College of Nurses of Ontario v. Groulx, 2019 ONCNO 73939

Discipline Committee of the College of Nurses of Ontario

Panel: David Edwards, RPN Panel Chair Laura Caravaggio, RPN Member Catherine Egerton, Public Member Deborah Graystone, NP Member Devinder Walia, Public Member

Between: College of Nurses of Ontario (Denise Cooney for College of Nurses of Ontario)

• and -

Barbara Groulx, Registration No. AA798940 (No Representation for Barbara Groulx)

Christopher Wirth, Independent Legal Counsel

Heard: March 25, 2019

Decision and Reasons

This matter came on for hearing before a panel of the Discipline Committee (the "Panel") on March 25, 2019 at the College of Nurses of Ontario (the "College") at Toronto. Barbara Groulx (the "Member") participated by teleconference.

The Allegations

The allegations against the Member as stated in the Notice of Hearing dated January 25, 2019 are as follows:

IT IS ALLEGED THAT:

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

(a) on or about March 28, 2014: i. you made inappropriate and/or unprofessional comments directed at a client; and/or ii. you made inappropriate and/or unprofessional comments about a client to your colleagues;

(b) on or about July 20, 2014, you provided inadequate care to [Client A], and/or inadequately documented the care you provided [Client A], including but not limited to the following: i. you disregarded [Client A's] physician's order with respect to transfer of [Client A]; and/or ii. you failed to maintain appropriate documentation with respect to the care you provided [Client A];

(c) in or about June 2016, you made comments to your nursing colleague about clients using inappropriate and/or unprofessional language, including words to the effect that patients could not be viewed as human beings;

(d) on or about September 28, 2016 you provided inadequate care to [Client B], including but not limited to the following: i. you failed to engage in appropriate therapeutic communication with [Client B]; and/or ii. you handled [Client B] in a rough manner;

(e) on or about September 28, 2016, you made inappropriate and/or unprofessional comments directed at [Client C];

(f) on or about September 28, 2016, you made inappropriate and/or unprofessional comments about [Client C] and/or her son to your colleague(s); and/or

(g) on or about September 28, 2016, you made inappropriate and/or unprofessional comments directed at [Client D].

2. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(7) of Ontario Regulation 799/93, in that while employed as a Registered Practical Nurse at the North Bay Regional Health Centre, you abused a client verbally, physically, and/or emotionally in that:

(a) on or about March 28, 2014, you made inappropriate and/or unprofessional comments directed at a client; and/or

(b) on or about September 28, 2016: i. you handled [Client B] in a rough manner; ii. you made inappropriate and/or unprofessional comments directed at [Client C]; and/or iii. you made inappropriate and/or unprofessional comments directed at [Client D].

3. You have committed an act of professional misconduct, as provided by subsection 51 (1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in paragraph 1(13) of Ontario Regulation 799/93, in that while employed as a Registered Practical Nurse at the North Bay Regional Health Centre, you failed to keep records as required, and in that on or about July 20, 2014 you failed to document the care that you provided [Client A].

4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that you engaged in conduct that would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional with respect to the following incidents:

(a) on or about March 28, 2014: i. you made inappropriate and/or unprofessional comments directed at a client; and/or ii. you made inappropriate and/or unprofessional comments about a client to your colleagues;

(b) on or about July 20, 2014, you provided inadequate care to [Client A], and/or inadequately documented the care you provided [Client A], including but not limited to the following: i. you disregarded [Client A's] physician's order with respect to transfer of [Client A]; and/or ii. you failed to maintain appropriate documentation with respect to the care you provided [Client A];

(c) in or about June 2016, you made comments to your nursing colleague about clients using inappropriate and/or unprofessional language, including words to the effect that patients could not be viewed as human beings;

(d) on or about September 28, 2016 you provided inadequate care to [Client B], including but not limited to the following: i. you failed to engage in appropriate therapeutic communication with [Client B]; and/or ii. you handled [Client B] in a rough manner;

(e) on or about September 28, 2016, you made inappropriate and/or unprofessional comments directed at [Client C];

(f) on or about September 28, 2016, you made inappropriate and/or unprofessional comments about [Client C] and/or her son to your colleague(s); and/or

(g) on or about September 28, 2016, you made inappropriate and/or unprofessional comments directed at [Client D].

Member's Plea

The Member admitted the allegations set out in paragraphs 1, 2, 3 and 4 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

College Counsel and the Member advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads as follows:

THE MEMBER

1. Barbara Groulx (the "Member") obtained a diploma in nursing from Canadore College in 2011.

2. The Member registered with the College of Nurses of Ontario (the "College") as a Registered Practical Nurse ("RPN") on July 22, 2011. The Member resigned her certificate of registration on July 24, 2018.

3. The Member was employed at North Bay Regional Health Centre (the "Hospital") from June 7, 2011 to October 13, 2016, when her employment was terminated as a result of the incidents below.

THE FACILITY

4. The Facility is located in North Bay, Ontario.

5. At the time of each of the incidents, the Member worked as a part-time staff nurse in the Hospital's Complex Continuing Care unit (the "Unit"), a 21-bed dementia unit.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

March 28, 2014 – Use of Vocera

6. The Hospital uses a hand-held communication device called "Vocera".

7. Vocera allows staff to be paged, to speak with other staff members directly, and to record a message for one another.

8. During the course of the Member's night shift on March 28, 2014, her Vocera device recorded the Member making the following comments about a client:

"Stop it! Stop ringing, no more ringing. Go to sleep, no more ringing the bell. Enough! God!"

9. The Member was then recorded making the following comments to her colleagues about her interactions with the client:

Well I almost killed her; I almost gave her a heart attack. She was sleeping, holding the bell pressing it so when I grabbed it, oh fuck, she didn't even die fuck! Ding! Right over the head! Like fuckin shut up!

10. The Hospital investigated the incident, and suspended the Member for one day without pay.

11. The Member acknowledges, and the parties agree, that she breached the College's Professional Standards and Therapeutic Nurse-Client Relationship standards, as set out below. In particular, she failed to communicate respectfully about clients and to conduct herself in a professional way with coworkers. The Member also acknowledges that the comment directed at the client was abusive (as set out below). She acknowledges that her conduct was unacceptable.

July 20, 2014 – Client A

12. [Client A] had a physician's order that a mechanical lift not be used to transfer her.

13. On July 20, 2014, contrary to the physician's order, the Member used a mechanical lift to transfer Client A into her wheelchair so that she could attend a birthday celebration with her family. The Member did not consult with Client A's husband, her physician, or the charge nurse, prior to initiating the transfer.

14. Upon seeing Client A in a wheelchair, Client A's husband asked the Member how Client A had gotten up (given the physician's order), and the Member explained that she had used the lift.

15. The Member did not document that she had transferred Client A using a lift on the date of the incident. Three days later, on July 23, 2014, the Member entered a late progress note, in which she documented that she had used the lift to transfer Client A. She did not document her disagreement with the physician's order.

16. The Hospital had a policy called "Disagreeing with the Plan of Care," which set out the process to be followed by staff when they disagreed with a client's plan of care. The policy required staff to consult with the client and/or substitute decision maker and colleagues, and if there remains a disagreement, to consult with a supervisor. The Member acknowledges that she failed to follow the Hospital's policy.

17. There was no injury to Client A as a result of the Member's actions, though there was a concern that the use of the lift may have injured her hip.

18. The Hospital investigated the incident, and suspended the Member for two days without pay.

19. The Member acknowledges, and the parties agree, that she breached the College's Professional Standards and Decisions about Procedures and Authority standards, as set out below, and the Hospital's policy which applied in this situation. She also acknowledges that she breached the College's Documentation standard, as set out below, in that she failed to document the fact that she disagreed with the physician's order, and that she acted contrary to the order without consulting the substitute decision maker or her supervisor. She acknowledges that her conduct was unacceptable.

June 2016 Incident

20. On June 16, 2016, the Member was providing orientation to a new RPN co-worker, [the Co-worker]. During the course of the orientation, the Member told [the Co-worker] that clients could not be viewed as human beings.

21. The Member acknowledges, and the parties agree, that she breached the College's Professional Standards, as set out below, and that her conduct was unacceptable. In particular, she failed to communicate respectfully about clients and to conduct herself in a professional way with coworkers. The Member had a heightened responsibility to be professional, given that she was in a leadership role providing orientation to a new staff member.

September 28, 2016 – Client B

22. [Client B] had dementia. His care plan provided that members of the healthcare team should use a warm blanket for Client B's care (as he was always complaining of being cold), explain to him what was being done prior to providing care, and promote his privacy, especially in relation to personal care.

23. On the morning of September 28, 2016, the Member was providing personal care to Client B in his room with two personal support workers.

24. Prior to providing care to Client B, the Member did not explain to him what she was doing and her approach to providing care to Client B was not gentle. The Member aggressively removed Client B's gown, and pried his legs open roughly in order to wash him.

25. The Member's care of Client B did not comply with his care plan or meet the College's standards of practice, which the Member acknowledges. Specifically, the Member breached the College's Professional Standards and the Therapeutic Nurse-Client Relationship standards, as set out below. The Member also acknowledges that her handling of Client B was abusive (as set out below). She acknowledges that her conduct was unacceptable.

September 28 2016 – Client C

26. The Member was providing care to [Client C] on September 28, 2016. Client C was admitted to the Hospital as a result of suffering from a stroke. Client C was on a two hour bathroom schedule, but requested to go to the bathroom several times an hour. Shortly before the incident, Client C was repeatedly asking to go to the bathroom, and staff told her that her next scheduled bathroom time was in 15 minutes.

27. In response to one of Client C's repeated requests to go to the bathroom, the Member told Client C "she was just in the john," or words to that effect.

28. The Member acknowledges that her tone towards Client C was unkind and unprofessional. It is not clear whether Client C heard or understood the Member's comment, but Client C's son heard it and cautioned the Member that she was speaking about his mother. If Client C's son were to testify, he would describe the Member's tone as "negative", and that he found the Member's comment upsetting. Other staff who witnessed the comment described the Member's tone as "not nice" and "loud."

29. On the same shift, Client C's son was helping Client C walk using a belt with a side rail. At the Hospital, the belt was used to help clients with walking, or to transition from their wheelchair to a standing position. It was clipped around a client's waist and held by the person helping them, while the client walked and held on to a side rail.

30. In response to seeing Client C and her son using the belt, the Member said to her coworkers, "I don't know why he bothers, it's not like the end result isn't going to be her in a wheelchair," or words to that effect.

31. The Member acknowledges, and the parties agree, that she breached the College's Professional Standards, as set out below, and that her conduct was unacceptable. In particular, she failed to communicate respectfully about clients and to conduct herself in a professional way with coworkers. The Member also acknowledges that she breached the College's Therapeutic Nurse-Client Relationship standard, as noted below. The Member also acknowledges that the comment directed at the client was abusive (as set out below).

September 28, 2016 – Client D

32. On September 28, 2016, the Member was providing care to [Client D]. During the course of providing care to Client D, he had a bowel movement. The Member made comments to her colleagues about Client D's stool, and specifically that it smelled like "chicken shit." The comments were heard by several coworkers and were made in front of Client D.

33. The Member also said "this is what happens to you when you get old," as she held Client D's penis and scrotum. Client D did not react to the Member's comments, but he was capable of understanding what was going on around him.

34. The Member acknowledges, and the parties agree, that she breached the College's Professional Standards, as set out below, and that her conduct was unacceptable. In particular, she failed to communicate respectfully about clients and to conduct herself in a professional way with coworkers. The Member also acknowledges that she breached the College's Therapeutic Nurse-Client Relationship standard, as noted below. The Member also acknowledges that the comment directed at the client was abusive (as set out below).

COLLEGE STANDARDS

Professional Standards

35. The College's Professional Standards provides that "[e]ach nurse establishes and maintains respectful, collaborative, therapeutic and professional relationships. One way of doing so is "demonstrating respect and empathy for, and interest in clients."

36. In terms of professional relationships, the standard sets out indicators nurses must demonstrate, including:

• nurses role-modelling positive collegial relationships;
• using a wide range of communication and interpersonal skills to effectively establish and maintain collegial relationships.

Therapeutic Nurse-Client Relationship

37. The College's Therapeutic Nurse-Client Relationship ("TNCR") standard requires that nurses use therapeutic communication when speaking to clients. Specifically, it states that nurses should "use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-client relationship."

38. The TNCR also requires that a nurse be "aware of her/his verbal and non-verbal communication style and how clients might perceive it."

39. The TNCR defines verbal and emotional abuse as including sarcasm, teasing or taunting, insensitivity to the client's preferences, and an inappropriate tone of voice, such as one expressing impatience. The TNCR requires that a nurse not exhibit "verbal and non-verbal behaviours toward a client that demonstrate disrespect for the client and/or perceived by the client and/or others as abusive".

40. The TNCR defines physical abuse as including "handling a client in a rough manner." The TNCR requires that a nurse not exhibit "physical … behaviours toward a client that demonstrate disrespect for the client and/or are perceived by others as abusive".

Decisions about Procedures and Authority

41. The College's Decisions About Procedures and Authority standard requires that nurses ensure that they have the appropriate authority before performing procedures, and ensuring that client records reflect the initiated procedures.

Documentation

42. The College's Documentation standard states that:

Nursing documentation is an important component of nursing practice and the interprofessional documentation that occurs within the client health record. Documentation — whether paper, electronic, audio or visual — is used to monitor a client's progress and communicate with other care providers. It also reflects the nursing care that is provided to a client.

43. The standard goes on to say that a nurse meets the standard by "ensuring their documentation of client care is accurate, timely and complete."

ADMISSIONS OF PROFESSIONAL MISCONDUCT

44. The Member admits that she committed the acts of professional misconduct as described in paragraphs 6 to 34 above, in that she contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as alleged in the Notice of Hearing, as follows:

• 1(a)(i) in that, on March 28, 2014, she made inappropriate and/or unprofessional comments directed at a client.
• 1(a)(ii) in that, on March 28, 2014, she made inappropriate and/or unprofessional comments about a client to her colleagues.
• 1(b) in that, on or about July 20, 2014, she provided inadequate care to Client A, and/or inadequately documented the care she provided to Client A, including but not limited to the following: o (i) she disregarded Client A's physician's order with respect to transfer of Client A; and/or o (ii) she failed to maintain appropriate documentation with respect to the care you provided Client A.
• 1(c) in that, in or about June 2016, she made comments to her nursing colleague about clients using inappropriate and/or unprofessional language, including words to the effect that patients could not be viewed as human beings.
• 1(d) in that, on or about September 28, 2016, she provided inadequate care to Client B, including but not limited to the following: o (i) she failed to engage in appropriate therapeutic communication with Client B; and/or o (ii) she handled Client B in a rough manner.
• 1(e) in that, on or about September 28, 2016, she made inappropriate and/or unprofessional comments directed at Client C.
• 1(f) in that, on or about September 28, 2016, she made inappropriate and/or unprofessional comments about Client C and/or her son to your colleague(s).
• 1(g) in that, on or about September 28, 2016, she made inappropriate and/or unprofessional comments directed at Client D.

45. The Member admits that she committed the acts of professional misconduct as described in paragraphs 6 to 34 above and as alleged in the Notice of Hearing as follows:

• 2(a) in that she verbally abused a client when she made inappropriate and/or unprofessional comments directed at a client, on or about March 28, 2014.
• 2(b)(i) in that she physically abused Client B when she handled him in a rough manner.
• 2(b)(ii) in that she verbally abused Client C when she made inappropriate and/or unprofessional comments directed at Client C.
• 2(b)(iii) in that she verbally abused Client D when she made inappropriate and/or unprofessional comments directed at Client D.

46. The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 of the Notice of Hearing, and in particular, she failed to keep records as required, when she failed to document the care she provided to Client A, on or about July 20, 2014.

47. The Member admits that she committed the acts of professional misconduct as described in paragraphs 6 to 34 above:

• 4(a)(i) in that her conduct was dishonourable and unprofessional.
• 4(a)(ii) in that her conduct was dishonourable and unprofessional.
• 4(b)(i) in that her conduct was unprofessional.
• 4(b)(ii) in that her conduct was unprofessional.
• 4(c) in that her conduct was dishonourable and unprofessional.
• 4(d)(i) in that her conduct was dishonourable and unprofessional.
• 4(d)(ii) in that her conduct was disgraceful, dishonourable and unprofessional.
• 4(e) in that her conduct was dishonourable and unprofessional.
• 4(f) in that her conduct was dishonourable and unprofessional.
• 4(g) in that her conduct was dishonourable and unprofessional.

Decision

The College bears the onus of proving the allegations in accordance with the standard of proof, that being the balance of probabilities based upon clear, cogent and convincing evidence.

Having considered the evidence, the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a)(i), (ii); 1(b)(i), (ii); 1(c); 1(d)(i), (ii); 1(e); 1(f); 1(g); 2(a); 2(b)(i), (ii), (iii); 3 and 4 of the Notice of Hearing.

As to allegations 4(a)(i), (ii); (c); (d)(i); (e); (f); and (g), the Panel finds the Member's conduct to be dishonourable and unprofessional. As to allegation 4(b)(i) and (ii), the Panel finds the Member's conduct to be unprofessional. With regard to allegation 4(d)(ii), the Panel finds the Member's conduct to be disgraceful, dishonourable and unprofessional.

Reasons for Decision

The Panel considered the Agreed Statement of Facts and the Member's plea and finds that this evidence supports findings of professional misconduct as alleged in the Notice of Hearing.

Allegation #1(a)(i) in the Notice of Hearing is supported by paragraphs 8 and 11 in the Agreed Statement of Facts. The Member admits that she failed to meet the College's Professional Standards and the Therapeutic Nurse-Client Relationship standards of practice when she made inappropriate and unprofessional comments directly to a client.

Allegation #1(a)(ii) in the Notice of Hearing is supported by paragraphs 9 and 11 in the Agreed Statement of Facts. The Member admits that she breached the College's Professional Standards and Therapeutic Nurse-Client Relationship standards of practice when she made inappropriate and unprofessional comments about a client to her colleagues.

Allegation #1(b)(i) in the Notice of Hearing is supported by paragraphs 12, 13, 14 and 19 in the Agreed Statement of Facts. The evidence shows that the Member disregarded Client A's physician's orders with respect to the transfer of this Client which breached the College's Professional Standards and the Decision about Procedures and Authority standards set by the Hospital policy.

Allegation #1(b)(ii) in the Notice of Hearing is supported by paragraphs 15, 16 and 19 in the Agreed Statement of Facts. The evidence shows that the Member failed to maintain appropriate documentation with respect to the care provided to Client A which breached the College's Documentation standard.

Allegation #1(c) in the Notice of Hearing is supported by paragraphs 20 and 21 in the Agreed Statement of Facts. The Member admits she made comments to colleagues that used words to the effect that patients could not be viewed as human beings. The Member admits she breached the College's Professional Standards.

Allegation #1(d)(i) in the Notice of Hearing is supported by paragraphs 22, 24 and 25 in the Agreed Statement of Facts. The Member admits that she failed to engage in appropriate therapeutic communication with Client B which is a breach of the College's Professional Standards and the Therapeutic Nurse-Client Relationship standard.

Allegation #1(d)(ii) in the Notice of Hearing is supported by paragraphs 24 and 25 in the Agreed Statement of Facts. The Member admits she breached the Therapeutic Nurse-Client Relationship standard when she handled Client B in a rough manner which is physical abuse.

Allegation #1(e) in the Notice of Hearing is supported by paragraphs 26, 27, 28 and 31 in the Agreed Statement of Facts. The evidence shows that the Member made inappropriate and unprofessional comments to Client C. The Member admits that she breached the Therapeutic Nurse-Client Relationship standard.

Allegation #1(f) in the Notice of Hearing is supported by paragraphs 28, 29, 30 and 31 in the Agreed Statement of Facts. The evidence shows that the Member made inappropriate and unprofessional comments about Client C and the son of the Client to her colleagues. The Member admits that she breached both the College's Professional Standards and the Therapeutic Nurse-Client Relationship standard.

Allegation #1(g) in the Notice of Hearing is supported by paragraphs 32, 33 and 34 in the Agreed Statement of Facts. The evidence shows that the Member made inappropriate and unprofessional comments directed to Client D. This is a breach of the Therapeutic Nurse-Client Relationship standard.

Allegation #2 (a) in the Notice of Hearing is supported by paragraphs 8 and 11 in the Agreed Statement of Facts. The Member admits that the inappropriate and unprofessional comments directed at a client were abusive and that the conduct was unacceptable.

Allegation #2(b)(i) in the Notice of Hearing is supported by paragraphs 24 and 25 in the Agreed Statement of Facts. The Member admits that she handled Client B in a manner that was abusive and her conduct was unacceptable.

Allegation #2(b)(ii) in the Notice of Hearing is supported by paragraphs 27, 28 and 31 in the Agreed Statement of Facts. The Member admits she made inappropriate and unprofessional comments to Client C that were abusive.

Allegation #2(b)(iii) in the Notice of Hearing is supported by paragraphs 32, 33 and 34 in the Agreed Statement of Facts. The Member admits she made inappropriate and unprofessional comments to Client D that were abusive.

Allegation #3 in the Notice of Hearing is supported by paragraphs 15, 16, 19 and 46 in the Agreed Statement of Facts. The Member breached the College's Professional Standards and Decision about Procedures and Authority standards as set by the Hospital policy when she failed to document the fact that she disagreed with the physician's order and she acted contrary to the order without consulting the substitute decision maker or her supervisor. She also admits that she breached the College's Documentation standard.

Allegation #4(a)(i) in the Notice of Hearing is supported by paragraphs 8, 9, 44, 45 and 47 in the Agreed Statement of Facts. The Member admits that she made inappropriate and unprofessional comments directed towards a client which would reasonably be regarded by members of the profession as dishonourable and unprofessional.

Allegation #4(a)(ii) in the Notice of Hearing is supported by paragraphs 9, 44, 45, and 47 in the Agreed Statement of Facts. The Member admits that she made inappropriate and unprofessional comments about a client to her colleagues which would reasonably be regarded by members of the profession as dishonourable and unprofessional.

Allegation #4(b)(i) in the Notice of Hearing is supported by paragraphs 12, 13, 14, 44, 45 and 47 in the Agreed Statement of Facts. The Member disregarded a physician's order for Client A and admits this misconduct was unprofessional.

Allegation #4(b)(ii) in the Notice of Hearing is supported by paragraphs 15, 16, 44, 45 and 47 in the Agreed Statement of Facts. The Member failed to maintain documentation for Client A and admits this misconduct was unprofessional.

Allegation #4(c) in the Notice of Hearing is supported by paragraphs 20, 44 and 47 in the Agreed Statement of Facts. The Member's conduct was dishonourable and unprofessional when she made comments to her nursing colleagues about clients using inappropriate words to the effect that patients could not be viewed as human beings.

Allegation #4(d)(i) in the Notice of Hearing is supported by paragraphs 22, 24, 44 and 47 in the Agreed Statement of Facts. The Member failed to engage in appropriate therapeutic communication with Client B and admits this was dishonorable and unprofessional conduct.

Allegation #4(d)(ii) in the Notice of Hearing is supported by paragraphs 24, 44, 45 and 47 in the Agreed Statement of Facts. The Member handled Client B in a rough manner and the Member admits the conduct was not only dishonorable and unprofessional, but also disgraceful.

Allegation #4(e) in the Notice of Hearing is supported by paragraphs 26, 27, 28, 44, 45 and 47 in the Agreed Statement of Facts. The Member made inappropriate comments to Client C which the Member admits were dishonorable and unprofessional.

Allegation #4(f) in the Notice of Hearing is supported by paragraphs 28, 30, 31, 44 and 47 in the Agreed Statement of Facts. The Member made inappropriate comments about Client C's son to her colleagues. The Member admits these comments were dishonorable and unprofessional.

Allegation #4(g) in the Notice of Hearing is supported by paragraphs 32, 33, 34, 44, 45 and 47 in the Agreed Statement of Facts. The Member made inappropriate comments directed towards Client D.

The Member admits these comments were dishonorable and unprofessional.

With respect to the Member's conduct under allegation #4, the Panel finds that:

The Member's conduct in 4(b)(i) and 4(b)(ii) was unprofessional, specifically with regard to how the Member disregarded a physician's order with respect to transfer of [Client A] and then failed to maintain documentation with a persistent disregard for her professional obligations.

With respect to allegations 4(a)(i), (ii); (c); (d)(i); (e); (f); and (g), the Member's conduct was dishonourable. It demonstrated an element of dishonesty and deceit through the manner in which the Member treated the Clients and her colleagues by making inappropriate comments. This demonstrated a serious and persistent disregard for her professional obligations.

Finally, the Member's conduct was disgraceful with respect to Allegation 4(d)(ii) as it shames the Member and by extension the profession. The Member physically abused Client B when she admitted to being rough when handling the Client. This conduct casts serious doubt on the Member's moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet.

Penalty

College Counsel and the Member advised the Panel that a Joint Submission on Order had been agreed upon. The Joint Submission on Order requests that this Panel make an order as follows:

1. Requiring the Member to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

Penalty Submissions

Submissions were made by College Counsel who advised the Panel that the Member has signed an undertaking with the College (the "Undertaking") in which she undertakes, acknowledges and agrees to the following:

• She will permanently resign as a member of the College;
• She will not reapply for membership with the College as a Registered Nurse or Registered Practical Nurse at any time in the future;
• The public portion of the Register maintained by the College will indefinitely reflect that she entered into the Undertaking to permanently resign as a member of the College as part of an agreed resolution of allegations of professional misconduct heard by a panel of the Discipline Committee; and
• The College is authorized to and may, in its sole discretion, provide a copy of the Undertaking and /or its terms to a governing body that regulates nursing in Canada or elsewhere in response to an inquiry or otherwise.

In light of the Undertaking, College Counsel submitted that the proposed penalty order supports general deterrence, protection of the public's interest and maintains the public's confidence in the ability of the nursing profession to self-regulate.

The Member has entered into a rigorous Undertaking which acknowledges that she resigned her membership with the College and will not pursue registration in the future. As well, the Undertaking includes a provision for the College to inform regulators in other jurisdictions should the Member attempt to gain registration in those areas. This outcome should inspire public confidence in the profession's ability to regulate members, as the Undertaking was given in the context of an admission by the Member and an entry on the public record, as opposed to a simple resignation from the College. Specific deterrence and rehabilitation are not essential components of the penalty to be ordered by the Panel in this case as the Member has permanently resigned from the profession.

College Counsel submitted cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee.

College of Nurses v. Cross (May 16, 2018). In this case, the member used excessive force including grabbing and shaking when handling an infant child. The member in this case also used inappropriate language while providing care to an infant. The penalty was an oral reprimand and the member entered into an Undertaking with College to permanently resign her membership with the College.

College of Nurses v. Muzylowsky (May 16, 2016). In this case, there were many allegations which included the member's inappropriate and demeaning comments to clients and colleagues. This member also failed to provide appropriate and timely care to clients. The penalty was an oral reprimand and the member entered into an Undertaking with the College to permanently resign her membership with it.

College of Nurses v. Rowe (November 20, 2017). In this case, the member entered into an Agreed Statement of Facts with the College. She admitted to professional misconduct in many areas. The similarity to this matter is that she physically abused clients, failed to follow a care plan and had inappropriate communication with a family member of a client. College Counsel noted that the member in this case had an oral reprimand, a six month suspension and terms, conditions and limitations imposed on her certificate of registration.

The Member had nothing further to add to these submissions.

Penalty Decision

The Panel accepted the Joint Submission on Order and accordingly orders:

1. The Member is required to appear before the Panel to be reprimanded within three months of the date that this Order becomes final.

Reasons for Penalty Decision

The Panel understands that the penalty ordered should protect the public and enhance public confidence in the ability of the College to regulate nurses. This is achieved through a penalty that addresses specific deterrence, general deterrence and, where appropriate, rehabilitation and remediation. The Panel also considered the penalty in light of the principle that joint submissions should not be interfered with lightly.

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 the proposed penalty, has accepted responsibility. The Panel finds that the penalty satisfies the principles of specific and general deterrence, rehabilitation and remediation, and public protection.

The penalty is in line with what has been ordered in previous cases.

I, David Edwards, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline Panel and on behalf of the members of the Discipline Panel.