DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Panel:

• Chairperson, RPN
• Member, RPN
• ember, RN
• Public Representative

BETWEEN

COLLEGE OF NURSES OF ONTARIO Councel for College of Nurses of Ontario

• and -

CHERYL SAUNDERS #IC-0536-7

REASONS FOR DECISION

Councel for Cheryl Saunders

Heard: May 2, 2000

A panel of the Discipline Committee convened a hearing on May 2, 2000 at 0900 at the Hearing Room of the College of Dental Surgeons of Ontario, 4th floor, Crescent Rd. Toronto, Ontario to hear the following allegations against Cheryl Saunders (the"ìMember").

1. You have committed an act of professional misconduct as provided by ss. 51(1)(c) of the Health Professions Procedural Code, and defined in ss. 1(1) of Ontario Regulation 799/93, in that between December 1, 1997 and December 31, 1998, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, the particulars of which are set out in paragraphs 1, 2, 3, and 4 of Appendix A.

2. You have committed an act of professional misconduct as provided by ss. 51(1)(c) of the Health Professions Procedural Code, and defined in ss. 1(14) of Ontario Regulation 799/93, in that between December 1, 1997 and December 9, 1998, you falsified a record or records relating to your practice, the particulars of which are set out in paragraphs 1, 2 and 4 of Appendix A.

3. You have committed an act of professional misconduct as provided by ss. 51(1)(c) of the Health Professions Procedural Code, and defined in ss. 1(15) of Ontario Regulation 799/93, in that between December 1, 1997 and December 9, 1998, you signed or issued, in your professional capacity, a document that you knew or ought to know contained a false or misleading statement, the particulars of which are set out in paragraphs 1, 2 and 4 of Appendix A.

4. You have committed an act of professional misconduct as provided by ss. 51(1)(c) of the Health Professions Procedural Code, and defined in ss. 1(16) of Ontario Regulation 799/93, in that between December 1, 1997 and December 9, 1998, you inappropriately used a term, title or designation in respect of your practice, the particulars of which are set out in paragraphs 1, 2, and 3 of Appendix A.

5. You have committed an act of professional misconduct as provided by ss. 51(1)(c) of the Health Professions Procedural Code, and defined in ss. 1(37) of Ontario Regulation 799/93, in that

between December 1, 1997 and December 31, 1998 you engaged in conduct or performed an act relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, the particulars of which are set out in paragraphs 1, 2, 3, and 4 of Appendix A.

Appendix A

Particulars of Specified Allegations Re: Cheryl Saunders RPN #IG-0556-7

1. In or about December 1997, when applying for a position as Director of Resident Care at Elim Homes, Cheryl Saunders made written representations that she held the designation of Registered Nurse (RN), and was registered with the College of Nurses of Ontario as a RN, when in fact she did not hold the designation and was not registered as such.

2. Between January 1, 1998 and December 9, 1998, Cheryl Saunders represented that she held the designation of RN, when in fact she did not, and in particular:

a. signed documents relating to client care which indicated that she held the designation of RN when she in fact did not;

b. signed documents relating to placement and supervision of personal service workers placed at Elim Homes, indicating that she held the designation of RN, when in fact she did not; and

3. Between December 1, 1997 and December 9, 1998 represented, in her professional capacity, that she held the designation of RN, when in fact she did not, and in particular,

a. represented to clients and to professional colleagues that she held the designation of RN;

b. failed to correct statements made, in reliance on her representations, by Elim Homes to its staff, residents and Board of Directors, indicating that she held the designation of RN;

c. falsely stated in a job interview at Elim Homes in December 1997 that she held the designation of RN.

4. In an application for professional employment submitted in or about December 1997, Cheryl Saunders stated that she was employed as a nurse in the intensive care unit at the Orillia Soldiers Memorial Hospital, when in fact she was not.

5. These allegations were contained in the Amended Notice of Hearing, which was filed as Exhibit #1.

MEMBERS PLEA

The Member, through her counsel, admitted that she had committed acts of professional misconduct as provided in allegations #4 and #5. These admissions were contained in an Agreed Statement of Facts referred to below.

The panel was not asked to make a finding on Allegations #1, #2 or #3 of the Amended Notice of Hearing.

AGREED STATEMENT OF FACTS

An Agreed Statement of Facts was received as Exhibit #2 and reproduced below. The panel also received a set of bound documents as appendices to the Agreed Statement of Facts.

THE MEMBER

1. In the fall of 1994, Cheryl Saunders ("the Member") entered the 3-year Nursing Diploma program

at Georgian College. In the summer of 1996, she completed the Practical Nurse bridging requirement and received her Certificate as a Practical Nurse from Georgian College.

2. From November 1996 to January of 1998, the Member was employed at Elim Homes ("Elim") as a part-time Health Aide and Registered Practical Nurse (RPN).

3. In February of 1997, the Member first registered as an RPN with the College of Nurses of Ontario ("the College").

4. While working as a part-time RPN at Elim, the Member continued to complete the educational requirements for her Nursing Diploma at Georgian College. From January to May of 1997, she completed the consolidation phase of the Diploma program in the ICU at Orillia Soldiers' Memorial Hospital. In the Spring of 1997, she received her Nursing Diploma.

5. In June of 1997, the Member wrote the Canadian Nursing Association's (CNA) Nurse Licensure Examination. She failed the examination.

6. From January 1, 1998, to December 9, 1998, the Member held the position of Head of Resident Care at Elim. The Member was terminated from this position when the Board of Elim discovered that she was not an RN.

7. In June of 1999, the Member passed the CNA examination, and subsequently registered as a Registered Nurse (RN) with the College for the first time in July of 1999.

8. Prior to the events described below, the Member had not been the subject of a complaint or report to the College.

SUMMARY OF MEMBER'S BACKGROUND

9. The preceding statements of fact concerning the Member are summarised as follows: Fall 1994 - Started 3-year Nursing Diploma Program at Georgian College Summer 1996 - Received Practical Nurse Certificate from Georgian College November 24, 1996 - Hired at Elim Homes

February 7, 1997 - Registered with College as RPN

Spring 1997 - Received Nursing Diploma from Georgian College

June 4, 1997 - Failed Canadian Nursing Association's (CNA) Nurse Licensure Examination January 1, 1998 - Assumed Head of Resident Care position at Elim as RN

December 9, 1998 - Terminated from Elim after Elim discovered Member is not an RN June 1999 - Passed Canadian Nursing Associationís (CNA) Nurse Licensure Examination July 1999 - Registered as a Registered Nurse

THE FACILITY

10. Elim Homes ("Elim") is a 40-bed private home for the aged in Waubaushene, Ontario. Elim serves residential clients who require minimal care, as well as residents that require more intensive extended care.

MISREPRESENTATIONS RE: DESIGNATION (1) -

Represented Self as RN in Application

11. In December of 1997, Elim posted a memorandum concerning the availability of the Head of Resident Care position. The memorandum indicated that the successful candidate "Must possess a valid R.N. licence".

12. On December 15, 1997, Elim received a written application from the Member, for the Head of Resident Care position. The Member's letter included the following statements regarding her professional status:

a. I believe that I would be an ideal candidate for this position as I am registered with the college of Nurses as an RN as well as an RPN. (emphasis added)

b. I have only been employed as an RN since June of 1997, but the experience I have gained from being an RPN for four years has proved to be invaluable. (emphasis added)

13. The Member made the above statements in her application letter knowing that the emphasized portions were false. The Member was not registered with the College as an RN at the time, as she indicated in her statement at 12(a), above. She first registered with the College as an RN in July of 1999. For the same reason, the Member had not held the designation of "RN" since June of 1997, as her statement at 12(b), above, implies.

14. The Member signed the application letter "Sincerely; Cheryl Saunders RN/RPN" when she knew she was not an RN.

15. THE MEMBER ADMITS that by submitting an application letter to Elim that contained the statements set out in paragraph 12, above, and by signing the letter as "Cheryl Saunders RN/RPN", she has committed professional misconduct by:

16. inappropriately using a term, title or designation in respect of her practice, specifically regarding her status as an RN, as alleged in paragraph 4 of the Notice of Hearing; and

17. engaging in conduct or performing an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional, as alleged in paragraph 5 of the Notice of Hearing.

MISREPRESENTATIONS RE: DESIGNATION (2.a.) - Signing

Documents Relating to Client Care

16. On January 8, 1998, the Member signed Resident Care Plans for Elim clients as "CA Saunders RN/RPN":

17. [client]

18. [client]

19. On January 11, 1998, the Member signed Resident Care Plans for the following Elim clients as "CA Saunders RN/RPN":

20. [client]

21. [client]

22. [client]

23. [client]

24. [client]

25. [client]

26. [client]

27. [client]

28. On January 12, 1998, the Member signed a Resident Care Plan for an Elim client as "CA Saunders RN/RPN".

29. The Simcoe County District Health Unit required Medical History forms to be filled out for the purposes of providing Elim clients with dental services. The Member signed Medical History forms for the following Elim clients as "CA Saunders RN", "CA Saunders RN/RPN", or "Cheryl Saunders RN/RPN", on the dates indicated:

30. [client], March 16, 1998

31. [client], March 19, 1998

32. [client] , March 20, 1998

33. [client], March 20, 1998

34. [client], March 20, 1998

35. [client], March 20, 1998

36. [client], March 20, 1998

37. [client], September 23, 1998.

38. The Member signed Incident Reports concerning the following Elim clients as "Cheryl Saunders RN/RPN" on the dates indicated:

39. [client], March 1, 1998

40. [client], March 24, 1998

41. The Member witnessed Health Care Directives concerning the following Elim clients by signing the Directives as "CA Saunders RN" or "CA Saunders RN/RPN" on the dates indicated:

42. [client], March 16, 1998

43. [client], March 19, 1998

44. [client], April 17, 1998

45. THE MEMBER ADMITS that by signing documents relating to client care which indicated that she held the designation of "RN", as described in paragraphs 16, 17, 18, 19, 20 and 21 above, when she knew in each case that she did not hold the designation at the relevant time, she has committed professional misconduct by:

46. inappropriately using a term, title or designation in respect of her practice, as alleged in paragraph 4 of the Notice of Hearing; and

47. engaging in conduct or performing an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional as alleged in paragraph 5 of the Notice of Hearing.

MISREPRESENTATIONS RE: DESIGNATION (2.b.) - Signing

Documents re: Personal Service Workers as RN

23. Several students of the Personal Support Worker Program at Georgian College did their practical placements at Elim in 1998. On behalf of Elim, the Member signed the Work Education Placement Agreements required for the placement of students #1, #2, and #3 as "Cheryl Saunders RN RPN" in the period January 1, 1998 to December 9, 1998.

24. THE MEMBER ADMITS that by signing documents relating to the placement and supervision of students of the Personal Service Workers Program using the designation "RN", as described in paragraph 23, above, when she knew in each case that she did not hold the designation at the relevant times, she has committed professional misconduct by:

25. inappropriately using a term, title or designation in respect of her practice, as alleged in paragraph 4 of the Notice of Hearing; and

26. engaging in conduct or performing an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional as alleged in paragraph 5 of the Notice of Hearing.

MISREPRESENTATIONS RE: DESIGNATION (3.a) -

Representing Self as RN to Clients and Colleagues

25. On December 26, 1997, the Member prepared a Nursing Care Plan for an Elim client in which she identified herself as "Cheryl Saunders RN RPN".

26. On March 24, 1998, the Member prepared and signed a letter to a nursing staff member informing her that she had been terminated from her position as an RPN at Elim for negligence and for creating a risk to client safety. Directly under her signature, the Member identified herself as "Cheryl Saunders RN/RPN, Head of Resident Care, Elim Homes."

27. On April 4, 1998, the Member prepared a "Supervisor's Appraisal" of an RPN. Directly under her signature, the Member identified herself as "Ms. Cheryl Saunders RN/RPN, Head of Resident Care, Elim Homes Inc.".

28. On November 3, 1998, the Member completed a memorandum to Mr. [blank], the Administrator of Elim, Ms. [blank], and Dr. [blank], the Elim staff physician, concerning significant weight losses and gains of Elim residents. Directly under her signature, the Member identified herself as "CA Saunders RN/RPN".

29. On November 13, 1998, the Member prepared and signed a letter to the Administrator of Elim, that expressed the gratitude of the Elim nursing team for the receipt of a gift from the family of an

Elim resident. Directly under her signature, the Member identified herself as "Cheryl Saunders RN/RPN". This letter was circulated to, and signed by, the other members of the Elim nursing team.

30. THE MEMBER ADMITS that by representing to clients and professional colleagues that she held the designation of "RN", as described in paragraphs 25, 26, 27, 28 and 29, above, when she knew that she was not an RN at the time, she has committed professional misconduct by:

31. inappropriately using a term, title or designation in respect of her practice, as alleged in paragraph 4 of the Notice of Hearing; and

32. engaging in conduct or performing an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional as alleged in paragraph 5 of the Notice of Hearing.

MISREPRESENTATIONS RE: DESIGNATION (3.b.) - Failed

to Correct Statement Made by Elim.

31. Between December 1, 1997 and December 9, 1998, Elim prepared and circulated a pamphlet for the purpose of advertising its services. This pamphlet was available to staff, residents, Directors of Elim, and others. The Member was aware that, relying on representations she had made concerning her qualifications, the pamphlet listed "Cheryl Saunders, RN" under the heading "Resident Care". Although the Member knew she was not an RN at the time, she did not correct the statement, or take steps to alert Elim that the statement was incorrect. Also on January 12, 1998, the Administrator of Elim Homes circulated a memorandum to staff and residents announcing her appointment. The Member was aware that, in reliance on the representations she had made concerning her qualifications, the memorandum describes her as Cheryl Saunders RN/RPN. The Member did not correct the statement, or take any steps to alert Elim that the statement was incorrect.

32. THE MEMBER ADMITS that by failing to correct representations made by Elim that she held the designation "RN", as described in paragraph 31, above, when she knew that she did not hold the designation at the time, she has committed professional misconduct by engaging in conduct relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, as alleged in paragraph 5 of the Notice of Hearing.

MISREPRESENTATIONS RE: DESIGNATION (3.c.) - Stated

She Held RN Designation in Interview

33. Elim interviewed the Member for the position Head of Resident Care in December of 1997. During that interview, the Member stated that she held the designation of RN, when she knew the statement was false. The Member was first registered with the College as an RN in July of 1999.

34. THE MEMBER ADMITS that by falsely stating that she held the designation of "RN" during her interview with Elim, as described in paragraph 33, above, she has committed professional misconduct by:

35. inappropriately using a term, title or designation in respect of her practice, as alleged in paragraph 4 of the Notice of Hearing; and

36. engaging in conduct or performing an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members as disgraceful, dishonourable or unprofessional as alleged in paragraph 5 of the Notice of Hearing.

MISREPRESENTATIONS REGARDING WORK HISTORY (4.)

35. In the application letter the Member submitted to Elim in December of 1997 for the Head of Resident Care position, the Member made the following statements concerning employment at the Orillia Soldiers' Memorial Hospital:

36. "I presently work in the ICU in Orillia and am directly responsible to the client's doctor, and have to deal directly with the public and family members";

37. "[I] will devote myself to Elim and give up ICU nursing"; and

38. "[I] work independently in ICU and at Elim and am directly responsible for my actions to the public, family and doctors".

39. The Member made the foregoing statements about her work history knowing they were false. Regarding the statement at 35 (a), the Member was not employed in the ICU of Orillia Soldiers' Memorial Hospital at the time she submitted the application letter. Rather, the Member had completed the consolidation phase of her nursing program in the ICU of Orillia Soldier's Memorial Hospital from January to May of 1997, approximately seven months earlier. The statement at 35 (b), implies that the Member had a career in ICU nursing, when she was merely completing part of her consolidation in the ICU. Finally, with respect to the statement at 35 (c), the Member did not work independently at the Hospital, but completed her consolidation under the supervision of a preceptor RN.

40. THE MEMBER ADMITS that by making false statements concerning her employment at Orillia Soldiers' Memorial Hospital set out in paragraph 35, above, she has committed professional misconduct by:

41. engaging in conduct relevant to the practice of nursing that, having regard to all the circumstances, would reasonably be regarded by members of the profession as disgraceful, dishonourable or unprofessional, as alleged in paragraph 5 of the Notice of Hearing.

EMPLOYER'S ACTIONS

38. The Member and the Administrator of Elim developed a strained professional relationship. As a result, in December of 1998, the Administrator began to investigate the Member's employment history. He contacted the Orillia Soldier's Memorial Hospital, and the College.

39. As a result of his inquiries, the Administrator learned that the Member had not been employed by Orillia Soldier's Memorial Hospital, and was not an RN as of December 1998.

40. On December 9, 1998, a meeting at Elim was convened between the Member, the Administrator of Elim, another staff member, and the Director of Elim. At the meeting, the Member stated that the information contained in her application for the Head of Resident Care position was correct, and that she was registered as an RN with the College of Nurses. However, when the Director of Elim indicated that Elim had received information that she was not registered as an RN with the College, the Member admitted that she was not registered as an RN. She explained that she chose not to register as an RN because she was unable to pay the $80.00 fee, but that she was registered as an RPN.

41. The Director of Elim then indicated that Elim had written confirmation that the Member had never been employed at the Orillia Soldier's Memorial Hospital. The Member admitted that she had not been employed at the Hospital, but had only done her consolidation there.

42. As a result of the information disclosed at this meeting, Elim terminated the Member's employment and contacted the College about making a complaint.

ADDITIONAL INFORMATION

43. In the December 15, 1997 application letter the Member submitted to Elim for the Head of Resident Care position, the Member made the following statement about her work history:

"I have only been employed as an RN since June of 1997, but the experience I have gained from being an RPN for four years has proved to be invaluable."

44. The Member made the above statement in her application letter knowing it was false. The Member first registered with the College as an RN in July of 1999. Furthermore, the Member did not have four years of experience as an RPN, since she was first registered with the College as a RPN in February of 1997, only 11 months before she submitted the letter to Elim.

45. The memorandum that was posted at Elim regarding the Head of Resident Care position, through which the Member learned of the availability of the position, stipulated the following under the heading "Qualifications":

"Must have a minimum of one year experience in a supervisory capacity in a hospital, retirement or nursing home, or other related medical facility."

46. The Member did not have a minimum of one year's experience in a supervisory capacity as stipulated by the memorandum, as above. She had never been employed in a supervisory capacity in a hospital, retirement or nursing home, or other related medical facility. The Member's only similar experience was gained through her work as a part-time RPN at Elim.

47. In the resume the Member submitted to Elim prior to being hired on November 24, 1996, the Member included the following statement:

"[I] completed my RPN certification in June of 1996. I will be writing my PN exam on October 25 of 1996. Temporary licences are available from the college of Nurses, and I am prepared to purchase one if required by your facility."

The Member also stated in the resume:

"Third Year: My placement is currently at Orillia's Soldier's Memorial Hospital. I have been placed between the ICU and the medical/surgical floor. I hope to complete my consolidation either in a trauma or gerontology setting."

48. At the time she was hired, the Member knew that she had received a Practical Nursing Certificate from Georgian College, but was not registered with the College as a RPN, or as an RN.

49. The Member was initially hired by Elim on November 24, 1996. At that time, the Administrator of Elim believed that she was qualified to practice as an RPN. The Member was only available to work part-time. Between November 1996 and February 1997 most of the member's shifts were worked as a Health Care Aide, at a rate of $8.68. For other shifts, the Member worked as a RPN and was paid the RPN rate for those shifts ($14.25). Between February and May 1997, the Member continued to work some shifts as a Health Care Aide (at the rate of $8.88 per hour) and others as a RPN (at the rate of $14.45 per hour).

50. Although the Member knew she was not registered as an RPN or an RN at the relevant times, she entered her signature under the column entitled "Nurse's Signature", among those of Elim's Registered Practical Nurses, on the following Medication Administration Records (MARs) for the following clients:

to 31/12/96 MAR for [client] to 22/01/97 MAR for [client] to 22/01/97 MAR for [client] to 21/02/97 MAR for [client]

December 7, 1996, 0800 hrs, injected 70 units of Novolin to [client]

December 31, 1996 1700 hrs injected 65 units of Novolin to [client]

January 1, 1997, 0800 hrs injected 70 units of Novolin to [client]

January 2, 1997, 1700 hrs injected 65 units of Novolin to [client]

January 11, 1997, 0800 hrs injected 70 units of Novolin to [client]

January 12, 1997, 0800 hrs injected 70 units of Novolin to [client]

December 31, 1996 1700 hrs injected 65 units of Novolin to [client]

January 1, 1997, 0800 hrs injected 70 units of Novolin to [client]

January 2, 1997, 1700 hrs injected 65 units of Novolin to [client]

January 11, 1997, 0800 hrs injected 70 units of Novolin to [client]

January 12, 1997, 0800 hrs injected 70 units of Novolin to [client]

Although the Member knew she was not registered as an RPN or an RN at the relevant times, on

the following dates, she performed controlled acts¹ on Elim clients, which had not been delegated to her, as indicated:

51. After June 1997, when Elim understood that the Member had successfully written her RN examinations, she was paid at the rate of $14.75 per hour and was working full-time hours. During the time the Member was Head of Resident Care, she was paid at the rate of $18.00 to

$19.00 per hour

OTHER EVIDENCE

52. The parties reserve the right to adduce other evidence as required.

PLEA INQUIRY

The Chair conducted a plea inquiry in order to ensure that the Member's admission of professional misconduct was informed and voluntarily made. The Member's responses to questions confirmed that her admission of professional misconduct was indeed informed and voluntarily made.

DECISION

Having regard to the admissions of professional misconduct made on the Member's behalf and the facts contained in the Agreed Statement of Facts, the panel found professional misconduct as alleged in Allegations #4 and #5 of the Agreed Statement of Fact (Exhibit #2).

JOINT SUBMISSION ON PENALTY

Counsel for the College and the Member's counsel then tendered a Joint Submission on Penalty (Exhibit #3) that provided as follows.

1. The Member is required to appear before a panel to be reprimanded.

2. The Registrar is directed to suspend the Member's RN and RPN Certificate of Registration, such suspension to commence May 14, 2000 and to run without interruption for thirty days.

3. The Member is required to pay a fine of $1,000.00 to the Minister of Finance for the Province of Ontario, and to provide proof of such payment to the Director of the College's Investigations and Hearings program in the form of a cancelled cheque or receipt, by no later than 1 year from the date of this Order.

The Member was then sworn to give evidence in her own defense about events that had gone on following termination from "Elim", her remorse for the preceding events and her current work situation including educational pursuits and goals.

DECISION ON PENALTY

The panel, after careful deliberation, unanimously accepted the Joint Submission on Penalty.

REASONS FOR DECISION ON PENALTY

The Member's expression of remorse impressed the panel. Although the Joint Submission contemplated a suspension of relatively short duration, the panel considered the Member's mitigating circumstances in deciding to accept it. The panel believes that this penalty serves to protect the public interest and reflects the principle of deterrence for the Member and sends a message to the College's membership that this conduct will not be tolerated.

The Member signed a waiver of appeal and received her oral reprimand.

I, , RPN, sign this decision and reasons for the decision as Chairperson Date: of this Discipline Panel and on behalf of the members of the Discipline Panel as listed below.

, Chairperson Date Member, RN

Member, RPN

Public Representative

Footnotes

1. 1As defined in subsection 27(2) of the Regulated Health Professions Act, 1991.