee receives a referral from the ICRC, they will send a Notice of Hearing to the nurse under investigation. This notice contains the details of the complaint, along with the time, place, and purpose of the disciplinary hearing.

Before the hearing takes place, though, there is a pre-hearing conference between the nurse under investigation and CNO investigators. This conference is a means to determine whether the nurse under investigation and the CNO can agree on the issues without going through a formal hearing. If the nurse and the CNO can reach an agreement, then that agreement goes to the Discipline Committee for approval. If the committee approves the agreement, the nurse accepts the proposed penalty, which ends the case. If the Discipline Committee does not approve the agreement or the nurse and the CNO investigators disagree on the issues, the committee will hold a formal hearing.

The Basics of CNO Disciplinary Hearings

A hearing before the Discipline Committee is an adversarial process, similar to a trial. A prosecutor represents the CNO at the hearing, while an Independent Legal Counsel typically attends to guide the Discipline Committee on legal and procedural matters. The nurse under investigation has the right to legal representation, and we strongly urge any nurse facing CNO disciplinary proceedings to retain a lawyer as soon as possible.

Ahead of the hearing, the CNO must provide the nurse under investigation with all the documents and evidence that it plans to present. It is also mandatory to provide a witness statement or summary of evidence for any witnesses the prosecution calls. The nurse must provide the same information to the committee before the hearing starts.

Like in a typical trial, Discipline Committee hearings are recorded, and either side can request a transcript once the hearing concludes. Discipline Committee hearings are also public, and in some instances, the complainant, a public interest group, or a professional association may attend the hearing.

Once the hearing ends, the Discipline Committee will decide if the nurse under investigation was guilty and whether a penalty is required. If the committee finds the nurse guilty, they will publish a summary of their decision and actions against the nurse. Either the nurse or the CNO may appeal the decision to the Divisional Court.

What Penalties Can the Disciplinary Committee Order?

According to information from the CNO, the actions the Disciplinary Committee can take if they find a nurse guilty include:

• An oral reprimand
• The revocation or suspension of a nurse’s certificate of registration
• Ordering restrictions or limitations on a nurse’s certificate of registration (costs, fines, meetings with regulatory experts, independent practice restrictions, etc.)
• Education and remedial activities

Why You Need a Lawyer for Your CNO Disciplinary Case

We urge any nurse facing CNO disciplinary proceedings to hire a lawyer as soon as possible. With so much at stake, including the possibility of losing your professional license, it’s crucial to have a skilled and experienced legal advocate in your corner. Remember, CNO’s lawyer and the Independent Legal Counsel do not represent nurses in these cases, so you need your own legal counsel.

Posner Craig Stein LLP is proud to represent Ontario nurses during CNO disciplinary investigations. Call us today at (416) 391-2118 or reach out online to discuss your case.