DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL: Glenda Hayward, RN Chairperson Sheila Pendock, RN Member Kendra O’Bryan, RPN Member Brian Stewart Public Member
Linda Bracken Public Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) GLYNNIS BURT for
) College of Nurses of Ontario
- and - )
) ARTHUR BARAT for
DEBORAH LYNN BRIAN [now MANN] ) D.L. Brian
Registration No. 8119182 )
) INDEPENDENT LEGAL COUNSEL ) Scott Hutchison
) Heard: November 14, 2005 and
) February 20, 2006
DECISION AND REASONS
This matter came on for hearing before a panel of the Discipline Committee on November 14, 2005 and February 20, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.
The Allegations
College Counsel informed the panel that allegations #1; # 2 a) vii, e), f), n); #3 a) vii, e), f), n) had been withdrawn. The remaining allegations against Deborah Lynn Brian ( the “Member” ) as stated in the Notice of Hearing ( Exhibit #1) dated September 23, 2005, 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 paragraph 1.01 of Ontario Regulation 799/93, in that, from in or about September 2001 until on or before September 6, 2002, while employed by [the Agency] as a Registered Nurse and while providing home care to [the husband], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that you failed to maintain appropriate boundaries within the therapeutic nurse-client relationship in that you:
a) disclosed details of your personal life to [the husband and the wife], including:
(i) [family difficulties]; and/or
(ii) [personal information about your family members ]
(iii) [ ]
(iv) [financial difficulties]
(v) [information pertaining to family financial arrangements ]
(vi) [ ]
(vii) [withdrawn]
(viii) [health problems]
b) you requested financial advice from [the husband and wife]; and/or
c) you gave [the husband] a gift basket; and/or
d) you allowed [the husband] to make arrangements for a new roof on your house and/or to attend at your house when the roof was put on; and/or
e) [withdrawn]
f) [withdrawn]
g) you wore unprofessional clothing such as short skirts, jeans and tight and/or short tops for home care visits with [the husband]; and/or
h) you became annoyed with [the wife] when she asked you to dress professionally; and/or
i) you allowed [the husband] to speak personally with you, to call you “hon”, and/or to talk with you about making a life with you; and/or
j) on or about May 19, 2002, you:
(i) arrived approximately three hours late without explanation; and/or
(ii) spent approximately 45 minutes alone in the bedroom with [the husband]; and/or
(iii) exited the bedroom whispering with [the husband]; and/or
(iv) failed or neglected to assist and/or assess [the wife] when she became visibly upset such that an ambulance was called; and/or
(v) you left [the husband’s] home before the ambulance arrived to assist [the wife] saying “It has been a slice”, or words to that effect; and/or
k) you failed to recognize warning signs that the boundaries of the therapeutic nurse-client relationship were being breached; and/or
l) you failed to properly reflect on the therapeutic nurse-client relationship to ensure that the boundaries of the therapeutic nurse-client relationship were maintained; and/or
m) you failed to consult with other members of [the husband’s] health care team to ensure that the boundaries of the therapeutic nurse-client relationship were maintained; and/or
n) [withdrawn]
- 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 paragraph 1.37 of Ontario Regulation 799/93, in that from in or about September 2001 until on or before September 6, 2002, while employed by [the Agency] as a Registered Nurse and while providing home care to [the husband], 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 you failed to maintain appropriate boundaries within the therapeutic nurse-client relationship in that you:
a) disclosed details of your personal life with [the husband and the wife], including:
(i) [family difficulties]; and/or
(ii) [personal information about your family members ]; and/or
(iii) [ ]; and/or
(iv) [financial difficulties]; and/or
(v) [information pertaining to family financial arrangements ]; and/or
(vi) [ ]; and/or
(vii) [withdrawn]
(viii) [health problems]; and/or
b) you requested financial advice from [the husband] and/or his wife [ ]; and/or
c) you gave [the husband] a gift basket; and/or
d) you allowed [the husband] to make arrangements for a new roof on your house and/or to attend at your house when the roof was put on; and/or
e) [withdrawn]
f) [withdrawn]
g) you wore unprofessional clothing such as short skirts, jeans and tight and/or short tops for home care visits with [the husband]; and/or
h) you became annoyed with [the wife] when she asked you to dress professionally; and/or
i) you allowed [the husband] to speak personally with you, to call you “hon”, and/or to talk with you about making a life with you; and/or
j) on or about May 19, 2002, you:
(i) arrived approximately three hours late without explanation; and/or
(ii) spent approximately 45 minutes alone in the bedroom with [the husband]; and/or
(iii) exited the bedroom whispering with [the husband]; and/or
(iv) failed or neglected to assist and/or assess [the wife] when she became visibly upset such that an ambulance was called; and/or
(v) you left [the husband’s] home before the ambulance arrived to assist [the wife], saying “it has been a slice” or words to that effect; and/or
k) you failed to recognize warning signs that the boundaries of the therapeutic nurse-client relationship were being breached; and/or
l) you failed to properly reflect on the therapeutic nurse-client relationship to ensure that the boundaries of the therapeutic nurse-client relationship were maintained; and/or
m) you failed to consult with other members of [the husband’s] health care team to ensure that the boundaries of the therapeutic nurse-client relationship were maintained; and/or
n) [withdrawn]
- 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 paragraph 1.37 of Ontario Regulation 799/93, in that from on and after September 7, 2002, immediately upon discharging [the husband] as [an Agency] patient and while a Registered Nurse, 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 you engaged in a personal relationship with [the husband], including:
a) you permitted [the husband] to attend [ ] in September and/or October, 2002 to visit your son in hospital; and/or
b) you dated [the husband]; and/or
c) within two months of terminating the nurse-client relationship, you moved in with [the husband]; and/or
d) within two months of terminating the nurse-client relationship, you opened a joint bank account with [the husband].
Member’s Plea
Deborah Lynn Brian ( the “Member” ) admitted the allegations set out in paragraphs numbered 2, 3, and 4 in the Notice of Hearing. The panel conducted a plea inquiry and was satisfied that the Member’s admission was voluntary, informed and unequivocal. A signed Plea Inquiry was entered as Exhibit #2.
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:
THE MEMBER
Ms. Deborah Lynn Brian (the “Member”) graduated from the [ ] School of Nursing with her RN Diploma in 1979. She registered with the College of Nurses of Ontario (the “College”) in 1981.
The Member was employed with [the Agency] from May 1998 until September 6, 2002. The Member then worked for [another Agency ] from January 2003 until March 2003, at which time she took a leave of absence and subsequently resigned her position.
The Member does not have a prior discipline record with the College. She has not been employed in nursing since March 2003.
THE CLIENT
The [husband], suffers from a neurological disease [ ]. He was diagnosed in [ ]. The disease is progressive and causes [ ], poor judgement and memory loss, among other things. [ ]
[The husband] has a history of [health problems]. He had a supra-public catheter in place from September 23, 1999 until September 3, 2002. He was on a number of medications [ ], all of which he chose to discontinue in August 2001. He has been hospitalized on numerous occasions.
[The wife] is the estranged spouse of [the husband]. They have [ ] adult children together. [ ]
[The husband and wife] separated after approximately 40 years of marriage on November 7, 2002, at which time [the husband] moved out of the family home and moved in with the Member.
[THE AGENCY]
- [The Agency] was the service provider for the five nursing visits per week authorized by [ ] to provide homecare nursing services to [the husband].
NURSE-CLIENT RELATIONSHIP
The Member provided nursing care to [the husband] by visiting him thrice weekly (Mondays, Wednesdays, Fridays) from July 2000 until September 6, 2002. Another registered nurse provided care to [the husband] on Tuesdays and Thursdays.
The Member’s nursing responsibilities in relation to [the husband] included flushing his supra-pubic catheter, taking his vital signs, and performing dressing changes. According to the Branch Manager for [the Agency], the Member visited and provided nursing services to [the husband] 254 times between July 2000 and September 6, 2002.
The Member began to provide nursing care to [the husband] at his home in July 2000. Throughout the duration of their nurse-client relationship, [the husband] lived with his wife and his [ ] daughter in the family home.
The Member’s nursing notes of the care she provided to [the husband] are comprehensive and consistent with his care plan.
Nursing services were discontinued on September 6, 2002 because [the husband] no longer required a supra-pubic catheter.
NURSE-CLIENT BOUNDARIES
The therapeutic nurse-client relationship between the Member and [the husband] developed, over time, into a personal relationship. This shift occurred in the presence of and/or with the knowledge of [the husband’s] family. Some of the changes in the nurse-client relationship during the period that ended September 6, 2002, are indicated below in paragraphs 15 to 31, inclusive.
The Member blurred the boundaries of the professional relationship when she began to disclose information about her personal life to [the husband and wife], revealing details such as [about her family life and health issues].
The Member also disclosed details of an extremely personal nature, such as [difficulties in her family life and her family’s health problems].
The Member sought financial advice from [the husband and wife], disclosing [her financial difficulties].
The Member sought advice from [the husband and wife] regarding her [difficulties with her family].
The Member provided gifts to [the husband], such as a large gift basket and “worry stones”. In addition, she gave him a number of greeting cards.
[The husband] gave the name of a roofer to the Member’s husband and participated in the arrangements for a new roof on the Member’s house by also showing the roofer the location of the Member’s house. Subsequently, [the husband] attended at the Member’s home when some of the roofing work was done.
Over time, [the husband’s] family began to notice that the Member’s visits to [the husband] routinely lasted much longer than the visits of the other nurses who provided similar nursing care to [the husband].
[The husband] admits that he had developed a rapport and friendship with the Member during the last year that she provided homecare services to him, although he cannot pinpoint exactly when he began to have romantic feelings for her. He repeatedly told his wife during this time that he and the Member were becoming emotionally bonded. He describes the Member as “the ventilator of [his] life”.
The Member acknowledges there were warning signs that signalled the development of a personal relationship between herself and [the husband] which the Member, in her professional capacity as [the husband’s] nurse, failed to recognize and address.
THE MEMBER’S ATTIRE
Over the course of the nurse-client relationship, the Member’s attire went from professional to unprofessional. Initially, the Member wore her nursing uniform to the home. In time, she stopped wearing her nursing uniform and began wearing provocative clothing including mini skirts, jeans and tight shirts or cropped tops, lots of rings, make-up and perfume. At one point in August 2001, [the wife] requested of the Member that she dress in a more professional manner which, according to [the wife], caused additional animosity between them.
If she were to testify, the Member would say that her attire changed because she began working with a special needs child at a grade school and was asked to dress in a manner similar to other people at the school.
MAY 19, 2002
On May 19, 2002, the Member attended at [the husband’s] home approximately three hours later than scheduled. She and [the husband] spent the next 45 minutes together in the bedroom. They emerged, whispering together. [The wife] became very upset and asked them whether there was something going on between them. Although both [the husband] and the Member denied having a personal relationship, [the wife] was so distraught that her blood pressure became dangerously elevated.
[The husband] called the paramedics. The Member left the house prior to the arrival of the paramedics. On her way out, the Member stated, “It’s been a slice”. [The husband] was unsympathetic and refused to assist his wife.
The Member failed to maintain an appropriate therapeutic nurse-client relationship with [the wife], as [the wife] was part of the “client” in the homecare setting.
If she were to testify, the Member would say that she advised [the wife] to call the paramedics but [the wife] refused to do so. The Member would also say that she telephoned the client’s home to explain why she was late.
SUMMER OF 2002
One day during the summer of 2002, [the husband’s] daughter returned home from work early and heard [the husband] speaking on the telephone to someone he called “Deb” and “Hon”. She heard [the husband] tell the person on the other end of the telephone call that he wanted to start a new life and go away with her.
[The husband’s] family approached [the husband] about the Member and the feelings brewing between them, and suggested that he request a new nurse. [The husband] informed them that the topic was taboo, that he was keeping the Member as his nurse, and that the family could not tell him what to do. [The husband] indicated to his family that they were no match for the likes of the Member, and he threatened to leave the family home if they contacted [the Agency].
AUTUMN OF 2002
[The husband] was discharged from [the Agency] on September 6, 2002, at which time the Member ceased providing nursing care to [the husband].
Following his discharge, and for six weeks prior to leaving [the wife] on November 7, 2002, [the husband] visited one of the Member’s sons daily, who was in hospital [ ] during September and October 2002. During this time, [the husband] met the Member’s parents.
On November 7, 2002, the Member and [the husband] moved into an apartment together. They have since bought a home together.
The Member and [the husband] established a joint bank account approximately two months after the nurse-client relationship had ended, which they continue to maintain as their household account.
ADDITIONAL INFORMATION
Prior to November 2002, the Member lived with her estranged husband of 23 years and their [sons]. [ ] One [son ]currently resides with the Member and [the husband].
The Member is not presently employed as a nurse, but takes care of [the husband] on a full-time basis.
[The husband has a short life expectancy.] [ ] [The husband] is currently on disability but stands to inherit [a] considerable estate.
The Member and [the husband] expect to marry once [the husband’s] divorce proceedings have been completed.
STANDARD OF PRACTICE
- In October 2000, the College of Nurses of Ontario published a document entitled “Standard for the Therapeutic Nurse-Client Relationship”. A copy of this document would have been sent to the Member in or about October 2000 as a member of the College of Nurses of Ontario. A copy of this document is attached as Appendix “A”. This Standards document specifically provides as follows, among other things:
“The nurse is responsible for managing the nurse-client relationship. There are a number of concepts that the nurse needs to understand and strategies she/he can apply to effectively manage the limits or boundaries in the therapeutic nurse-client relationship.
To achieve an effective relationship with a client, the nurse continuously reflects on her or his interactions with clients … and on her/his own personal needs, wishes, feelings, fears, strengths and weaknesses, which can interfere with understanding and providing for the client. …
The therapeutic relationship differs from a social relationship or friendship in that the needs of the client always come first. The nurse is in a privileged position because of the trust the client puts in the nurse and because of the power imbalance. Nurses must not abuse this trust by using the power inherent in the relationship to meet their own needs.
… The client’s home may feel like an informal environment in which to provide care, making the boundary between professional and social relationships less clear. …
… There are a number of warning signs that indicate nurses may be crossing the boundaries in the nurse-client relationship. … Examples of these are:
disclosing personal problems to a specific client;
dressing differently when seeing a specific client;
being guarded or defensive when someone questions your interactions with the client;
…If a nurse believes boundaries are being crossed in her/his own or a colleagues’ relationships with clients, she needs to take further action.”
EXPERT OPINION
The College of Nurses of Ontario has had this matter reviewed by an expert, [ ]. [The expert] obtained her nursing diploma in 1981 from [ ] and has been a Member of the College of Nurses of Ontario since that time. [The expert] has worked as a staff nurse at [ ] Hospital, as Corporate Quality Management Director for [the Agency], as Senior Vice President of Eastern Ontario Operations and Service Quality for [another Agency], as Administrator and Director of Resident Care of [a] Retirement Centre, and as the Administrator for Specialty Care at [ ]. In addition, [the expert] provides consultation services on nursing practice and administration related to long-term and home care.
If [the expert] were to testify, she would opine that, based on the facts set out in paragraphs 15 to 40 inclusive, the Member has breached the expected standards of practice with respect to the therapeutic nurse-client relationship with [the husband] during the period that the Member provided homecare nursing services to [the husband]. In addition, [the expert] would testify that the Member failed to maintain appropriate boundaries of the nurse-client relationship with [the husband], and that she has engaged in conduct that is relevant to the practice of nursing and that, in all of the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional. [The expert] would also say that Ms Brian’s conduct in the two months immediately after the therapeutic nurse-client relationship with [the husband] was discontinued was also conduct that is relevant to the practice of nursing and that, in all of the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional.
ADMISSIONS
The Member acknowledges that during the course of providing nursing treatment to [the husband], she failed to recognize certain warning signs that the boundaries of the therapeutic nurse-client relationship were being breached and she failed to ensure that the boundaries of the therapeutic nurse-client relationship were maintained.
The Member admits that she 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 paragraph 1.01 of Ontario Regulation 799/93, in that, from in or about September 2001 until on or before September 6, 2002, while employed by [the Agency] as a Registered Nurse and while providing home care to [the husband], she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that she failed to maintain appropriate boundaries within the therapeutic nurse-client relationship in that she:
(a) disclosed details of her personal life to [the husband and wife], including:
(i) [family difficulties];
(ii) [ personal information about her family members];
(iii) [financial difficulties];
(iv) [information pertaining to family financial arrangements];
(v) [ ];
(vi) [health problems];
(b) she requested financial advice from [the husband] and/or [the wife];
(c) she gave [the husband] a gift basket;
(d) she allowed [the husband] to make arrangements for a new roof on her house and to attend at her house when the roof was put on;
(e) she wore unprofessional clothing such as short skirts, jeans and tight and short tops for home care visits with [the husband];
(f) she became annoyed with [the wife] when [the wife] asked her to dress professionally;
(g) she allowed [the husband] to speak personally with her, to call her “hon”, and to talk with her about making a life with her;
(h) on or about May 19, 2002, she:
a) arrived approximately three hours late without explanation;
b) spent approximately 45 minutes alone in the bedroom with [the husband];
c) exited the bedroom whispering with [the husband];
d) failed or neglected to assist and/ or assess [the wife] when she became visibly upset such that an ambulance was called;
e) left [the husband’s] home before the ambulance arrived to assist [the wife], saying “it has been a slice”, or words to that effect;
(i) failed to recognize warning signs that the boundaries of the therapeutic nurse-client relationship were being breached;
(j) failed to properly reflect on the therapeutic nurse-client relationship to ensure that the boundaries of the therapeutic nurse-client relationship were maintained; and
(k) failed to consult with other members of [the husband’s] health care team to ensure that the boundaries of the therapeutic nurse-client relationship were maintained.
- The Member admits that she 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 paragraph 1.37 of Ontario Regulation 799/93, in that, from in or about September 2001 until on or before September 6, 2002, while employed by [the Agency] as a Registered Nurse and while providing home care to [the husband], 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, in that she failed to maintain appropriate boundaries within the therapeutic nurse-client relationship in that she:
(a) disclosed details of her personal life to [the husband and wife], including [family difficulties];
(i) [personal information about her family members ];
(ii) [ ];
(iii) [financial difficulties];
(iv) [ information pertaining to family financial arrangements];
(v) [ ];
(vi) [health problems];
(b) she requested financial advice from [the husband or the wife];
(c) she gave [the husband] a gift basket;
(d) she allowed [the husband] to make arrangements for a new roof on her house and to attend at her house when the roof was put on;
(e) she wore unprofessional clothing such as short skirts, jeans and tight and/or short tops for home care visits with [the husband];
(f) she became annoyed with [the wife] when [the wife] asked her to dress professionally;
(g) she allowed [the husband] to speak personally with her, to call her “hon”, and to talk with her about making a life with her;
(h) on or about May 19, 2002, she:
(i) arrived approximately three hours late without explanation;
(ii) spent approximately 45 minutes alone in the bedroom with [the husband];
(iii) exited the bedroom whispering with [the husband];
(iv) failed or neglected to assist and/ or assess [the wife] when she became visibly upset such that an ambulance was called;
(v) left [the husband’s] home before the ambulance arrived to assist [the wife], saying “it has been a slice”, or words to that effect;
(i) failed to recognize warning signs that the boundaries of the therapeutic nurse-client relationship were being breached;
(j) failed to properly reflect on the therapeutic nurse-client relationship to ensure that the boundaries of the therapeutic nurse-client relationship were maintained; and
(k) failed to consult with other members of [the husband’s] health care team to ensure that the boundaries of the therapeutic nurse-client relationship were maintained.
- The Member admits that she has 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 paragraph 1.37 of the Ontario Regulation 799/93, in that from on and after September 7, 2002, immediately upon discharging [the husband] as [an Agency] patient and while a Registered Nurse, 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, in that she engaged in a personal relationship with [the husband], including:
a) she permitted [the husband] to attend [ ] in September and/or October, 2002 to visit her son in hospital;
b) she dated [the husband];
i. within two months of terminating the nurse-client relationship, she moved in with [the husband]; and
ii. within two months of terminating the nurse-client relationship, she opened a joint bank account with [the husband].
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 acts of professional misconduct as alleged in paragraphs 2, 3 and 4 of the Notice of Hearing in that she:
contravened the standard of practice by failing to maintain appropriate boundaries within the therapeutic nurse - client relationship, and
engaged in behaviours which would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional in failing to maintain appropriate boundaries within the therapeutic nurse-client relationship.
Reasons for Decision
The panel finds that the following facts as detailed in the Agreed Statement of Facts support the findings of professional misconduct in that the Member:
failed to recognize that the development of a personal relationship with [the husband] breached the boundaries of the therapeutic nurse – client relationship;
failed to either assess or assist the client’s wife when she was visibly upset and required the assistance of an ambulance. The Member admitted to leaving the home prior to the arrival of the ambulance.
failed to see the family as her client when providing care to [the husband] in the family home;
solicited personal and financial advice from the client and accepted assistance from the client to have her roof replaced; and
wore inappropriate clothing when caring for [the husband].
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 (Exhibit #4) provides 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 a period of three (3) months from the day the Member’s appeal rights end as a result of exhaustion, expiry or waiver.
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s Certificate of Registration:
A. Within twelve (12) months of the imposition of the above penalty, the Member shall:
(a) successfully complete a community college level course of study in ethics and/or professional boundaries as applied to the health care provider/ client relationship that has been previously approved by the Director of Investigations and Hearings of the College, and must provide proof of successful completion of the course to the Director; and
(b) meet with a Practice Consultant of the College to review ethical issues in the nurse-client relationship and the College’s Standards with respect to the allegations that gave rise to these proceedings;
B. For a period of one year following the Member’s return to nursing practice, the Member:
(a) shall only practice nursing where she has provided any and all employers with a copy of the Decision and Reasons and the Penalty Order, and the employer has agreed to write to the Director at the College within 14 days of the commencement of practice confirming receipt of the Decision and Reasons and Penalty Order; and
(b) shall only practice nursing for an employer who will agree to notify the College of any suspected breaches of the Nursing Act and/or its regulations by her; in particular with respect to the maintenance of appropriate boundaries with clients.
Counsel for the College submitted that the facts in this case are unusual in that the Member and the client have sustained a long term relationship and plan to marry. Counsel added that no psychological harm had come to the client and there was no evidence of a physical relationship during the time the Member was assigned to care for [the husband]. The mitigating factors in this case include that the Member:
has no previous disciplinary history with the College;
acknowledges wrong doing; and
is willing to remediate.
Counsel submitted that the aggravating factors were that the Member acted out of self interest in order to meet her own financial and emotional needs and this behaviour reoccurred over a lengthy period of time with the Member failing to recognize the breach of the standard.
Counsel for Member submitted that the Joint Submission as to Penalty was appropriate because it was crafted to bring the Member back into practice and there was no previous discipline history with the College. Counsel acknowledged that the Member admitted to failing to recognize the breach in the therapeutic nurse – client relationship and had agreed to the monitoring requirement although it was not necessary.
Penalty Decision
The panel accepts the Joint Submission as to Penalty and accordingly orders:
the Member to appear before the Panel to be reprimanded.
the Executive Director to suspend the Member’s certificate of Registration for a period of three (3) months from the day the Member’s appeal rights end as a result of exhaustion, expiry or waiver.
the Executive Director to impose the following terms, conditions and limitations on the Member’s Certificate of Registration:
A. Within twelve (12) months of the imposition of the above penalty, the Member shall:
(a) successfully complete a community college level course of study in ethics and/or professional boundaries as applied to the health care provider/ client relationship that has been previously approved by the Director of Investigations and Hearings of the College, and must provide proof of successful completion of the course to the Director; and
(b) meet with a Practice Consultant of the College to review ethical issues in the nurse-client relationship and the College’s Standards with respect to the allegations that gave rise to these proceedings;
B. For a period of one year following the Member’s return to nursing practice, the Member:
(a) shall only practice nursing where she has provided any and all employers with a copy of the Decision and Reasons and the Penalty Order, and the employer has agreed to write to the Director at the College within 14 days of the commencement of practice confirming receipt of the Decision and Reasons and Penalty Order; and
(b) shall only practice nursing for an employer who will agree to notify the College of any suspected breaches of the Nursing Act and/or its regulations by her; in particular with respect to the maintenance of appropriate boundaries with clients.
Reasons for Decision
The panel deliberated for some time on the question of the length of the suspension proposed in the Joint Submission as to Penalty and the reasons offered to support a relatively modest suspension. In particular, the panel disagreed with Counsel for the College that this case was different from others in that there was no harm done to the client. The panel is of the opinion that as the Member cared for [the client] in the family home, the family, including [the wife], was the client and the breach in the therapeutic relationship affected the family rather than just [the husband]. While it may be that [the husband] is happy in his relationship with the Member, the other members of the family were affected by the Member’s professional misconduct and in future may find it difficult to engage in or trust a therapeutic relationship with another nurse. They, and other members of the public, expect more from nurses.
The panel was concerned that the proposed suspension was not long enough to reflect the seriousness of the conduct and might be both inconsistent with protecting the public interest and not a significant deterrent to other members of the College.
After the panel identified its concern with respect to the Joint Submission as to Penalty, we reconvened and sought the advice of independent legal counsel. This advice was sought and received on the record, with the parties present.
Independent legal counsel advised that before rejecting or altering a Joint Submission as to Penalty, the panel would have to be convinced that the Joint Submission was inconsistent with the public interest. A Joint Submission would be inconsistent with the protection of the public interest if the submission would fail to maintain public confidence in nursing, or fail to maintain high professional standards. Independent legal counsel advised that before rejecting a Joint Submission as to Penalty, we should inform the parties of our concerns and invite their submissions.
The panel advised the parties that it was concerned that the Joint Submission they were proposing did not adequately reflect the seriousness of the professional misconduct admitted. The panel invited the parties to make further submissions, specifically addressing the concerns raised with respect to the length of the proposed suspension. Counsel for both parties subsequently prepared written submissions respecting the length of the proposed suspension. Having reviewed these written submissions and deliberated further, we are, somewhat reluctantly, prepared to accept the Joint Submission as to Penalty. Counsel have taken our attention to other cases in which similar penalties were ordered, and it is on this basis that we accept the Joint Submission as to Penalty.
In addition, at the conclusion of the hearing, the panel consulted with independent legal counsel regarding concerns that we had about the Member’s conduct during the hearing. At times, the Member conducted herself in a way that appeared to be disrespectful of the solemnity of these proceedings. While the proceedings of the Discipline Committee are not as formal as those which take place in a traditional courtroom, they are, nonetheless, the proceedings of a quasi-judicial body and call for the careful attention and respect of all individuals appearing before the Committee, including counsel, witnesses, and the parties. At our direction, independent legal counsel wrote to counsel for the parties, seeking their submissions with respect to this question. Based on the submissions we have received from counsel for the Member, we are satisfied that the Member understands and respects the formality associated with proceedings of the Discipline Committee. We agree with counsel for the College who observed that it would have been appropriate for the panel to comment on the Member’s behaviour during the hearing with a view to receiving an explanation and encouraging improvement at that time.
I, Glenda Hayward, 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:
Sheila Pendock, RN
Kendra O’Bryan, RPN
Linda Bracken, Public Member
Brian Stewart, Public Member