College of Nurses of Ontario v. Susan (Evans) Wood, 2006 ONCNO 81733

PANEL: Deanne Barber, RPN Chairperson Susan Silver, RN Member Marcia Taylor, RN Member Faira Bari Public Member Bill Dowson Public Member

BETWEEN:

) ANIL KAPOOR for COLLEGE OF NURSES OF ONTARIO ) College of Nurses of Ontario

and - ) ROBERT K. STEPHENSON for ) Susan (Evans) Wood SUSAN (Evans) WOOD ) Registration No. 9983644 ) Heard: July 21, 2006

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on July 21, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

College Counsel informed the panel that allegations 1 and 2(a) have been dismissed. The remaining allegations against Susan (Evans) Wood (the “Member”) as stated in the Notice of Hearing [ ] dated May 15, 2006 are as follows:

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 the Ontario Regulations 799/93 in that you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, in that:

b) On or about November 24. 2003 when applying for a position at [Facility B] in [], Ontario you, knowing it to be untrue, indicated that you had never applied for or been interviewed for a position at [Facility B] in [ ];

c) On or about October 11, 2002 you placed a nipple from a baby bottle on the end of a syringe plunger which [you] used as a makeshift nipple for a new born patient [ ];

d) On or about August 14/15 2002 you claimed pay for a 12-hour shift at [Facility A], having not worked the full 12-hour shift;

e) On or about August 20, 2002 you claimed pay for a 12-hour shift at [Facility A] having not worked the full 12-hour shift;

f) On or about October 8, 2002 you claimed pay for a shift from 1130 to 1930 at [Facility A] having worked from 1130 to 1815.

Member’s Plea

The Member admitted the allegations set out in paragraphs numbered 2 (b) (c) (d) (e) and (f) in the Notice of Hearing. The panel conducted a plea inquiry 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 which provided as follows:

THE MEMBER

Susan Evans (the “Member”) has been registered with the College of Nurses of Ontario (the “College”) since 1999. She is currently employed at [ ].
The Member graduated [ ] in 1999, at which time she commenced part-time employment as a Registered Nurse with [ ] at the [ ] site in the Post Partum area of a Level 2 Obstetrical Unit. She held this position from 1999-2001.
In 2002 the Member was employed on a part-time basis as a Registered Nurse at [ ] in [ ] on a Level 1 combined Obstetrical/Medical-Surgical Unit.
Subsequent to her employment at [ ] in [ ], but still in 2002, the Member commenced employment on a part time basis as a Registered Nurse at [Facility A] in [ ] in the Level 1 Family Centered Care/Medical & Surgical Overflow Unit.
In 2003, the Member was employed as a part-time Charge Nurse at [ ]. Later in 2003 she commenced employment as a part-time Director of Care at [ ].
From August 2005 until February 2006 the Member was employed with [ ] in [ ].
According to College records the Member commenced employment with [ ] in January 2005.

FACILITY 1 – [FACILITY A] IN [ ] - ALLEGATIONS 2(c)(d)(e)(f)

At the time of the incidents one to four, [Facility A] was an 80-bed (56 Acute and 24 Complex Continuing Care) community hospital located in [ ]. The Family Centered Care and Surgical Overflow Unit handled up to 150 deliveries per year.
The Obstetrical Unit at [Facility A] consisted of 3 “swing beds” used for Medical or Obstetrical patients, 2 post-partum beds, 1 Labour Room, 1 Birthing Room and 3 Paediatric beds. Newborns roomed in with mothers.
On night shifts the unit was staffed with one nurse and a second nurse was always on call. The College investigation demonstrated that an experienced obstetrical nursing coordinator was always on duty and available for support if required. If the Member were to give evidence she would deny that an experienced obstetrical nursing coordinator was always on duty.
The College investigation has revealed that the nursing staff worked 12-hour shifts. The day shift ran from 0730h to 1930h. The night shift ran from 1930h to 0730h. There were 2 antenatal clinics, where one nurse was assigned for an 8-hour shift. All nursing staff members were Registered Nurses. If the Member were to give evidence she would state that there was 1 antenatal clinic every week or two.
This was a small rural hospital and the nurses could face serious cases, which required that the nurses work well as a team and exercise good judgment in patient care. It was not unusual for the hospital to receive patients already pushing in labour who had received no prenatal care. As such, it was important for the staff members to feel that they could rely on one another. If the Member were to give evidence she would state that there was often no second staff member available for support.

The sign-in procedure at [Facility A] was not computerized. Rather, staff members were expected to record their hours worked in a binder which was located in the nursing office. Each staff person had a binder with his/her name on it. The nursing schedule was posted on the wall of the office. Staff members were expected to record the actual hours worked in the binder, not the hours scheduled.
If the Member were to give evidence she would state that it was her practice to record in the binder the hours she was scheduled to work rather than the hours that she actually worked. As well she would say that each staff person had a section in the binder.
Once the sheets in the binders were completed, the payroll clerk entered the data into the computer. The payroll clerk would not be aware of the hours actually worked by the nurses, but instead relied on the entries as accurate.

ALLEGATION 2(d)

The Member was scheduled to work the night shift on August 14/15, 2002. As such her shift commenced at 19:30. The Member left at 23:30 as she was ill. However, she signed for the full twelve-hour shift. [RN A] was working as the Nurse Coordinator on the August 14/15 night shift with the Member and reported the discrepancy to the payroll department. [RN A] was aware that the Member went home sick and noticed that the sign-in sheet did not reflect the actual hours worked.
If the Member were to give evidence she would state that it was further her practice to pre-sign her hours in the sign-in binder upon her arrival for her shift. Additionally she would state that when she arrived for her August 14/15 shift she recorded her hours in accordance with her practice of pre-signing her scheduled work hours. Finally, the Member would state that due to her illness the Member forgot to change the entry upon her departure.

ALLEGATION 2(e)

The Member was on call for the August 20, 2002 night shift. She was called in for the shift, which commenced at 19:30. [RN B] was working with the Member on August 20, 2002 as was [RN A]. The Member phoned the unit from [ ] to advise that she would be late. She arrived for her shift two hours late at 21:30 but signed for the full twelve-hour shift.
If the Member were to give evidence she would state that she signed in for the full shift in accordance with her practice of recording her scheduled hours as opposed to the hours that she actually worked. The Member would also say that she was not “on call” but rather came to work as a favour.
[RN B] noticed that the Member signed in for the full twelve hours and advised [RN A], who was the nurse coordinator. [RN A] spoke to the Member. With the Member present, [RN A] corrected the timesheet so that it accurately reflected the Member’s arrival at 21:30 rather than 19:30. [RN A] initialled the change for payroll. [RN B] observed the corrected time sheet.
If the Member were to testify she would state that she has no recollection of this conversation with [RN A].
[RN B] was later seated at the nursing station, from which she had a clear view of the nursing office. She observed the Member in the nursing office at the sign-in book. After the Member left the nursing office [RN B] went in to look at the sign-in sheet. [RN B] observed that the sign-in sheet had been altered with white-out so that it appeared that the Member worked the full twelve-hour shift. [RN A]’s initials were not whited out.
[RN A] informed [ ], the nurse manager, that the Member had used white- out to alter the time and payroll record so that it appeared as though she commenced her shift at 19:30 rather than 21:30.
The Member acknowledges making the changes. If she were to testify the Member would state that she made the changes because she did not know who or why her entry on the sheet had been whited out.
If [RN A] were to give evidence she would state that she had explained the sign-in procedure to the Member and further explained why it was unacceptable for her to use white-out on a legal document such as the payroll records.
[The nurse manager] spoke to the Member and advised her that she was not to use white-out on the payroll sheet since it was a legal document. [The nurse manager] also advised the Member that she was to sign in only for the hours that she actually worked rather than the hours marked on the schedule.
[The nurse manager] sent the Member correspondence dated August 21, 2002 which detailed the sign-in policy and also confirmed the conversations between [RN A] and [the nurse manager] and the Member wherein the sign- in procedure had been explained.

ALLEGATION 2(f)

The Member was scheduled to work the October 8, 2002 shift in the antenatal clinic which ran from 11:30 to 19:30.
When the antenatal unit was slow it was acceptable practice for nurses to leave early, provided that their co-worker agreed and the supervisor approved. If a nurse did not take a supper break she could leave at 18:45 and receive full pay for the shift. However, the nurse was expected to document accurately the time that she actually left the shift, which was the standard sign-out procedure.
On October 8, 2002 the Member asked to leave the shift early since it was a slow day. This was approved and she left at 18:15. However the Member documented on the time sheet that she left at 19:30.
If the Member were to testify she would say that she documented as having worked the full shift on October 8, 2002 because she did not take any coffee breaks or dinner breaks on that shift.

ALLEGATION 2(c)

The Member was working the night shift with [RN C], who was acting as the nursing coordinator. [RN C] was completing her rounds when she walked by the nursing office at 22:00 hours. She noticed that the Member had a baby in a bassinet in the office with her.
It was standard practice in the unit to bring babies into the nursing office in the Family Care Centre while mothers were taking showers or otherwise unable to care for their infants.
[RN C] looked into the nursing office to observe the infant. The newborn infant was in a clear plastic bassinet so [RN C] could see her clearly. The baby was [lying] on her right side. A nipple from a bottle was propped in her mouth. Inside the hollow of the nipple was a cotton swab and a plunger from a syringe was placed into the area where the cotton swab was placed. The other end of the plunger was lodged against the side of the bassinet.
[RN C] removed the make-shift soother. The Member stated that the baby had already been fed and was fussy. [RN C] did not believe that the Member understood the seriousness of her actions. [RN C] documented the incident to [the nurse manager]. If the Member were to give evidence she would state that she had been shown this procedure and trained in it at the []. She would further state that at the time of this incident she did not believe it to be an unsafe practice but now understands that the practice is not acceptable.

ACTIONS TAKEN BY THE FACILITY

As a result of incidents one to four, [Facility A] terminated the Member’s employment on November 15, 2002.

FACILITY 2 – [FACILITY B] IN [ ] – ALLEGATION 2(b)

[Facility B] in [ ] is a regional health centre level II facility, providing primary and specialized care to the population of [ ] and surrounding area.

ALLEGATION 2(b)

The Member applied for employment with [Facility B] in [ ] and was interviewed for a position on June 17, 2003. She was not given a position.
The Member again applied to [Facility B] and was interviewed by [an individual] on November 23, 2003 for a position as a Registered Nurse in the Paediatric Unit. It is standard practice for [the individual] to ask nursing candidates if they have interviewed with the hospital previously. The Member did not advise [the individual] that she had been interviewed for a position at [Facility B] in June 2003. Further, when the Member completed the application form following her interview with [the individual], she indicated that she had not interviewed with the hospital previously.
If the Member were to testify she would state that she was not asked by [the individual] whether she had been interviewed previously. The Member would further state that she did not carefully review the application form when she incorrectly filled it out.
[The individual] learned of the June 17, 2003 interview after she brought the Member’s application package to the facility’s Human Resources Department so that a reference check could be performed. [ ], a Human Resources Consultant, overheard an Assistant in her office performing a reference check over the phone and recalled the June 17, 2003 application when she heard the Member’s name. [The Human Resources Consultant] informed [the individual] that there were issues surrounding the reference check performed following the Member’s June 17, 2003 interview. The Member was advised that her November 23, 2003 application would not be pursued any further.

ADMISSIONS

The Member acknowledges that she committed acts of professional misconduct as set out in allegation 2 (b) to (f) of the Notice of Hearing, in that she engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.

Decision

The panel considered the Agreed Statement of Facts and 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 2 (b) (c) (d) (e) and (f) of the Notice of Hearing

Penalty

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

Susan Evans (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 Fact, and the Member’s admissions of professional misconduct, the panel of the Discipline Committee should make an Order as follows:

Requiring the Member to appear before the panel to be reprimanded;
Directing the Executive Director to suspend the Member’s certificate of registration for 30 days, to commence on the date that this Order becomes final;
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

(a) The Member must successfully complete a relevant Ethics Course approved by the Director of Investigations and Hearings at her own expense within six months of the date of this Order;

(b) The Member must notify the Director of the names, addresses, and phone numbers of all facilities or agencies at which she is directly employed to practise nursing, within 14 days of resuming practice, until the Member has completed 12 months of nursing practice following the date of this Order. Such notification must be in writing and sent by verifiable form of delivery (such as courier), and the Member must retain proof of delivery.

(d) The Member must meet with a Practice Consultant from the College within three months of the date of this Order to discuss the professional standards expected of her in Ontario in regard to the issues surrounding allegation 2(c). In preparation for this meeting, the Member shall review the current standards relevant to the issues contained in the Agreed Statement of Facts. The Member shall complete any assignments and reading requested of her by the Practice Consultant.

College Counsel stated that being a member of the nursing profession brings public respect and trust. It is an obligation to uphold the standards and to be self regulating. The Member met her accountability by entering the plea of responsibility for the allegations and she rose above self-interest by doing so.

Penalty Decision

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

Requiring the Member to appear before the panel to be reprimanded;
Directing the Executive Director to suspend the Member’s certificate of registration for 30 days, to commence the date that this Order becomes final;
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

(a) The Member must successfully complete a relevant Ethics Course approved by the Director of Investigations and Hearings at her own expense within six months of the date of this Order;

The Panel also ordered that the suspension of the Member’s certificate of registration for 30 days is to commence on August 1, 2006.

Reasons for Penalty Decision

The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions

I, Deanne Barber, 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:

Susan Silver, RN

Marcia Taylor, RN

Faira Bari, Public Member

Bill Dowson, Public Member