DISCIPLINE COMMITTEE

OF THE COLLEGE OF NURSES OF ONTARIO

PANEL: Dennis Curry, RN Chairperson Rosalie Woods, RPN Member Karen Breen-Reid, RN Member Jerry Dobie Public Member Faira Bari Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) MEGAN SHORTREED for ) College of Nurses of Ontario

• and - )

AMANDA JONES, RPN ) NO REPRESENTATION for Registration No. JB03505 ) Amanda Jones ) Heard: September 19, 2006

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on September 19, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

The allegations are set out in the Amended Amended Notice of Hearing dated August 31, 2006 (Exhibit #1). College Counsel advised the panel that in relation to allegation #3, the College would be seeking a finding of “unprofessional conduct” only, and that allegation #4 was withdrawn. Consequently, the hearing proceeded on the basis of the following allegations against Amanda Jones (the “Member”):

1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that while working as a Registered Practical Nurse for [the Agency], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession as follows:

a. between August 26 and September 28, 2004, you failed to maintain the boundaries of the nurse-client relationship in respect of [client A]; and/or

b. between August 26 and September 28, 2004, you disclosed information about clients [B, C and D] to [client A]; and/or

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(10) of Ontario Regulation 799/93, in that while employed as a Registered Practical Nurse for [the Agency], you gave information about a client to a person other than the client or his or her authorized representative without the consent of the client or his or her authorized representative or as required or allowed by law, as follows:

a. between August 26 and September 28, 2004, you disclosed information about clients [B, C and D] to [client A]; and/or

3. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that while employed as a Registered Practical Nurse for [the Agency], you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional, as follows:

a. between August 26 and September 28, 2004, you failed to maintain the boundaries of the nurse-client relationship in respect of [client A]; and/or

b. between August 26 and September 28, 2004, you disclosed information about clients [B, C and D] to [client A].

Member’s Plea

Amanda Jones admitted the allegations set out in paragraphs numbered 1, 2, and 3 in the Notice of Hearing. The panel conducted a plea inquiry (Exhibit #2) and was satisfied that the Member’s admission was voluntary, informed and unequivocal.

Agreed Statement of Facts

Counsel for the College advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts (Exhibit #3) which provided as follows:

BACKGROUND

1. Amanda Jones has been a member of the College of Nurses since February 26, 2002. From 2002 to 2004, Ms. Jones provided nursing care in an institutional setting with geriatric patients.

2. In August, 2004, Ms. Jones was hired by [the Agency] to provide in-home nursing care to patients in the [ ] area.

3. [The Agency] assigned Ms. Jones to the care of the clients [A, C, B, D and E].

4. Ms. Jones commenced care of [client A] on August 26, 2004, and worked approximately 14 shifts with [client A] until September 30, 2004 when Ms. Jones was suspended and ultimately terminated by [the Agency] in relation to the incidents described below.

INCIDENTS RELATED TO ALLEGATIONS

5. [Client A] had received nursing care from [Agency] staff for approximately six years when Ms. Jones was assigned to her. [Client A] is a quadriplegic who requires both morning and evening care. [Client A] is permitted to smoke marijuana for medical purposes and did so on a daily basis during August and September 2004.

6. [Client A] is [ ] and describes [client A] as “a very flirtatious person.”

7. Ms. Jones worked a morning and an evening orientation shift with another [Agency] nurse on August 26, 2004, her first day with the Client. Ms. Jones stayed late on the morning shift and arrived early for the evening shift on that day to get to know the Client better.

8. At the beginning of the first shift, the Client removed an eye shield worn during sleep and Ms. Jones commented that the Client had blue eyes. The client perceived that Ms. Jones said this comment in a flirtatious manner.

9. Ms Jones worked 14 days (including morning and/or evening shifts) with the Client in September 2004.

10. During the shifts that followed in September 2004, the Client was often flirtatious with Ms. Jones, including:

a. Singing a song entitled “I’m hot for teacher”;

b. Asking Ms. Jones if she (Ms. Jones) found the Client attractive;

c. Suggesting Ms. Jones should kiss the Client;

d. Stating that Ms. Jones “looked good” in certain items of clothing; and

e. Calling Ms. Jones at home.

11. Ms. Jones dismissed this flirtation by “laughing it off.”

12. On the eve of the anniversary of the Client’s accident, there was physical contact of a non-therapeutic nature between Ms. Jones and the Client. If she testified, the Client would state that Ms. Jones put her arm around [client A] and kissed [client A] briefly on the mouth. Ms. Jones admits that she put her arm around the Client and hugged [client A], but denies kissing [client A].

13. Ms. Jones and the client had a number of conversations of a sexual nature which were initiated by the Client. For example, Ms. Jones and the client spoke of oral sex, genital piercings, sex toys and lingerie. Ms. Jones and the Client spoke frequently of the Client’s former [relationship]. If Ms. Jones were to testify, she would state that she was not comfortable with the conversations but she did not take steps to prevent these conversations from occurring.

14. In the course of discussions with the Client, Ms. Jones made inappropriate disclosures about her personal life, family and relationship with her boyfriend to the Client.

15. On occasion, Ms. Jones brought the Client coffee and purchased cigarettes for the client. On two occasions, Ms. Jones stayed after she had finished the Client’s care, talking and watching TV.

16. On a number of occasions, the client asked Ms. Jones about other clients in her care. As a long term client of [the Agency] and because her mother was an employee of [the Agency], the Client knew or knew of a number of [Agency] clients in the [ ] area. Ms. Jones made improper disclosures about the clients [C and D] to the Client. In particular, Ms. Jones told to the Client that she did provide care for [clients C and D] and commented on their conditions and home care arrangements.

17. Ms. Jones sought out the advice of two [Agency] nurses, [nurse A] and [nurse B], and told each of them that she was uncomfortable with the Client. Both suggested that she speak to the [Agency] management.

18. On September 27, 2004, Ms. Jones contacted [ ], a Nursing Supervisor at [the Agency]. Ms. Jones requested that she re-assigned from the Client’s care. Following an investigation by [the Agency] regarding Ms. Jones’ relationship with the Client, Ms. Jones was suspended on September 30, 2004 and terminated on October 7, 2004.

19. Ms. Jones acknowledges that she did not establish and maintain the appropriate nurse-client therapeutic boundary and that the Client perceived Ms. Jones’ friendliness as flirtatiousness and attraction. Ms. Jones also acknowledges that her failure to maintain the appropriate therapeutic nurse-client boundary caused harm to the Client, as the Client was saddened to learn that Ms. Jones did not want to continue a relationship with the Client.

20. Ms. Jones acknowledges that, as an inexperienced nurse, she was not prepared to deal with the Client’s advances and did not handle the situation appropriately.

21. If the Client were to testify, [client A] would state that [client A] does not believe that Ms. Jones would re-offend with another client.

ALLEGATION 1 – FAILURE TO MEET THE STANDARDS OF PRACTICE

22. The Member admits that she has committed an act of professional misconduct in that while employed as a Registered Practical Nurse for [the Agency], she contravened or failed to meet the standards of practice of the profession with respect to her care of [client A] by engaging in a non-therapeutic relationship with [client A].

ALLEGATION 2 – UNAUTHORIZED DISCLOSURE OF CLIENT INFORMATION

23. The Member admits that she has committed an act of professional misconduct in that while employed as a Registered Practical Nurse for [the Agency], she disclosed information about other nursing clients to [client A] without the consent of the other clients or their authorized representatives or as required or allowed by law.

ALLEGATION 3 – DISGRACEFUL, DISHONOURABLE OR UNPROFESSIONAL CONDUCT

24. The Member admits that she committed an act of professional misconduct in that she has engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional with respect to her care of [client A] by engaging in a non-therapeutic relationship with [client A].

25. The College submits no evidence with respect the other allegations.

Decision

The panel considered the Agreed Statement of Facts (ASF) finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed an act of professional misconduct as alleged in paragraphs 1, 2 and 3 of the Notice of Hearing in that the Member:

• Failed to maintain the boundaries of the nurse-client relationship in respect of client [client A];

• Failed to maintain client confidentiality by disclosing information about clients [B, C and D] to [client A]; and

• Engaged in conduct or performed an act, relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as unprofessional.

Reasons for Decision

The panel deliberated and after due consideration of all the facts and the Member’s admissions of professional misconduct as alleged in paragraphs 1, 2, and 3, unanimously decided to accept the ASF as presented. The ASF substantiates findings of professional misconduct, in that the Member:

• Participated in non-therapeutic interactions with [client A];

• Participated in conversations of a sexual nature with [client A];

• Made inappropriate personal disclosures about her life, family and relationships with [client A];

• Remained in the client’s home to talk and watch television after her assigned shift; and

• Disclosed information about other clients [B, C and D] to [client A].

Penalty

Counsel for the College advised the panel that a Joint Submission as to Penalty (Exhibit #4) had been agreed upon. The Joint Submission as to Penalty provides as follows:

Amanda Jones (“the Member”) and the College of Nurses of Ontario (“the College”) respectfully submit that, in view of the circumstances set out in the Agreed Statement of Facts and the Member’s admissions of professional misconduct, the Panel of the Discipline Committee (“the Panel”) should make an Order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three months of the date that the Order becomes final; and

2. Directing the Executive Director to impose the following terms, conditions and limitations on the Member's certificate of registration:

a. within 3 months of the day that this Order becomes final, the Member must purchase and complete the College’s abuse prevention program One is One Too Many by viewing the video and completing the workbook and submitting the workbook to the Director, Investigations and Hearings for confirmation of satisfactory completion;

b. within 6 months of the day that this Order becomes final, the Member must, at her own expense, complete a course on therapeutic boundaries approved by the Director, Investigations and Hearings; and

c. within 6 months of the day that this Order becomes final, the Member must meet with the Director, Investigations and Hearings, to discuss the impact of the program and course referred to in paragraphs 2(a) and 2(b) above on her future practice.

Penalty Decision

The panel accepts the Joint Submission as to Penalty and accordingly orders that:

1. The Member appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three months of the date on which the Order becomes final; and

2. The Executive Director impose the following terms, conditions and limitations on the Member's certificate of registration:

a. within 3 months of the day that this Order becomes final, the Member must purchase and complete the College’s abuse prevention program One is One Too Many by viewing the video and completing the workbook and submitting the workbook to the Director, Investigations and Hearings for confirmation of satisfactory completion;

b. within 6 months of the day that this Order becomes final, the Member must, at her own expense, complete a course on therapeutic boundaries approved by the Director, Investigations and Hearings; and

c. within 6 months of the day that this Order becomes final, the Member must meet with the Director, Investigations and Hearings, to discuss the impact of the program and course referred to in paragraphs 2(a) and 2(b) above on her future practice.

Reasons for Penalty Decision

Some of the mitigating factors presented by the Counsel for the College were as follows:

• This was the Member’s first home care assignment and she was inexperienced in dealing with this type of client;

• The Member sought the advice of senior nurses, reported the situation to her supervisor, and was terminated as a result of the investigation; and

• The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions and has avoided unnecessary expense to the College.

Aggravating factors included:

• The harm to clients that occurs in all cases of breach of confidentiality and of nurse-client relationship boundaries.

• The confusion and sense of abandonment that occurs when client confuses the therapeutic relationship with friendship and the relationship ends.

The panel concluded that the proposed penalty is reasonable and in the public interest. The penalty provides a specific deterrence to the Member and sends a clear message to the general membership that this behaviour is not acceptable. The penalty provides for remediation for the Member through the education component. The panel also feels it provides protection for the public.

I, Dennis Curry, RN, sign this decision and reasons for the decision as Chairperson of this Discipline panel and on behalf of the members of the Discipline panel as listed below:

Chairperson Date

Panel Members:

Rosalie Woods, RPN Member

Karen Breen-Reid, RN Member

Jerry Dobie Public Member

Faira Bari Public Member