College of Nurses of Ontario v. Jelley, 2006 ONCNO 81749

PANEL: Lori McInerney, RN, Chairperson Dennis Curry, RN Member Rosalie Woods, RPN Member Jerry Dobie Public Member Faira Bari Public Member

BETWEEN:

JUNIOR SIRIVAR for College of Nurses of Ontario

and -

MARY HART for Sharon Jelley, RN

SHARON JELLEY Registration No. 7308083

Heard: September 6, 2006

This matter came on for hearing before a panel of the Discipline Committee on September 6, 2006 at the College of Nurses of Ontario (the “College”) at Toronto.

The Allegations

College Counsel informed the panel that allegations #1(d), 2, 4(d) and (f) had been withdrawn. The remaining allegations against Sharon Jelley (the “Member”) as stated in the Notice of Hearing dated June 27, 2006 are as follows:

You have committed an act of professional misconduct as provided by sub-section 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.1 of Ontario Regulation 799/93, in that, in or about late October 2004 and/or early November 2004, while employed as a nurse at [the Hospital], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that you:

(a) between October 30, 2004 and October 31, 2004 positioned a [ ] patient, [the client], at a nursing station and failed to respond to [the client’s] repeated requests for assistance going to the bathroom; and/or

(b) between October 30, 2004 and October 31, 2004 placed a patient, [the client], in a darkened room, with the door closed, and without access to a call bell; and/or

(c) between October 30, 2004 and October 31, 2004 restrained a patient, [the client], without consent and without a physician’s order, contrary to [the Hospital] policy with regard to restraints and inappropriately used a bed sheet to secure the patient to a geri-chair; and/or

(d) (withdrawn)

(e) between October 30, 2004 and October 31, 2004 failed to contact the facility’s supervisor, to request that a safety attendant be assigned to [the client]

(Withdrawn)
You have committed an act of professional misconduct as provided by sub-section 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.13 of Ontario Regulation 799/93, in that, in or about late October 2004 and/or early November 2004, while employed as a nurse at [the Hospital], you failed to keep records as required in that you, on or about October 30, 2004 to October 31, 2004 to October 31, 2004, failed to document that you had restrained [the client], and the reason for the restraint.
You have committed an act of professional misconduct as provided by sub-section 51(1)(c) of the Health Professions Procedural Code and defined in paragraph 1.37 of Ontario Regulation 799/93, in that, in or about late October 2004 and/or early November 2004, while employed as a nurse at [the Hospital], you engaged in conduct or performed an act, relevant to the practise of nursing that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional in that you:

(b) between October 30, 2004 and October 31, 2004 placed a patient, [the client], in a darkened room, with the door closed, and without access to a call bell; and/or

(d) (withdrawn)

(e) between October 30, 2004 and October 31, 2004 failed to contact the facility’s supervisor, to request that a safety attendant be assigned to [the client]; and/or

(f) (withdrawn)

(g) between October 30, 2004 and October 31, 2004 glared at a patient, [the client], and yelled at [the client], telling [the client] to “Just shut [ ] fucking mouth!” and to “Shut up right now!” or words to that effect.

Member’s Plea

The Member admitted the allegations set out in paragraphs numbered 1(a), (b), (c), and (e), 3 and 4 (a), (b), (c), (e), and (g) 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

Sharon R. Jelley has been registered as a Registered Nurse with the College of Nurses of Ontario (“the College”) since January 1, 1973.
Commencing August 21, 1972, Ms Jelley worked as a permanent full-time R.N. on [a unit] at [the Hospital].
At the time of the incidents described in this Agreed Statement of Fact, Ms Jelley was employed on [Unit A] at the Hospital. She had been employed on this Unit since 1982.
Ms Jelley’s registration was current at the time of the incidents set out in this Agreed Statement of Fact.
On November 11, 2004, Ms Jelley’s employment at the Hospital was terminated as a result of the incidents described in this Agreed Statement of Fact. The termination of Ms Jelley’s employment was the subject of a grievance which was resolved by way of agreement. Ms Jelley was not reinstated as an employee of the Hospital following the resolution of the grievance.
On May 3, 2006, Ms Jelley terminated (resigned) her membership with the College of Nurses of Ontario.

[THE HOSPITAL]

The incidents described in this Agreed Statement of Fact took place on [Unit A] at the Hospital. The Hospital is a [ ] located in [ ], Ontario.
[Unit A] is a 34-bed Unit at the Hospital. [Unit A] is a unit which provides care to clients with diagnoses including pneumonia, stroke, cancer, diabetes, respiratory disease, renal disease, and a variety of other chronic illnesses. Of the 34 beds, eight are designated psychiatric (and are staffed separately), four are designated palliative, and 22 are medical. Thus, [Unit A] is essentially a medical unit.

THE CLIENT

[The client] was admitted on October 3, 2004, to [another unit] at the Hospital, with an admitting diagnosis of [ ]. [The client] was transferred to [Unit A] on October 10, 2004. Additional diagnoses included [ ] and exacerbation of congestive heart failure. Secondary diagnoses included Coronary Artery Disease, type 2 diabetes, [ ] and deep vein thrombosis.
At the time of admission, [the client] was 83 years old.
The incidents at issue took place on October 31 and November 1, 2004.
[The client] died on November 4, 2004.

OCTOBER 30/31, 2004

On the night of October 30/31, Ms Jelley worked a twelve-hour night shift, from 19:00 to 07:00, on [Unit A] at the Hospital. One of the patients assigned to her for care that night was [the client].
After [the client]’s family members left on the evening of October 30th (at approximately 11:30 p.m.), [the client] slept for approximately one hour and then started calling out loudly. [Nurse A], the other nurse working on the Unit that night, went in to [the client]’s room a number of times to try to calm her down. Ultimately, [Nurse A] found [the client] wedged between the bed rails and the mattress on the bed. Ms Jelley and [Nurse A] assisted in removing [the client] from the position she was in. [The client] said that [the client] needed to use the commode and Ms Jelly and [Nurse A] assisted [the client] onto the commode. [the client] was then re-settled into bed.
After being re-settled into bed, [the client] continued to call out and was making a lot of noise.
Ms Jelley, together with [Nurse A], then placed [the client] into a Broda or geri-chair. Pillows were placed under the patient’s arms on both sides of the chair for comfort. In order to ensure that [the client] would not fall out of the chair, Ms Jelley, together with [Nurse A], placed a sheet around [the client’s] waist and the geri-chair. Ms Jelley then placed [the client] in the geri-chair near Ms Jelley’s nursing station in order that she could keep an eye on [the client].
While [the client] did sleep for a short time in the geri-chair, [the client] became restless and loud again. The RPN who worked on the Unit that night, [RPN A], would say if she testified that she saw [the client] seated in a geri-chair in a reclining position beside the nursing station indicating repeatedly that she needed to go to the bathroom. [RPN A] would say that Ms Jelley did not respond.
If Ms Jelley were to testify she would say that [the client] was toileted on more than one occasion during this period and possibly when [RPN A] was absent from the immediate vicinity. She acknowledges, however, that she did not respond to every request by [the client] to use the washroom.
At some point, Ms Jelley glared at [the client] and, with a raised voice, asked [the client] to hush up and be quiet.
When other patients rang their call bells in response to the noise that [the client] was making, Ms Jelley placed [the client] in the television room [ ] without a call bell. The television room was dark and the door was initially pulled closed although it was not shut entirely. The television room door is flanked on one side by a full length window. The hallway was lit with reduced night lighting. Ms Jelley admits that the door to the television room was completely closed at times during the shift, although she does not remember doing it herself.
There was no order on [the client’s] chart for the use of restraints as at October 30/31, 2004. [The client] did not give [ ] consent for the use of any restraint, nor was [the client’s] family notified of the intention to use a restraint.
There was no documentation on [the client’s] chart that a restraint of any sort was used on [the client] on October 30/31, 2004. Similarly, there was no documentation of any reason why a restraint was used on [the client] on this date.
At no time did Ms Jelley make any effort to contact the facility supervisor to request that a safety attendant be assigned to [the client]

OCTOBER 31/NOVEMBER 1, 2004

On the night of October 31/November 1, 2004, Ms Jelley worked another twelve hour night shift, from 19:00 to 07:00, on [the Unit] at the Hospital. One of the patients again assigned to her for care that night was [the client].
After [the client’s] family members left on the evening of October 31st (at approximately 11:30 p.m.), [the client] was again found wedged in her bed between the side rails and the mattress on the bed. Ms Jelley and the second registered nurse working on the Unit that night assisted [the client] onto the commode, following which she was settled back into bed.
When [the client] again became loud, Ms Jelley attended in the room with the second RN. The two nurses placed [the client] into a Broda or geri chair, again with a sheet around her waist. If she were to testify, Ms Jelley would say that the sheet was placed around [the client’s] waist for her own safety.
Ms Jelley thought it would be better to put [the client] into the lounge room as the floor was busy. Ms Jelley thought that [the client] might settle better if it was dark and quiet. Therefore, [the client] was placed in the lounge room. The room was dark, and [the client] did not have a call bell. If she were to testify, Ms Jelley would say that [the client] was not settling and she therefore determined that she would return to the nursing station to place a call to the family for assistance.
Ms Jelley returned to the nursing station. [The client]’s son, [ ], who also worked at the Hospital, came onto the Unit at this time. [The son] arrived on [the Unit] at approximately 2425 on November 1, 2004. Ms Jelley explained about the difficulties that they were having with [the client] and asked [the son] to do what he could to try to calm his mother down. [The son] talked to his [parent] and called his sister, [ ]. [The sister] and another sister attended at the Hospital and assisted with attempts to keep [the client] calm.

DOCUMENTATION

Attached to this Agreed Statement of Fact are copies of the following:

(a) the page from [the client]’s progress notes at the Hospital which includes Ms Jelley’s note for the October 30/31 night shift, marked as Appendix “A”; and,

(b) the page from [the client’s] progress notes at the Hospital which includes Ms Jelley’s note for the October 31/November 1 night shift, marked as Appendix “B”.

ADMISSIONS

If she were to testify, Ms Jelly would admit the following:

(a) that she did not appropriately or fully document the events of October 30/31 and October 31/November 1 in [the client]’s chart; and,

(b) that she did not obtain a physician’s order for restraint use, as was then the practice on [the Unit], a practice which she now appreciates was not acceptable.

EVENTS AFTER NOVEMBER 1, 2004

After the events of October 30/31, various of [the client]’s family members reported seeing bruising on [the client’s] wrists. They did not report seeing bruising on [the client’s] wrists before October 30th. [The client] was on coumadin, a blood thinner, at the time of the events at issue. This medication put [the client] at higher risk of bruising. There is no evidence indicating that the bruising which [the client’s] family saw was caused by any rough handling of [the client]
After the events of October 30/31 and October 31/November 1, 2004, and very close on the heels of the events described in this Agreed Statement of Fact, the Hospital significantly increased the number of RNs and RPNs on the night shift. In the case of RNs, there are now three on the night shift instead of two; in the case of RPNs there are now two instead of one.

THE HOSPITAL POLICY REGARDING USE OF RESTRAINTS

At the time of the events described in this Agreed Statement of Fact, The Hospital had a written policy entitled “Restraints”. The written policy was dated July 1997. It provided as follows:

The decision to use restraints is based on the principle that least restraint and the use of alternatives is best. In hospital, all patients should be cared for in a fashion that respects their dignity, independence and freedom, and provides for the safety of patients and staff. Restraints shall be used only after the patient has been assessed and when there are reasonable grounds to believe that there will be imminent injury/harm to self or others if restraints are not used. Such situations will be exceptional and temporary and only necessary when less restrictive measures or alternatives have been attempted and proven ineffective. Collaboration among medical, nursing and others [sic] members of the inter-disciplinary team, the patient and family members/significant others, is essential.

Types of restraints:

Bed sheets and towels are not to be used as physical restraints. [emphasis in original]

Procedures

Considerations

… (b) The patient and/or family must be informed of assessed necessity for restraint, with explanations of rationale, the method and the expected duration when restraint of any kind is to be applied. This must be documented in the Inter-disciplinary Progress Notes.

Orders for Restraints

(a) A verbal or written physician order is required for the use of all restraints (except in Code White situations), specifying the type, reason for, location of and the duration of the restraint to be used.

NOTE: P.R.N. ORDERS ARE NOT ACCEPTABLE

[Emphasis in original]

(b) The restraint order must be reassessed every 24 hours.

(c) The decision to continue restraining a patient will be ongoing and documented accordingly in the Inter-disciplinary Progress Notes.

APPENDIX A to the Hospital policy on restraints is entitled “ALTERNATIVES TO RESTRAINT USE”. The proposed alternatives include the following:
Providing companionship and supervision

Ask family, friends, or volunteers to stay with the patient. * Determine when the patients needs one-to-one attention (typically at night) and intervene accordingly.

While the principles and standards reflected in the document referred to in paragraph 33, above, were known to nursing staff, including Ms Jelley, the existence of the Restraints policy document was apparently not known to all staff at the Hospital at the relevant time. For example, when the Director of Family Medicine and Continuing Care spoke with Ms Jelley’s Manager about the Unit’s practice related to patient restraint in light of the incidents referred to in this Agreed Statement of Fact, the Manager indicated that there were no written policies in effect at the time related to restraints.
Subsequent to the events set out in this Agreed Statement of Fact, the Hospital developed a new hospital-wide Restraint policy and commenced in-service training for all staff.

COLLEGE OF NURSES OF ONTARIO STANDARDS

At the relevant time, the College’s applicable Practice Standard, the “Therapeutic Nurse-Client Relationship”, provided as follows:

The nurse must not neglect the client. Neglect occurs when nurses fail to meet the basic needs of clients who are unable to meet them. Such behaviours include, but are not limited to, the withholding of care needs…

The following could also be considered neglect:

confining, isolating or ignoring the clients;
denying the client care; and
denying the client privileges.

At the relevant time, the College’s applicable Guide with respect to the use of restraints, “A Guide on the Use of Restraints”, provided as follows:

“4. Consent is essential to nursing interventions. Clients have the right to make decisions regarding their care and treatment. The nurse informs the client or substitute decision-maker of any proposed intervention and alternative measures available. Nurses cannot use any form of restraint without client consent, except in emergency situations where there exists a serious threat of harm to the individual or others, and all other measures have been unsuccessful. Emergency situations are time-limited. Once the situation is no longer critical, client consent is required.

“POLICY DIRECTION: LEAST RESTRAINT

“Least restraint means all possible alternative interventions are exhausted before deciding to use a restraint. This requires assessment and analysis of what is causing the behaviour. Most behaviour has meaning. When the reason for the behaviour is identified, interventions can be planned to resolve whatever difficulty the client is having that contributes to the consideration of restraint use. For example, if a client has poor balance or is frequently falling, interventions, such as giving the client a walker, can be developed to help protect the client’s safety while allowing freedom of mobility. A policy of least restraint indicates that other interventions have been considered and/or implemented to address the behaviour that is interfering with client safety.

“CNO endorses the least restraint approach. Nurses need to assess and implement alternative measures before using any form of restraint.

At the relevant time, the College’s applicable Practice Standard with respect to documentation, provided as follows, among other things:

“Documentation needs to reflect the care given” (p. 7).

“The recording needs to reflect the care given and the identity of the caregiver” (p. 7).

“A record of the care given or service provided needs to be retained” (p. 8).

“The health record needs to reflect who saw the event or performed the action (s)” (p. 8).

“A clear, concise and accurate account of an incident is required” (p. 9).

“Accountability for nursing care needs to be clear and nurses need to understand expectations” (p. 10).

“A chronological record of care improves communication” (p. 10).

“Including the date and time that care was given, the signature and the designation of the caregiver promote communication and accountability” (p. 11).

“The health record needs to reflect the care given and the caregiver” (p. 11).

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that she committed acts 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 1.1 of Ontario Regulation 799/93, in that in or about late October 2004 and/or early November 2004, while employed as a nurse at [the Hospital]. she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that she:

(a) between October 30, 2004 and October 31, 2004 positioned a female patient, [the client], at a nursing station and failed to respond to her repeated requests for assistance going to the bathroom; and/or

(b) between October 30, 2004 and October 31, 2004 placed a patient, [the client], in a darkened room, with the door closed, and without access to a call bell; and/or

(d) between October 30, 2004 and October 31, 2004 failed to contact the facility’s supervisor, to request that a safety attendant be assigned to [the client]

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 1.13 of Ontario Regulation 799/93, in that in or about late October 2004 and/or early November 2004, while employed as a nurse at [the Hospital], she failed to keep records as required in that she, on or about October 30, 2004 to October 31, 2004 failed to document that she had restrained [the client], and the reason for the restraint.
The Member admits that she committed acts 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 in or about late October 2004 and/or early November 2004, while employed as a nurse at [the Hospital], 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:

(b) between October 30, 2004 and October 31, 2004 placed a patient, [the client], in a darkened room, with the door closed, and without access to a call bell; and/or

(d) between October 30, 2004 and October 31, 2004 failed to contact the facility’s supervisor, to request that a safety attendant be assigned to [the client], and/or

(e) between October 30, 2004 and October 31, 2004 glared at a patient, [the client], and/or yelled at her, telling her to “Just shut [her] fucking mouth!” and to “Shut up right now!” or words to that effect.

The College seeks leave of the Discipline Committee to withdraw allegations # 1(d), 2, and 4 (d) and (f) in the Notice of Hearing.

Decision

The panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct. In particular, the Member contravened the standards of practice of the profession as alleged in paragraphs 1(a), (b), (c), and (e) of the Notice of Hearing. In addition, the Member failed to keep records as alleged in paragraph 3. Furthermore, the Member engaged in behaviour that was unprofessional as alleged in paragraph 4(e), dishonourable and unprofessional as alleged in paragraphs 4(a) and 4(c), and disgraceful, dishonourable, and unprofessional as alleged in paragraphs 4(b) and 4(g). Specific to allegation 4(g), the Member glared at [the client] and with a raised voice, asking [the client] to hush up and be quiet, as described in both the Notice of Hearing and the Agreed Statement of Facts.

Penalty

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

MS JELLEY AND THE COLLEGE JOINTLY SUBMIT that, in view of the circumstances set out in the Agreed Statement of Facts and Ms Jelley’s admissions of professional misconduct, the panel of the Discipline Committee should make an Order as follows:

Requiring Ms Jelley to appear before the Panel of the Discipline Committee to be reprimanded, on a date to be arranged between the panel and Ms Jelley, within three months of the date that this Order becomes final;
If Ms Jelley obtains a Certificate of Registration with the College of Nurses of Ontario in the future (the “new certificate of registration”):

(a) directing the Executive Director to suspend Ms Jelley’s new certificate of registration for a period of three months, said suspension to commence on the date that Ms Jelley’s new certificate of registration becomes effective;

(b) directing the Executive Director to impose the following terms, conditions and limitations on Ms Jelley’s new certificate of registration, namely:

(c) prior to seeking any employment in nursing, Ms Jelley shall purchase and complete the College’s self-directed learning package, One Is One Too Many;

(i) prior to seeking any employment in nursing, and after Ms Jelley has completed the One is One Too Many package, as outlined in 2(b)(i) above, Ms Jelley shall meet with a College Practice Consultant, at the Consultant’s convenience, to discuss the One is One too Many abuse prevention program as it relates to the conduct for which Ms Jelley was found to have committed professional misconduct and to discuss with Ms Jelley how to prevent such conduct from occurring in the future;

(ii) for an eighteen month period (“the Period”) following the date upon which Ms Jelley’s new certificate of registration becomes effective, Ms Jelley shall:

A. provide a copy of the discipline decision in this matter to her employer and provide proof of its delivery to the employer to the Director of the Investigations and Hearings Department of the College (the “Director”), within 14 days from the date Ms Jelley commences employment, to be delivered by verifiable means such as courier or registered letter and Ms Jelley shall retain proof of the College’s receipt of the communication;

B. communicate to the Director of the Investigations and Hearings Department of the College (the “Director”), in writing, the names and addresses of any employer or employers for whom Ms Jelley is employed as a nurse within 14 days from the date Ms Jelley commences employment, to be delivered by verifiable means such as courier or registered letter and Ms Jelley shall retain proof of the College’s receipt of the communication;

C. provide the Director with copies of any written performance appraisals that are completed by Ms Jelley’s employers during the Period.

Counsel for the College submitted that mitigating factors to consider included that the Member has had:

a long career as a member of the profession; and
no history of any prior problems.

Aggravating factors present in this case included the fact that these incidents:

go to the core values of the nursing profession; and
were not isolated, but rather occurred over two different days.

Suspension of the Member’s new certificate of registration will serve as a deterrent, sending a message to members of the profession that misconduct of this type will not be tolerated.

The Member has resigned her certificate of registration. If the Member ever applies for a new certificate of registration, the public will be protected through the terms, conditions and limitations referred to in the JSP.

Counsel for the Member submitted that the Member:

ended a 32 year career at the same hospital with termination that was later resolved by agreement;
tendered resignation of her membership in the College, surrendering her certificate of registration;
appreciates and understands the issues and concerns raised within the allegations;
never expressed or believed that her practice relating to restraints was appropriate or acceptable;
found ending her career and leaving her place of long term employment painful; and
has taken responsibility and remains accountable to the profession and the College.

Counsel for the Member also noted that since these incidents, the employer has:

significantly increased the night staff; and
developed a new hospital-wide restraint policy, and has provided in-service training for all staff.

The panel retired to consider the JSP. Clarification was sought in session regarding the panel’s ability to impose a penalty, given that Ms. Jelley is no longer a member of the College.

College Counsel submitted:

the panel has the ability to adjudicate allegations of professional misconduct against a former member of the College;
the conduct in question relates to a time when the Member was a member of the College; and
previous, similar cases could be provided for the panel’s review at the panel’s request

Counsel for the Member agreed with the submissions made by College Counsel.

The panel again recessed to consider the JSP. A majority of the panel was concerned with the timing of the oral reprimand. Some panel members wanted to change the requirement for the oral reprimand to occur once the Member had become re-registered with the College. [ ], Independent Legal Counsel (ILC) was contacted and advice was given to the panel. The hearing was reconvened, and on the record, ILC informed the parties of the advice given to the panel.

[ILC] advised that:

under subsection 14(1) of the Health Professions Procedural Code (“Code”), a person whose certificate of registration is revoked or who resigns as a member continues to be subject to the jurisdiction of the College for professional misconduct referable to the time when the person was a member (and therefore, that person is still subject to the discipline process);
under paragraph 51(2) 4 of the Code, where a finding of professional misconduct has been made, the panel is able to impose a penalty which includes requiring the Member to appear before the panel for an oral reprimand; and
there is a potential for unintended and absurd results if the reprimand were to be administered only once the Member has become re-registered. Such unintended and absurd results would include allowing opportunity for members to avoid an important aspect of the discipline process – the reprimand – simply be opting against re-registration.

Both Counsel for the College and Member’s counsel agreed with ILC and made no further submissions.

Penalty Decision

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

Ms Jelley to appear before the Panel of the Discipline Committee to be reprimanded, on a date to be arranged between the panel and Ms Jelley, within three months of the date that this Order becomes final;
If Ms Jelley obtains a Certificate of Registration with the College of Nurses of Ontario in the future (the “new certificate of registration”):

(a) the Executive Director is directed to suspend Ms Jelley’s new certificate of registration for a period of three months, said suspension to commence on the date that Ms Jelley’s new certificate of registration becomes effective;

(b) the Executive Director is directed to impose the following terms, conditions and limitations on Ms Jelley’s new certificate of registration, namely:

(c) prior to seeking any employment in nursing, Ms Jelley shall purchase and complete the College’s self-directed learning package, One Is One Too Many;

(ii) for an eighteen month period (“the Period”) following the date upon which Ms Jelley’s new certificate of registration becomes effective, Ms Jelley shall:

C. provide the Director with copies of any written performance appraisals that are completed by Ms Jelley’s employers during the Period.

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. The panel concluded that the oral reprimand and suspension penalties imposed meet the objectives of providing specific deterrence to the Member and general deterrence to the College’s membership. The terms, conditions and limitations imposed on the Member’s new certificate of registration will serve the College’s mandate to protect the public.

I, Lori McInerney, 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:

Dennis Curry, RN

Rosalie Woods, RPN

Jerry Dobie, Public Member

Faira Bari, Public Member