College of Nurses of Ontario v. Sandra Lewis, 2013 ONCNO 90638

PANEL: Nancy Sears, RN Chairperson Tammy Hedge, RPN Member Susan Roger, RN Member Cathy Egerton Public Member Gino Cucchi Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) BONNI ELLIS for ) College of Nurses of Ontario

and - )

SANDRA LEWIS ) ROBERT STEPHENSON for Registration No. 9022112 ) Sandra Lewis

) LUISA RITACCA (on call) ) Independent Legal Counsel

) Heard: February 14, 2013

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee on February 14, 2013, at the College of Nurses of Ontario (“the College”) at Toronto.

The Allegations

Counsel for the College advised the panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1(b), 2(b), and 6(a) of the Notice of Hearing dated September 19, 2012. The panel granted this request.

After making certain typographical corrections to the Notice of Hearing (agreed upon by both counsel), the remaining allegations as set out in the corrected Notice of Hearing are as follows.

IT IS ALLEGED THAT:

You have committed an act or 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 you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession and, in particular:

(a) on or about December 26, 2007, while working as a nurse at [Facility A], you spoke to [Client A] in a rude and condescending manner when [Client A] questioned you regarding a physician’s order to change the dose of her Effexor medication;

(b) withdrawn

(c) on or about December 30, 2007, while working as a nurse at [Facility A], you responded to [Client B]’s concerns about the well-being of her husband by stating that she should “get her act together” or expressing a sentiment to that effect;

(d) on or about June 18, 2008, while working as a nurse at [Facility A], you used a sarcastic and/or condescending tone with [Client C] when she refused to self-administer a soap suds enema at your request;

(e) on or about June 18, 2008, while working as a nurse at [Facility A], you administered an enema to [Client C] that was sufficiently hot to cause [Client C] to experience a burning sensation and to run to the bathroom;

(f) on or about January 24, 2009, while employed as a nurse at [Facility A], you refused to take a client assignment and/or to hear report from your nursing colleagues when you arrived for your evening shift;

(g) on or about March 17, 2007, while working as a nurse at [Facility B], you denied [Client D] a dose of Imovane on two occasions, despite the fact that she had been ordered to receive the medication on an as needed basis by a physician;

(h) on or about October 25, 2009, while working as a nurse at [Facility B], you left the facility approximately three hours into your scheduled twelve-hour shift without advising the on-call Manager or Patient Services Coordinator to ensure that alternative or replacement services were arranged and in circumstances where your absence increased the risk of harm to your clients and/or your colleagues;

(i) on or about October 25, 2009, while working as a nurse at [Facility B], you documented having performed the q15 observations for [Clients D, E, F and G] between approximately 14:15 and 15:45, despite the fact that you did not perform these observations; and/or

(j) on or about October 25, 2009, while working as a nurse at [Facility B], you provided to [ ] an unregulated care provider your computer code and/or handwritten notes in relation to one or more clients that you were assigned to and directed her to enter the notes in the clients’ electronic records on your behalf.

You have committed an act or 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 1.7 of Ontario Regulation 799/93 in that, you abused a client physically or emotionally and, in particular:

(a) on or about December 26, 2007, while working as a nurse at [Facility A] you spoke to [Client A] in a rude and condescending manner when [Client A] questioned you regarding a physician’s order to change the dose of her Effexor medication;

(b) withdrawn

(f) on or about March 17, 2007, while working as a nurse at [Facility B], you denied [Client D] a dose of Imovane on two occasions, despite the fact that she had been ordered to receive the medication on an as needed basis by a physician.

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 1.15 of Ontario Regulation 799/93 in that, on or about January 23, 2008, while working as a nurse at [Facility A], you signed or issued, in your professional capacity, a document that you knew or ought to have known contained a false or misleading statement with respect to your charting of your administration of a soap suds enema to [Client C] and, in particular, your failure to document that the client experienced the temperature of the enema as being sufficiently hot to cause a burning sensation and to cause the client to run to the bathroom.
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 1.14 of Ontario Regulation 799/93 in that, on or about October 25, 2009, while working as a nurse at [Facility B], you falsified a record relating to you practice when you documented having performed the q15 observations for [Clients D, E, F and G] between approximately 14:15 and 15:45, despite the fact that you did not perform these observations.
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 1.5 of Ontario Regulation 799/93 in that, on or about October 25, 2009, while working as a nurse at [Facility B], you discontinued professional services that were needed when you left the facility approximately three hours into your scheduled twelve-hour shift and failed to contact the on-call Manager or Patient Services Coordinator to ensure that alternative or replacement services were arranged.
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, you engaged in conduct or performed an act, 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 and, in particular:

(a) withdrawn

(b) on or about December 26, 2007, while working as a nurse at [Facility A] you spoke to [Client A] in a rude and condescending manner when [Client A] questioned you regarding a physician’s order to change the dose of her Effexor medication;

(d) on or about June 23, 2008, while working as a nurse at [Facility A], you administered an enema to [Client C] that was sufficiently hot to cause [Client C] to experience a burning sensation and to run to the bathroom;

(e) on or about June 23, 2009, while employed as a nurse at [Facility A], you stated to a colleague that you would take your manager “to the fucking union if she cancels me” in the context of confirming your shift for the next day;

(g) on or about January 24, 2009, while employed as a nurse at [Facility A], you spent over two hours surfing the internet and/or reading magazines during your evening shift;

(h) on or about January 24, 2009, while employed as a nurse at [Facility A], you stated to a colleague “this is my part-time job and I don’t give a fuck” or used words to that effect;

(i) on or about March 17, 2007, while working as a nurse at [Facility B], you were heard by [Client D] to be raising your voice, slamming the phone down and/or using profanities while at the nursing station;

(j) on or about March 17, 2007, while working as a nurse at [Facility B], you denied [Client D] a dose of Imovane on two occasions, despite the fact that she had been ordered to receive the medication on an as needed basis by a physician;

(k) on or about October 25, 2009, while working as a nurse at [Facility B], you left the facility approximately three hours into your scheduled twelve-hour shift without advising the on-call Manager or Patient Services Coordinator to ensure that alternative or replacement services were arranged and in circumstances where your absence increased the risk of harm to your clients and/or your colleagues;

(l) on or about October 25, 2009, while working as a nurse at [Facility B], you documented having performed the q15 observations for [Clients D, E, F, and G] between approximately 14:15 and 15:45, despite the fact that you did not perform these observations; and/or

(m) on or about October 25, 2009, while working as a nurse at [Facility B], you provided to [ ] an unregulated care provider your computer code and/or handwritten notes in relation to one or more clients that you were assigned to and directed her to enter the notes in the clients’ electronic records on your behalf.

Member’s Plea

Sandra Lewis admitted the allegations set out in paragraphs numbered 1(a), (c), (d), (e), (f), (g), (h),(i), (j), 2 (a), (c), (d), (e), (f), 3, 4, 5, 6 (b), (c), (d), (e), (f), (g), (h), (i), (j), (k), (l) and (m) in the Notice of Hearing. The panel received a written plea inquiry which was signed by the Member. The panel also conducted an oral 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

Sandra A. Lewis (the “Member”) obtained a diploma in nursing [ ] in 1989.
The Member registered with the College of Nurses of Ontario (the “College”) as a Registered Nurse (“RN”) on January 24, 1990.

THE FACILITIES

A. [Facility A]

[Facility A] is located in [ ], Ontario. It is a large community hospital that provides emergency, inpatient, ambulatory, continuing and long-term care services to a community of over 500,000 residents [ ].
The Member was employed at Facility A as a part-time staff nurse in acute care. However, the Member worked mostly night shifts on [ ] an inpatient psychiatric unit for clients 18 years of age or older.

B. [Facility B]

[Facility B] is located in [ ], Ontario. It serves a catchment area of more than 850,000 people [ ]. The hospital operates on three sites [ ].
The Member was employed at [a] site of Facility B as a full-time staff nurse. She worked on [a child and adolescent inpatient unit].
[The Unit] serves children and adolescents up to their 19th birthday, whose mental health needs could not be met on an outpatient basis. The [ ] inpatient beds were used for acutely ill children and adolescents in need of a 24-hour protective, therapeutic environment and close professional assessment and stabilization.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

A. Facility A

The Member worked at Facility A from January 8, 2007, to February 18, 2009, when she was terminated.

i. Incident with [Client A]

[Client A] was admitted to the inpatient psychiatric unit on December 18, 2007 for depression. She was [ ] years old at the time of the incident.
On December 20, 2007, her dose of Effexor was increased to 75 mg for both her 9 am and 5 pm administrations. She was also prescribed 25 mg of Seroquel every evening.
On December 21, 2007, [Client A] spoke to her physician about increasing her dose of Effexor as she was concerned that it was not having the desired effect. [Client A] had previously been prescribed Effexor with positive results.
Following that discussion, [Client A]’s physician documented in her progress notes that her morning dose of Effexor was to increase from 75 mg to 150 mg on Monday, December 24, 2007. The evening dose was to remain at 75 mg. The note further provided that [Client A]’s dose of Seroquel should be increased and that Immovane be discontinued. The physician did not write an order for the change.
A nursing note authored at 22:00 on December 25, 2007, reflects that [Client A] asked another nurse about the increased dose of Effexor. The nursing note states “will be discussed with duty doctor.”
On December 26, 2007, the Member was scheduled to work from 07:00 to 19:00. The Member provided care to [Client A] on this shift.
In the morning on December 26, 2007, [Client A] asked the Member if she could call the doctor about the increase to her morning dose of Effexor because she had not yet received it and was not feeling right.
According to [Client A], the Member responded by stating that it was Christmas time and that she would not bother the doctor as he did not know [Client A] The Member suggested that they might find a doctor who knew [Client A] better the following day.
According to [Client A], the Member was rude and condescending in her response and made [Client A] feel like she was bothering the Member.
The Member’s documentation regarding the exchange is reflected in her 14:00 progress note:

Care received of [Client A] @ 0900 hr, mood upon rising appeared downcast + sombre. Pt continues to state feeling very low and finds herself crying quite a bit, meals and meds taken. Enquired about discussion with night nurse re: increase in Seroquel. Explanation given after discussion with team that said info was written as part of the plan in Dr. [ ] notes, and psychiatrist covering for him would look into it tomorrow, pt accepted explanation of same and spent the remainder of the day visible about the unit, no management issues to note.

[Client A] was sufficiently upset by the exchange that she reported the Member’s conduct to the Manager of the Unit and subsequently lodged a written complaint, which included a request that the Member not be assigned to provide care to her again.

ii. Incident with [Client B]

[Client B] was admitted to the inpatient psychiatric unit on December 29, 2007, with a pre-existing diagnosis of chronic paranoid schizophrenia and Obsessive Compulsive Disorder. [ ]
On December 30, 2007, the Member was scheduled to work from 19:00 to 23:00. She provided care to [Client B] on that shift until 20:00, when care was transferred to another RN.
On that evening, [Client B] received a visit from her husband. Following his visit, [Client B] was concerned about his safety based on comments he had made to her and because he had threatened suicide in the past and was going to be home alone. [Client B] told the Member about her concerns. In an angry tone of voice, the Member told [Client B] to “get her act together,” or words to that effect.
The Member’s response was sufficiently upsetting to [Client B] that she threw something and was required to receive an early administration of her bedtime medications as well as prn doses of Immovane and Clonazepam.

iii. Incidents with [Client C]

[Client C] was admitted to the inpatient psychiatric unit on June 16, 2008, with a diagnosis of bad hypomania, Attention Deficit Disorder and significant constipation. [ ]
On June 17, 2008, to address the constipation, [Client C] was ordered to receive a fleet enema and Colace. The next day, the order for the fleet enema was repeated with a notation that [Client C] should receive either a soap suds or mineral oil enema if the fleet enema did not produce a bowel movement by dinner time.
On June 18, 2008, the Member was scheduled to work 15:00 to 23:00. On June 23, 2008, the Member was scheduled to work 19:00 to 07:00. She provided care to [Client C] on both shifts.
On June 18, 2008, the Member told [Client C] to administer her own soap suds enema. According to [Client C], the Member responded in a sarcastic and condescending tone when she refused to administer the enema on her own. The Member then asked [Client C] to administer her own oil enema and, despite her hesitation, she complied.
On June 23, 2008, the Member administered a soap suds enema to [Client C] that was too cold. She then heated the enema to such a degree that it caused [Client C] to jump out of bed and run to the bathroom in pain. The Member did not record the fact that [Client C] had experienced pain because the enema was too hot. The Member documented the following in her June 23, 2008, progress note at 23:40:

Pt continues to complain of bloating and discomfort. Soap suds enema given @ 2000hr with no result. 2nd soap sud given at 2300 hr, meds reassessed by attending psy.

When the Member was later questioned about the incidents by management after [Client C]’s physician learned about what had occurred, the Member admitted that she was not sure how to properly administer a soap suds enema and acknowledged that she did not read the instructions or seek assistance from a colleague.

iv. Incidents on January 23-24, 2009

On January 23, 2009, the Member called the unit to confirm that she was scheduled to work the following day. Over the phone, the Member told her colleague that she would take her manager “to the fucking union if she cancels on me,” or words to that effect.
On January 24, 2009, the Member was scheduled to work 15:00 to 23:00. When the Member arrived on the unit for her shift, she refused to take any client assignments, despite the fact that it was standard practice for nurses on the evening shift to take client assignments from the day shift nurses. The Member also refused to listen to report from her colleagues about the day shift.
During her shift, the Member used the internet for personal use for more than two hours and sat at the nursing station reading magazines. She told her colleagues “this is my part-time job and I don’t give a fuck,” or words to that effect.

B. Facility B

The Member worked at Facility B from April 8, 2002, to December 7, 2009, when she was terminated.

i. Incident with [Client D]

[Client D] was voluntarily admitted to the inpatient unit on March 15, 2007 for depression and severe anxiety. [Client D] was [an adolescent] at the time.
On March 16, 2007, [Client D] was ordered to receive Lorazepam for anxiety as well as Imovane at bedtime, as needed, although her usual psychotropic medications had been discontinued at admission as part of her inpatient assessment.
On March 17, 2007, the Member worked from 19:30 to 07:30. She was assigned to provide care to [Client D] on this shift. It was [Client D]’s third night at the facility and she was the only client on the unit.
During the shift, [Client D] overheard the Member yelling, swearing and banging the phone down at the nursing station, which made [Client D] anxious. Because of the Member’s conduct, [Client D] was not comfortable approaching the Member to request Lorazepam to calm her anxiety.
When the Member subsequently entered [Client D]’s room, [Client D] told the Member she was anxious and tried to speak to the Member about how she was feeling. [Client D] felt from the Member’s response that the Member was not being receptive and asked to call her mother.
After calling her mother, [Client D] asked the Member if she could speak to another nurse, with whom she had developed a rapport. According to [Client D], the Member responded to this request in a manner that suggested she was angry and offended.
When the Member refused her request, [Client D] asked the Member for Imovane to help her sleep, as ordered. The Member refused [Client D]’s request, advising her that “sleeping pills are addictive,” or words to that effect. The Member told [Client D] that if she needed something in an hour, she should ask for it. When [Client D] came out of her room around 02:00 to ask for Imovane again, the Member told her it was too late and she should return to her room. The Member did not offer [Client D] Lorazepam on either occasion.
[Client D]’s parents waited until their daughter’s discharge from the facility before submitting a formal, written complaint regarding the Member’s treatment of their daughter on that evening. They attributed the delay in filing the complaint to concerns that their daughter might face repercussions from the Member.

ii. Leaving Shift Early on October 25, 2009

On October 25, 2009, the Member was scheduled to work 07:30 to 19:30 as the Team Leader. In addition to the Member, there was another RN and two unregistered staff (Child and Youth Workers) scheduled on that shift.
The Member was assigned three clients. The other RN was assigned four clients, one of whom was [Client E], who was on constant observation because he was considered a flight risk. [Client E] had attempted to flee the unit previously and was under involuntary admission for psychosis. Nursing notes in [Client E]’s record for the evening of October 24, 2009 indicate that he was on 1:1 observation “with security as pt high AWOL risk.” Because of [Client E], the unit was staffed with an extra Child and Youth Worker on October 25, 2009.
At the beginning of her shift, the Member advised the other RN on duty that she would be leaving the unit at 10:00 and would not be returning.
The Member left the unit between 10:00 and 10:45. She did tell the other RN where she was going and the other RN did not ask based on her previous interactions with the Member.
At approximately noon, [Client E] pulled a firm alarm and ran down the stairwell to exit the building, taking a swing at security on his way out. The police were in front of the facility because of a traffic accident. They spotted [Client E] running from the facility with no shoes on and were able to bring him back without further incident.
Another client, [Client G], was receiving a neuroleptic medication. Clients receiving this type of medication need to be carefully monitored for side effects, including laryngeal spasms, which can lead to death if not treated quickly. The other RN on duty was left to manage [Client G]’s care alone, which included providing urgent treatment to [Client G] for a suspected laryngeal spasm.
In March 2007, the Member left a shift for almost three hours, which led to her receiving a counselling letter from the facility. As a result of that incident, the Member was advised of the proper procedure for leaving a shift, which included obtaining approval from the Patient Services Coordinator before leaving or asking staff to call on her behalf so that alternative or replacement staff could be arranged.
The Member did not contact the Patient Services Coordinator prior to or at any point subsequent to her departure on October 25, 2009, nor did she ask another staff member to call on her behalf. As a result, the Member was not replaced during her absence and this increased the risk of harm to the Member’s colleagues and clients on the unit.

iii. Providing Computer Code to Unregulated Care Provider on October 25, 2009

On October 25, 2009, prior to leaving her shift, the Member provided [ ] an unregulated care provider [(UCP)] with her computer access code. The Member asked [the UCP] to use the code to enter her handwritten notes in her clients’ electronic charts.

iv. Pre-Signing q15 Records on October 25, 2009

The Member was scheduled to conduct q15 checks on October 25, 2009 between 08:30 and 09:30, 13:30 and 14:30 and 17:30 and 18:30.
Prior to leaving her shift early on October 25, 2009, the Member documented that she performed q15 observations for [Clients D, E, F and G] by pre-signing some q15 records before she left the facility. Specifically, the Member’s initials appear on the Close or Constant Observation Record every 15 minutes from 14:15 to 15:45 for [Clients D, E, F and G], even though she was not at the facility at these times and did not make the observations.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that she committed the acts of professional misconduct described above and as alleged in the Notice of Hearing, as set out in paragraphs:

1(a), (c), (d), (e), (f), (g), (h), (i) and (j),
2(a), (c), (d), (e) and (f),
3,
4,
5, and,
6(b), (c), (d), (e), (f), (g), (h), (i), (j), (k), (l) and (m) in that her conduct was disgraceful, dishonourable and unprofessional.

With leave of the Discipline Committee, the College withdraws the allegations of professional misconduct alleged in the Notice of Hearing, as set out in paragraphs:

1(b),
2(b), and
6(a).

College counsel did not make any further substantive submissions. Counsel for the Member declined the opportunity to make a submission.

Decision

The panel considered the Agreed Statement of Facts and finds that the facts, along with the admissions of the Member, support findings of professional misconduct and, in particular, finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a), (c), (d), (e), (f), (g), (h), (i), (j), 2 (a), (c), (d), (e), (f), 3, 4, 5, 6 (b), (c), (d), (e), (f), (g), (h), (i), (j), (k), (l) and (m) of the Notice of Hearing. With respect to allegations 6(b), (c) (d), (e), (f), (g), (h), (i), (j), (k), (l) and (m), the panel finds that across this set of allegations, the Member committed acts of professional misconduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable and unprofessional.

Reasons for Decision

The Agreed Statement of Facts and the Member’s plea provide valid and sufficient reasons for the panel’s findings. With respect to Allegation 6(b), (c) (d), (e), (f), (g), (h), (i), (j), (k), (l) and (m), the panel found that the evidence as set out in the Agreed Statement of Facts demonstrates behaviour that the Member disregarded her professional obligations as a nurse in both a serious and [a] persistent manner. In addition, across these behaviours, the Member engaged in conduct that had elements of moral failing. She had, or ought to have had, the knowledge that her conduct was seriously wrongful.

Penalty

Counsel for the College advised the panel that a Joint Submission on Order had been agreed upon. The Joint Submission as to Order requests that the panel make an order as follows:

Requiring the Member to appear before the Panel to be reprimanded within three months [of the date] that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for six months. This suspension shall take effect from the date the Member obtains an active certificate of registration and shall continue to run without interruption.
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend three meetings with a Nursing Expert (the “Expert”), at her own expense and within six months of the date the Member obtains an active certificate of registration. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least seven days before the first meeting, the Member provides the Expert with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules:

Professional Standards,
Therapeutic Nurse-Client Relationship

iv. Before the first meeting, the Member reviews and completes the College’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;

v. Before the first meeting, the Member completes the College of Registered Nurses of British Columbia online learning module, Communication in Nursing Practice Module, and the accompanying workbook [ ].

vi. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses’ Workbook;

vii. The subject of the sessions with the Expert will include:

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
the development of a learning plan in collaboration with the Expert;

viii. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into her behaviour;

ix. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration;

b) For a period of 24 months from the date the Member returns to clinical nursing practice, the Member will notify her employers of the decision. To comply, the Member is required to:

(i) Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

(ii) Provide her employer(s) with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
a copy of the Panel’s Decision and Reasons, once available;

(iii) Only practise nursing for an employer who agrees to, and does, forward a report to the Director, within 14 days of the commencement or resumption of the Member’s employment in any nursing position, confirming that the employer:

received a copy of the required documents,
agrees to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession, and
agrees to conduct random spot audits of the Member’s practice at the following intervals:

a) the first audit shall take place within four months from the date the Member returns to clinical nursing practice;

b) the second audit shall take place within eight months from the date the Member returns to clinical nursing practice, and;

c) the third audit shall take place within 12 months from the date the Member returns to clinical nursing practice.

ii. The audits shall on each occasion involve:

a) Discussing, with at least three of the Member’s clients, the care provided by the Member to verify that the Member is utilizing appropriate communication techniques that are consistent with the therapeutic nurse-client relationship;

c) The Member shall not practise independently in the community or as the only registered staff on duty for a period of 12 months from the date the Member returns to clinical nursing practice.

All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will retain.

Penalty Submissions

College Counsel requested that the panel accept the proposed penalty, which covers the six general allegations of professional misconduct, including conduct that would be considered as disgraceful, dishonourable and unprofessional; multiple breaches of nursing standards between March 2007 and October 2009; emotional and physical abuse of clients; falsification of a record; failure to provide correct documentation regarding clients and her nursing care; and discontinuation of nursing services without notice. On a mitigating note, the Member is considered to have shown remorse for her actions and has avoided the need to have clients with mental health challenges face the stress of testifying at a contested hearing.

Counsel for the College submitted that in these circumstances, a six-month suspension is a significant one which serves as both a general and specific deterrent. The meetings with an expert, at the Member’s own expense, include[ ] strategies and a learning plan that would review the conduct on which the panel made findings, and would support a likelihood that such conduct will not be repeated. The restriction that the Member will not practi[s]e independently in the community, as well as audits to determine if the Member is demonstrating expected and appropriate conduct, both act to protect the public. College counsel submitted that the Joint Submission on Order offers rehabilitation, specific and general deterrence, and the protection of the public. Publication of such an order would act to maintain public confidence in the ability of the College to govern the nursing profession.

As the Member has resigned her certificate of registration, all aspects of the penalty except for the reprimand would commence if and when the Member again becomes active with the College.

College counsel provided the panel with three previous cases of this College to establish a range of what penalty would be appropriate. All three cases (M McLean, D L Jalbert and C Craigen) were resolved between October 2007 and October 2009 by means of agreed statements of fact and joint submissions on order. Although the facts across those cases were not exactly the same as those in this case, together they dealt with abusive comments directed at a vulnerable adult, incomplete documentation of client assessment and/or care, inattentive care and lack of empathy for clients and a client’s family members and inappropriate discontinuation of care. Across these three cases, findings of professional misconduct resulted in orders that included reprimands, suspensions, and terms, conditions and limitations on practice.

Counsel for the Member advised [ ] that for reasons unrelated to this case, the Member has resigned her certificate of registration. He submitted that the Member fully participated in the disciplinary process and cooperated with the College. The Member’s counsel submitted that if the member [were] to testify today, she would say I am not avoiding responsibility. Should I try to re-enter into nursing these penalties will apply.

Penalty Decision

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

The Member to appear before the Panel to be reprimanded within three months [of the date] that this Order becomes final.
The Executive Director to suspend the Member’s certificate of registration for six months. This suspension shall take effect from the date the Member obtains and active certificate of registration and shall continue to run without interruption.
The Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:

a) The Member will attend three meetings with a Nursing Expert (the “Expert”), at her own expense and within six months of the date the Member obtains [an] active certificate of registration. To comply, the Member is required to ensure that:

i. The Expert has expertise in nursing regulation and has been approved by the Director of Professional Conduct (the “Director”) in advance of the meetings;

ii. At least seven days before the first meeting, the Member provides the Expert with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
if available, a copy of the Panel’s Decision and Reasons;

iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules:

Professional Standards,
Therapeutic Nurse-Client Relationship

iv. Before the first meeting, the Member reviews and completes the College’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook

v. Before the first meeting, the Member completes the College of Registered Nurses of British Columbia online learning module, Communication in Nursing Practice Module, and the accompanying workbook;

vi. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses’ Workbook;

vii. The subject of the sessions with the Expert will include:

the acts or omissions for which the Member was found to have committed professional misconduct,
the potential consequences of the misconduct to the Member’s clients, colleagues, profession and self,
strategies for preventing the misconduct from recurring,
the publications, questionnaires and modules set out above, and
the development of a learning plan in collaboration with the Expert;

viii. Within 30 days after the Member has completed the last session, the Member will confirm that the Expert forwards his/her report to the Director, in which the Expert will confirm:

the dates the Member attended the sessions,
that the Expert received the required documents from the Member,
that the Expert reviewed the required documents and subjects with the Member, and
the Expert’s assessment of the Member’s insight into her behaviour;

b) For a period of 24 months from the date the Member returns to clinical nursing practice, the Member will notify her employers of the decision. To comply, the Member is required to:

(i) Ensure that the Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position;

(ii) Provide her employer(s) with a copy of:

the Panel’s Order,
the Notice of Hearing,
the Agreed Statement of Facts,
this Joint Submission on Order, and
a copy of the Panel’s Decision and Reasons, once available;

received a copy of the required documents,
agrees to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession, and
agrees to conduct random spot audits of the Member’s practice at the following intervals:

a) the first audit shall take place within four months from the date the Member returns to clinical nursing practice;

b) the second audit shall take place within eight months from the date the Member returns to clinical nursing practice, and;

c) the third audit shall take place within 12 months from the date the Member returns to clinical nursing practice.

The audits shall on each occasion involve discussing, with at least three of the Member’s clients, the care provided by the Member to verify that the Member is utilizing appropriate communication techniques that are consistent with the therapeutic nurse-client relationship;

c) The Member shall not practise independently in the community or as the only registered staff on duty for a period of 12 months from the date the Member returns to clinical nursing practice.

All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will retain.

Reasons for Penalty Decision

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

The penalty imposed provides for specific deterrence and rehabilitation in that, should the Member return to practice, she will have the opportunity and guidance to reflect on her past practice and improve the quality of her practice through monitoring and sessions with the expert. The penalty provides public protection by means of 24 months of audits and a restriction on practising independently, as well as 24 months of employer monitoring and notification. These penalties all serve in general deterrence by sending a clear message that such conduct will not be tolerated and may result in a lengthy suspension and significant terms, conditions and limitations. The goal of public protection is met with the extensive opportunity for rehabilitation and education. The suspension of six months is appropriate, given that the Member’s conduct involved clients who were vulnerable and not able to advocate for themselves.

I, Nancy Sears, 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:

Tammy Hedge, RPN

Susan Roger, RN

Cathy Egerton, Public Member

Gino Cucchi, Public Member