Lawyer for Nurses (CNO)

What will Happen if I am Reported to the CNO?

Virtually anyone can report a nurse to the College of Nurses for alleged professional misconduct. If you have been reported to the CNO for professional misconduct, you will either be notified by the individual or institution who made the report, or by the CNO themselves. When a member is reported by their employer, their employer may notify them that a complaint has been made. Other times, the Member will find out that a complaint has been filed against them when the College sends them a Notification of Appointment of Investigator. This is a notice indicating that an investigation has been started.

A Notification of Appointment of Investigator is a notice sent to the Member indicating that the College has received a complaint about the nurses practice that has raised concerns. The letter will go on to indicate that the College has appointed an investigator to look into the matter and will provide the contact information of the investigator. From there, the Member will be provided with some general information about the complaint(s) being investigated.

Once the Member has been notified about the investigation, the investigator will begin collecting evidence. This typically includes gathering patient records, interviewing potential witnesses including other staff members at the Member’s place of employment, and anyone else who may have information about the alleged incident(s).

Once the investigator has completed their investigation, they will send the evidence gathered to the Member. The Member will then be provided with an opportunity to submit a written response to the allegations. The submissions are sent to the investigator who will then pass along the entire file to the Inquiries, Complaints, and Reports Committee (ICRC). The ICRC will then review the file and make a determination regarding the outcome. The ICRC can choose to issue a penalty, close the file without issuing a penalty, or refer the matter to the discipline committee.

What to do if you have been Wrongfully Reported to the CNO

When the College of Nurses of Ontario receives a complaint about a member’s practice, they will briefly review the complaint to determine whether an investigation is necessary. Where the complaint is frivolous or clearly vexatious, the CNO will decline to appoint an investigator. Where the complaint raises a legitimate concern, the College will appoint an investigator. While the goal of this initial vetting process is to weed out any complaints that are not valid, in some cases more of an investigation is necessary to make a decision. This can lead, in some situations, to the College investigating a complaint that does not have merit.  Regardless of whether or not the allegations are true, the Member is required to participate in the investigation process. Failure to do so could result in an additional prosecution for professional misconduct.

If you have been wrongfully accused of misconduct by an employer or by a member of the public, it is important to protect yourself as early on as possible. Nurses are advised to document everything and preserve evidence. Typically, once a complaint is filed, it will be several months before the nurse is asked to provide a response. By documenting everything while evidence is fresh, the Member can ensure they do not lose any important evidence or misremember information in the future.

In addition to keeping detailed records of everything, a nurse who has been reported to the College is advised to seek legal counsel as soon as possible, regardless of whether or not the complaint is true. The College of Nurses has broad powers to limit a nurse’s ability to practice, and to place notations on the nurses online CNO profile indicating they have been investigated for or found guilty of misconduct. A lawyer can assist in preserving evidence, drafting submissions, informing you of your rights and obligations under the law, and ensuring that the investigation process runs smoothly. Due to the serious consequences that can result from a CNO prosecution, it is important to develop a strong legal theory of the case prior to submitting a response. In almost all cases, simply denying the allegations will not suffice.

What is the Role of the Investigator?

The role of a CNO investigator is to collect evidence to be presented to the Inquiries, Complaints, and Reports Committee. The investigator is a neutral party in the investigation whose job is to collect evidence in an impartial manner. The investigator does not determine the outcome of the file, nor do they provide an opinion on the investigation. The ICRC is responsible for reviewing the investigation material and determining what steps to take next, if any.

What is the Role of the Inquiries, Complaints, and Reports Committee (ICRC)?

The Inquiries, Complaints, and Reports Committee (ICRC) is the committee responsible for determining the outcome of a file once the investigation is complete. Once an investigation into a member’s nursing practice has been completed and the Member has been provided an opportunity to provide a written response, the ICRC will review the whole file. They will then determine the appropriate next steps. The ICRC can choose to take no further action and close the file. This happens when the ICRC is of the opinion that there are no valid concerns related to the Member’s practice. This may be because the complaint was vexatious or fabricated, or because the contents of the complaint do not rise to the level of professional misconduct.

Where further action is deemed necessary, the ICRC may refer the Member to a remediation program, provide advice, or order a caution. These outcomes do not mean the Member has been found guilty of professional misconduct. Instead, it means that there is some concern with the nurse’s nursing practice, however it does not rise to the level of professional misconduct, and therefore it is not necessary to refer the Member for discipline. It is important to note that where the ICRC orders a remediation program, a caution, or provides the nurse with advice, a note of this will be made on the nurse’s profile on the CNO website.

In cases where the ICRC is of the opinion that the nurse may be guilty of professional misconduct, they will refer the matter to the Discipline Committee for prosecution. The Discipline Committee will then take over the file from that point on.

What Potential Penalties do Nurses Face for Misconduct?

When a matter is before the ICRC (prior to being referred to discipline), and the ICRC has concerns with the nurses practice, they have several options. They may choose to order a caution, provide advice to the nurse, or order the nurse to complete a remediation program. A caution involves the nurse attending a meeting before the Committee to discuss the alleged incident and to be cautioned by the Committee. The Committee may also provide the nurse with advice on how to avoid a similar situation in the future. A remediation program is an education program that nurse members must complete where there are concerns with their practice. The programs help to ensure the nurse is up to date on knowledge related to their practice. If the ICRC believes the matter rises to the level of professional misconduct, they will refer the matter to the Discipline Committee.

The Discipline Committee will determine if the Member is guilty of misconduct, and then determine the appropriate penalty. The Committee has several options in terms of penalty, depending on the nature and severity of the misconduct. On the low end of the spectrum, the Committee may order an oral reprimand, where the Member will attend in front of the Committee to be reprimanded for their actions. The Committee may order the nurse to complete a remediation program or some other education program to ensure their practice knowledge is up to date. They may order the nurse’s employer to audit and monitor their work to ensure there are no further issues. The Committee may place restrictions on the nurse’s ability to practice including requiring them to attend a meeting with a regulatory expert regarding their practice. In cases of serious misconduct, the Committee can suspend the nurse’s certificate of registration, prohibiting them from practicing for a period of time. In the most serious of cases, the Committee may revoke the nurse’s certificate of registration, meaning they can never practice again.