Professionals should not go up against their regulator alone
The College of Nurses of Ontario (“CNO”) is the regulator for registered nurses, registered practical nurses, and nurse practitioners in Ontario. They:
- decide who has a certificate to practice as a nurse
- handle complaints against nurses and reports made by your employer to the College
But your College does not work for you. In fact, the College can:
- deny an applicant’s application for a certificate to practice or
- suspend, revoke or place terms, conditions, or limitations on nurse’s certificate to practice
If you plan to apply to the College or have received notice of complaint it is important that you have representation to protect your interests and defend your rights.
Our team of experienced lawyers can assist nurses with matters including:
- Advising nurses on compliance with relevant legislation and standards
- Responding to complaints, executive director investigations, and health inquiries at the College
- Representing nurses at the College’s Fitness to Practise Committee
- Defending nurses in hearings before the Discipline Committee
- Advocating for nurses to resolve matters through the College’s Alternative Dispute Resolution process
- Advising nurses on the Nurses Health Program
- Representing nurses in appeals before the Divisional Court of Ontario
- Advising nurses on issues within their field including those related to licensing, privacy, and confidentiality
Registration
Applying for a certificate of registration at a college can be a rather complex process.
To become a registered nurse in Ontario, you must meet the following requirements:
- Successful completion of a nursing education program
- Evidence of recent experience practising as a nurse
- Successful completion of the registration examination
- Successful completion of either the RN/RPN Jurisprudence Examination
Once an application is submitted, it is reviewed by the Registrar who may direct the Executive Director to:
- Issue a certificate of registration
- Issue a certificate of registration with terms, conditions, or limitations
- Issue a certificate of registration if the applicant completes specified training or additional exams
- Refuse to issue a certificate of registration
Our office can help you prepare this information and offer legal advice on concerns you may have. If you are planning to apply for a certificate from the CNO, contact us today.
Complaint Process
The College of Nurses of Ontario (“CNO”) receives information about a nurses practice from:
- members of the public
- clients of nurses
- employers of nurses
- fellow nurses
- the police
- the media
- anonymous sources
There are two types of investigations that may take place at the College after it receives information about a nurse, each with its own distinct process – a Complaints Investigation and an Executive Director Investigation.
Complaints investigations are initiated by the members of the public who report concerns about a nurses practice to the College.
When a complaint is received, the College takes the following steps:
- The College confirms receipt of the complaint with the complainant, explains the complaints process, and identifies the complainant’s concerns
- The College informs the nurse named in the complaint that a complaint has been filed and explains the complaints process
- If appropriate, the College may resolve the complaint using an alternative dispute resolution process
- If the matter cannot be dealt with through alternative dispute resolution, it goes through the investigation process
- The College investigator will then gather information about the issues raised in the report
- Once the investigation is complete, the nurse is provided with a copy of the documents obtained and is given the opportunity to respond via written submissions to the complaint within 30 days
- The Inquiries, Complaints and Reports Committee (ICRC) will review all documents and issue a decision
Executive Director Investigations are initiated if the College received information about a practicing nurse in which they have reasonable and probably ground to believe that a member has committed an act of professional misconduct or is incompetent.
The Executive Director will determine if an investigation is warranted. If not, the College may still issue a letter of advice to the nurse in question or require that the nurse meet with a practice consultant
Members of the College are required to file a report, if during their practise they have obtained reasonable grounds to believe that another member of the same or different College has sexually abused a patient, is incompetent or is incapacitated
If the Executive Director decides a formal Investigation is warranted, the College takes the following steps:
- The College confirms receipt of the Report with the source of the information and explains the investigation process
- The College notifies the nurse named in the report informing them of the investigation and explains the process
- The College’s alternative dispute resolution process is not available for Executive Investigations
- The College investigator will then gather information about the issues raised in the complaint. This may include interviewing witnesses and compiling documentation, such as client health records
- Following the investigation, the member will have the opportunity to respond to the complaint via written submissions
- The Inquiries, Complaints and Reports Committee (ICRC) will review the information gathered by the investigator, the member’s response and issue a decision
The potential outcomes of a decision by the ICRC are the same for Complaints Investigations and Executive Director Investigations, they include:
- Determining that no further action against the registrant is required
- ICRC may “issue advice” to the nurse about the standards of practice and conduct
- Requiring the nurse to appear before the ICRC for a caution
- Requiring the nurse to complete a Remediation Program
- Referring the registrant to the Discipline Committee or Fitness to Practice Committee
These outcomes can have very serious financial and personal impacts on members. If you have received a complaint from the CNO, please contact us today.
Discipline Committee
If the ICRC considers a complaint to be “high risk” it can be referred to the Discipline Committee.
Before a matter progresses to a hearing at the Discipline Committee a pre-hearing may occur. A pre-hearing is an opportunity for the College and the member to present their case in an informal manner.
In our experience a pre-hearing at a college can be used to:
- Reduce the allegations against a member
- Reduce the penalty being sought by a member
- Raise important legal issues before trial
At the Discipline Committee, a trial may take place where witnesses are called, and evidence is heard.
Outcomes at the Discipline Committee can include:
- Requiring the nurse to complete remedial education
- Requiring the nurse to appear in person for a reprimand
- Requiring the nurse to pay a fine to the Ontario Government
- Placing conditions and limits on a nurse’s practice
- Suspending a nurse from working for a set period of time
- Revoking a nurse’s membership in the College
These are extremely serious public outcomes. If your matter has or could be referred to the Discipline Committee, please contact us today.
Member’s Fitness
Concerns about a nurse’s fitness to practice can be addressed in the following ways:
- A referral to the Fitness to Practise Committee
- The Nurses Health Program
- Health Inquiry
The Fitness to Practise Committee is a specialized Committee dealing with cases where a member’s conduct may be impacted by an ongoing physical or mental medical condition.
In our experience, a referral to the Fitness to Practise Committee can offer a number of benefits to members, because:
- Complaints are generally resolved in a more private manner
- The goal of the process is ensuring the health of the member
The Nurses Health Program is a voluntary program for nurses suffering from a substance use and/or mental health disorder that could affect their ability to practice nursing. A nurse may voluntarily enroll in the program or may receive a letter from the College inviting them to enroll
The College may conduct a Health Inquiry if they receive information that identifies concerns about a nurse’s ability to practise safely due to a physical or mental condition or disorder. The ICRC will conduct an inquiry and may direct the nurse to attend and Independent Medical Examination to assess their health. Following the Inquiry, the ICRC will issue a decision which may lead to a referral to the Fitness to Practise Committee
If there is a complaint against you that may be referred to the Fitness to Practise Committee, you have been notified of a Health Inquiry, or are thinking of enrolling in the Nurses Health Program, contact us today for legal advice.
Appeals
Decisions of the:
- ICRC (regarding complaints investigations), and
- Registration Committee
can be appealed to the Health Professions Appeal and Review Board (“HPARB”).
ICRC decisions related to Executive Direction Investigations are subject to judicial review by the Divisional Court.
Decisions of the:
- Discipline Committee, and
- Fitness to Practise Committee,
Can be appealed to the Ontario Divisional Court.
Unfortunately, self-represented individuals are very rarely successful in appeals. We have unique expertise in appeals from regulatory colleges. If you are considering an appeal, please contact us today.
