DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL: Dawn Cutler, RN Chairperson
Jay Armitage Public Member Margarita Cleghorne, RPN Member Sylvia Douglas Public Member
Neil Hillier, RPN Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) DENISE COONEY for
) College of Nurses of Ontario
- and - )
SANDRA GOY ) NO REPRESENTATION for
Registration No. 8912834 ) Sandra Goy
) CHRISTOPHER WIRTH
) Independent Legal Counsel
) ) Heard: April 26, 2021
DECISION AND REASONS
This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on April 26, 2021, via videoconference.
Publication Ban
College Counsel brought a motion pursuant to s.45(3) of the Health Professions Procedural Code of the Nursing Act, 1991, for an order preventing public disclosure and banning publication or broadcasting of the names of the patients, or any information that could disclose the identities of the patients referred to orally or in any documents presented in the Discipline hearing of Sandra Goy.
The Panel considered the submissions of the Parties and has decided that there be an order preventing public disclosure and banning publication or broadcasting of the names of the patients, or any information that could disclose the identities of the patients referred to orally or in any documents presented in the Discipline hearing of Sandra Goy.
The Allegations
The allegations against Sandra Goy (the “Member”) as stated in the Notice of Hearing dated March 18, 2021 are as follows:
IT IS ALLEGED THAT:
- 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 Nurse at Columbia Forest Long Term Care Centre in Guelph, Ontario (the Facility”), 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 August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient A], including but not limited to:
i. you told [Patient A], “if you don’t sit down, I will tie you to the chair”, or words to that effect; and/or
ii. you referred to [Patient A] as “Drooly”, or words to that effect;
(b) on or about August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient B], including but not limited to:
i. you referred to [Patient B] as a “dictator”, or words to that effect;
ii. you referred to [Patient B] using words to the effect of “I’m the boss, not him, he needs to know he’s on my schedule, I’m not on his”;
iii. you referred to [Patient B] using words to the effect of “if you put a gun in his hand he will look like Fidel Castro”; and/or
iv. you referred to [Patient B] using words to the effect of “what does the dictator want now”;
(c) on or about August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient C], including but not limited to you made comments to the effect of “you have to wonder what these people do and why they end up like this”;
(d) on or about August 26, 2016, you made inappropriate and/or unprofessional comments about patients, including but not limited to:
i. you referred to a patient as “Jiminy Cricket”, or words to that effect;
ii. you referred to a patient using words to the effect of “Let’s go Jiminy!”
iii. you referred to a patient as a caterpillar from the film “Alice in Wonderland”;
(e) on or about September 8, 2016 you provided inadequate care to [Patient D], including but not limited to:
i. you failed to appropriately respond to [Patient D’s] attempt to exit the Facility;
ii. you inappropriately restrained [Patient D’s] movement; and/or
iii. you used unnecessary force in response to [Patient D’s] behaviour; and/or
(f) on or about August 26, 2016, you made inappropriate and/or unprofessional comments about your colleague, [the Colleague], including but not limited to referring to her as “Jabba the Hutt”, or words to that effect.
- 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 Nurse at the Facility, you abused a client verbally, physically, and/or emotionally in that:
(a) on or about August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient A], including but not limited to:
i. you told [Patient A], “if you don’t sit down, I will tie you to the chair”, or used words to that effect; and/or
ii. you referred to [Patient A] as “Drooly”, or words to that effect;
(b) on or about August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient B], including but not limited to:
i. you referred to [Patient B] as a “dictator”, or words to that effect;
ii. you referred to [Patient B] using words to the effect of “I’m the boss, not him, he needs to know he’s on my schedule, I’m not on his”;
iii. you referred to [Patient B] using words to the effect of “if you put a gun in his hand he will look like Fidel Castro”; and/or
iv. you referred to [Patient B] using words to the effect of “what does the dictator want now”;
(c) on or about August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient C], including but not limited to you made comments to the effect of “you have to wonder what these people do and why they end up like this”;
(d) on or about August 26, 2016, you made inappropriate and/or unprofessional comments about patients, including but not limited to:
i. you referred to a patient as “Jiminy Cricket”, or words to that effect;
ii. you referred to a patient using words to the effect of “Let’s go Jiminy!”
iii. you referred to a patient as a caterpillar from the film “Alice in Wonderland”;
(e) on or about September 8, 2016:
i. you inappropriately restrained [Patient D’s] movement; and/or
ii. you used unnecessary force in response to [Patient D’s] behaviour.
- 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 August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient A], including but not limited to:
i. you told [Patient A], “if you don’t sit down, I will tie you to the chair”, or used words to that effect; and/or
ii. you referred to [Patient A] as “Drooly”, or words to that effect;
(b) on or about August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient B], including but not limited to:
i. you referred to [Patient B] as a “dictator”, or words to that effect;
ii. you referred to [Patient B] using words to the effect of “I’m the boss, not him, he needs to know he’s on my schedule, I’m not on his”;
iii. you referred to [Patient B] using words to the effect of “if you put a gun in his hand he will look like Fidel Castro”; and/or
iv. you referred to [Patient B] using words to the effect of “what does the dictator want now”;
(c) on or about August 26, 2016, you made inappropriate and/or unprofessional comments directed at [Patient C], including but not limited to you made comments to the effect of “you have to wonder what these people do and why they end up like this”;
(d) on or about August 26, 2016, you made inappropriate and/or unprofessional comments about patients, including but not limited to:
i. you referred to a patient as “Jiminy Cricket”, or words to that effect;
ii. you referred to a patient using words to the effect of “Let’s go Jiminy!”
iii. you referred to a patient as a caterpillar from the film “Alice in Wonderland”;
(e) on or about September 8, 2016 you provided inadequate care to [Patient D], including but not limited to:
i. you failed to appropriately respond to [Patient D’s] attempt to exit the Facility;
ii. you inappropriately restrained [Patient D’s] movement; and/or
iii. you used unnecessary force in response to [Patient D’s] behaviour; and/or
(f) on or about August 26, 2016, you made inappropriate and/or unprofessional comments about your colleague, [the Colleague], including but not limited to referring to her as “Jabba the Hutt”, or words to that effect.
Member’s Plea
The Member admitted the allegations set out in paragraphs 1(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), (iii), (f), 2(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), 3(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), (iii) and (f) 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 as amended reads, unedited, as follows:
THE MEMBER
Sandra Goy (the “Member”) obtained a diploma in nursing from Conestoga College in 1988.
The Member registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on January 19, 1989. She resigned her Certificate of Registration on February 27, 2018. She is not currently entitled to practice nursing.
The Member was employed as a casual RN at Columbia Forest Long Term Care Centre (the “Facility”) in Waterloo, Ontario from August 22, 2016 to September 15, 2016.
The Facility terminated the Member’s employment on September 15, 2016, after concerns arose about her conduct and patient care, including in relation to the incidents giving rise to these allegations of professional misconduct.
THE FACILITY
The Facility is a 156-bed long-term care facility.
When new staff are onboarded, the Facility arranges for the employee to complete three orientation shifts, as well as a 12-hour shift alongside a colleague, to review additional protocols for vulnerable elderly residents.
The Member completed 16 hours of training on August 22 and 23, 2016, which covered the Facility’s “Resident Bill of Rights” document, abuse policy, general resident assistance procedures (e.g., feeding, hygiene, therapeutic needs, the Gentle Persuasive Approach) and general information about the Facility. The Member also completed the Facility’s required abuse intervention quiz as a condition of hire, for which the Facility issued the Member a certificate of completion dated August 22, 2016.
On August 22, 2016, the Member signed an acknowledgment that she had read, understood and had the opportunity to ask questions about the Facility’s mission, values, pledge and code of conduct. In signing these forms, the Member affirmed that she agreed to abide by the Facility’s “Enhancing Lives” handbook.
INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT
The Member Made Inappropriate and/or Unprofessional Comments toward Patients and [the Colleague] on August 26, 2016
[Patient A]
[Patient A] was an 80-year-old male with Parkinson’s disease and dementia who had suffered a stroke. He was also at a heightened risk of falls. [Patient A] used his walker to stand up and maintain balance.
On August 26, 2016, the Member saw [Patient A] stand up with his walker, and directed words to the effect of “if you don’t sit down, I will tie you to the chair” to him. She also called [Patient A] “Drooly”.
The Member’s nurse preceptor during this orientation shift, [ ], RN, (“Preceptor”) told the Member that her comment was threatening and intimidating and asked her to stop.
[Patient B]
[Patient B] was an 80-year-old male with assorted health complications. [Patient B] was known to be vocal when he required medications.
On August 26, 2016, [Patient B] was yelling for his medications. In response, the Member stood by the medication cart, with her arms crossed, staring at [Patient B] as he called for his medications.
The Preceptor asked the Member why she was not assisting [Patient B], to which the Member replied with words to the effect of “I’m the boss, not him. He needs to know that he is on my schedule, I’m not on his.”
When [Patient B] subsequently called out for his medications again, the Member responded, within earshot of [Patient B], with words to the effect of “what does the dictator want now?”. She also called him a “dictator” and remarked, “If you put a gun in his hand, he will look like Fidel Castro” or words to that effect.
[Patient C]
[Patient C] was a 52-year-old female. [Patient C] was admitted to the Facility with chronic obstructive pulmonary disease, gastro-oesophageal reflux disease and a seizure disorder. She communicated using an assistive device but was unable to speak for the majority of the time. [Patient C] was cognitively aware. As a result of her deteriorative conditions and difficulty swallowing, [Patient C’s] medications and nutritional needs were administered through a feeding tube.
On August 26, 2016, the Member and the Preceptor were administering [Patient C’s] medications through her feeding tube.
As they were administering the medications, the Member made remarks to the effect of “You have to wonder what these people do and why they end up like this”, referring to [Patient C], while standing in front of [Patient C].
Upon hearing the Member’s comment, [Patient C] became tearful.
Concerned by the comment said in front of [Patient C], the Preceptor took the Member outside the patient’s room and said, “You can’t talk like that in front of residents” and explained that the Member’s likely hurt [Patient C’s] feelings. The Member responded with words to the effect of “oh well”.
The Member walked away and did not apologize to [Patient C].
Unidentified Patient(s)
On August 26, 2016, the Member referred to an unidentified patient as “Jiminy Cricket” in the presence of her Preceptor and said, “Let’s go Jiminy!” or words to that effect.
The Member referred to an unidentified patient as the caterpillar from Lewis Carroll’s novel, and the film adaptations of Alice in Wonderland.
[The Colleague]
- On August 26, 2016, the Member remarked to the Preceptor that [the Colleague] was like “Jabba the Hutt”, the Star Wars character, because she “keeps stuffing her mouth with food”.
The Member Provided Inadequate Care to [Patient D] on September 8, 2016
[Patient D] was a 94-year-old female with memory issues who used a walker to navigate.
On or about 0700-1900 hours on September 8, 2016, [Patient D] attempted to leave the Facility through the front doors, which were closed and locked. As the doors were locked, there was no immediate risk to [Patient D’s] safety.
In response to [Patient D’s] attempts to leave the Facility, the Member approached [Patient D] and positioned herself between [Patient D] and the security-locked doors. The Member held onto [Patient D’s] walker, immobilizing her in place.
In response to the Member’s actions, [Patient D] became agitated and started banging her walker on the floor.
The Member continued to forcefully hold onto [Patient D’s] walker.
[ ], RPN, asked the Member to let go of [Patient D’s] walker and step back in order to deescalate the patient’s increasing agitation.
The Member continued to grip [Patient D’s] walker. The Member did not utilize the Gentle Persuasive Approach protocol she had recently been taught during her orientation.
[The RPN] asked the Member to release [Patient D’s] walker several times thereafter because [Patient D] became more agitated by the Member continuing to hold onto the walker. In response to [the RPN’s] suggestion to step away from [Patient D], the Member glared at her in a manner suggestive of, “who are you to tell me what to do?”
The Member eventually stepped away from [Patient D], at which point [Patient D] calmed down and allowed [the RPN] to redirect her to her room.
CNO STANDARDS OF PRACTICE
- CNO publishes nursing standards to set out the expectations for the practice of nursing. CNO’s published standards inform nurses of their accountabilities and apply to all nurses regardless of their role, job description or area of practice.
Professional Standards
CNO’s Professional Standards states that each nurse is accountable to the public and responsible for ensuring that her or his practice and conduct meet legislative requirements and the standards of the profession. A nurse demonstrates this expectation by providing, facilitating, advocating and promoting the best possible care for patients.
Nurses are held accountable to providing patients with competent and compassionate care. Ensuring that patient safety and well-being are never compromised is a touchstone of a nurse’s obligations toward her or his patients. Whether through accurate and timely medication administration, or empathetic and respectful nurse-patient interactions, nurses have a duty to comport themselves with the highest degree of professionalism in all circumstances.
The Professional Standards also requires nurses to maintain collaborative relationships with colleagues. Nurses are expected to model professional values, beliefs and attributes, especially in the presence of patients, families and members of the public. This assists with cultivating partnerships with patients and their families, which further reassures all involved that patients’ needs are being met with responsive and compassionate care.
Therapeutic Nurse-Client Relationship Standard
The Therapeutic Nurse-Client Relationship Standard (the “TNCR Standard”) places the responsibility on nurses to establish and maintain respectful, empathetic and appropriate professional relationships with patients.
At the core of the TNCR Standard is the expectation that nurses will place patient safety, care and well-being at the centre of their practice. There is no place for patient abuse in any practice setting, under any circumstance. In no uncertain terms, the TNCR Standard reinforces the importance of protecting patients from all forms of abuse, including physical, emotional and verbal abuse.
The TNCR Standard defines abuse as follows:
Abuse means the misuse of the power imbalance intrinsic in the nurse-[patient] relationship. It can also mean the nurse betraying the [patient’s] trust, or violating the respect or professional intimacy inherent in the relationship, when the nurse knew, or ought to have known, the action could cause, or could be reasonably expected to cause, physical, emotional or spiritual harm to the [patient]. Abuse may be verbal, emotional, physical, sexual, financial or take the form of neglect. The intent of the nurse does not justify a misuse of power within the nurse-[patient] relationship.
- Nurses are expected to uphold the TNCR Standard by understanding that emotional and verbal abuse can take many forms, including sarcasm, name-calling, and inappropriate jokes. The emphasis is on the impact to the patient’s wellbeing, not on the intention of the nurse.
ADMISSIONS OF PROFESSIONAL MISCONDUCT
The Member acknowledges that she failed to meet both the Professional Standard and the TNCR Standard by making several inappropriate, hurtful, dismissive and unprofessional comments directed at or within earshot of multiple vulnerable patients on August 26, 2016 and September 8, 2016. The Member also acknowledges that she failed to meet the Professional Standards in making inappropriate and unprofessional comments about her colleague, [the Colleague], on August 26, 2016.
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1-2 of the Notice of Hearing, and in particular, that she failed to meet the standards of practice of the profession and physically, emotionally and verbally abused several vulnerable patients, as described in paragraphs 9-33 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3 of the Notice of Hearing and that, in particular, her conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 9-33 above.
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 and 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), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), (iii), (f), 2(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), 3(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), (iii) and (f) of the Notice of Hearing. With respect to allegations #2(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i) and (ii), the Panel finds that the Member verbally, physically and emotionally abused a patient. As to allegations #3(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), (iii) and (f), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession 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.
Allegations #1(a)(i) and (ii) in the Notice of Hearing are supported by paragraphs 9 through 11 and 34 through 43 in the Agreed Statement of Facts. The Member admitted and the Panel finds that she failed to meet the standards of practice when the Member made inappropriate and/or unprofessional comments to [Patient A] such as “if you don’t sit down, I will tie you to the chair.”
Allegations #1(b)(i), (ii), (iii) and (iv) in the Notice of Hearing are supported by paragraphs 12 through 15 and 34 through 43 in the Agreed Statement of Facts. The Member admitted and the Panel finds that she failed to meet the standards of practice when in response to [Patient B] calling for his medications, the Member stood by the medication cart, with her arms crossed, staring at [Patient B] as he called for his medications. When the Member was asked why she was not assisting [Patient B] the Member replied with the words to the effect of “I’m the boss, not him. He needs to know that he is on my schedule, I’m not on his.”
Allegation #1(c) in the Notice of Hearing is supported by paragraphs 16 through 21 and 34 through 43 in the Agreed Statement of Facts. The Member admitted and the Panel finds that she failed to meet the standards of practice when as she was administering medications to [Patient C] via her feeding tube, the Member made remarks to the effect of “You have to wonder what these people do and why they end up like this”.
Allegations #1(d)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 22, 23 and 34 through 43 in the Agreed Statement of Facts. The Member admitted and the Panel finds that she failed to meet the standards of practice when she referred to an unidentified patient as “Jiminy Cricket”, used words to the effect “Let’s go Jiminy” and referred to another unidentified patient as a caterpillar from Alice in Wonderland.
Allegations #1(e)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 25 through 43 in the Agreed Statement of Facts. The Member admitted and the Panel finds that she failed to meet the standards of practice when she held on to [Patient D’s] walker immobilizing her.
Allegation #1(f) in the Notice of Hearing is supported by paragraphs 24 and 34 through 37 in the Agreed Statement of Facts. The Member admitted and the Panel finds that she failed to meet the standards of practice when the Member remarked to the Preceptor that [the Colleague] was like “Jabba the Hutt.”
In all of the above allegations the Member admitted and the Panel finds that she failed to meet the Professional Standards and the TNCR Standard by making several inappropriate, hurtful, dismissive, and unprofessional comments directed at several vulnerable patients. The Member also admitted and the Panel also finds that she failed to meet the Professional Standards by making inappropriate and unprofessional comments about her colleague.
With respect to the allegations in paragraph 2 in the Notice of Hearing, the Member admitted that she physically, emotionally, and verbally abused several vulnerable patients.
Allegations #2(a)(i) and (ii) in the Notice of Hearing are supported by paragraphs 9 through 11 and 34 through 43 in the Agreed Statement of Facts. The Member admitted that she directed words toward [Patient A] to the effect of “if you don’t sit down, I will tie you to the chair” which the Panel considered was verbal and emotional abuse
Allegations #2(b)(i), (ii), (iii) and (iv) in the Notice of Hearing are supported by paragraphs 12 through 15 and 34 through 43 in the Agreed Statement of Facts. The Member admitted that when [Patient B] again requested medications the Member within earshot of [Patient B] called [Patient B] a “dictator.” The Panel considered this to be verbal and emotional abuse.
Allegation #2(c) in the Notice of Hearing is supported by paragraphs 16 through 21 and 34 through 43 in the Agreed Statement of Facts. The Member made inappropriate comments towards [Patient C] while standing in front of the patient which the Panel considered was emotional and verbal abuse
Allegations #2(d)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 22, 23 and 34 through 43 in the Agreed Statement of Facts. The Member admitted that she used words to the effect of “Let’s go Jiminy”, towards an unidentified patient which the Panel considered was emotional and verbal abuse
Allegations #2(e)(i) and (ii) in the Notice of Hearing are supported by paragraphs 25 through 43 in the Agreed Statement of Facts. The Member continued to grip [Patient D’s] walker which the Panel considered was physical abuse.
The TNCR Standard reinforces the importance of protecting patients from all forms of abuse, including physical, emotional and verbal abuse.
Allegations #3(a)(i), (ii), (b)(i), (ii), (iii) and (iv) in the Notice of Hearing are supported by paragraphs 9 through 11, 34 through 42 and 44 in the Agreed Statement of Facts.
Allegation #3(c) in the Notice of Hearing is supported by paragraphs 16 through 21, 34 through 42 and 44 in the Agreed Statement of Facts.
Allegations #3(d)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 22, 23, 34 through 42 and 44 in the Agreed Statement of Facts.
Allegations #3(e)(i), (ii) and (iii) in the Notice of Hearing are supported by paragraphs 25 through 42 and 44 in the Agreed Statement of Facts.
Allegation #3(f) in the Notice of Hearing is supported by paragraphs 24 and 34 through 37 in the Agreed Statement of Facts.
With respect to Allegations #3(a)(i), (ii), (b)(i), (ii), (iii), (iv), (c), (d)(i), (ii), (iii), (e)(i), (ii), (iii) and (f), the Panel finds that the Member’s conduct in making inappropriate, hurtful, dismissive and unprofessional comments towards several patients, and also making inappropriate and unprofessional comments towards a member of the health care team was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations.
The Panel finds that the Member’s conduct was also dishonourable and disgraceful as it shames the Member and by extension the profession. The Member’s conduct of physically, emotionally and verbally abusing four patients over a short period of time casts serious doubt on the Member’s moral fitness and inherent ability to discharge the higher obligations the public expects professionals to meet. The Member knew or ought to have known that her conduct was unacceptable and fell below the standards of a professional.
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:
Requiring the Member to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for 5 months. This suspension shall take effect from the date the Member obtains an active certificate of registration in a practicing class and shall continue to run without interruption as long as the Member remains in a practicing class.
Directing the Executive Director to impose the following terms, conditions and limitations on the Member’s certificate of registration:
a) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) at her own expense and within 6 months from the date the Member obtains an active certificate of registration in a practicing class. If the Expert determines that a greater number of sessions are required, the Expert will advise the Director of Professional Conduct (the “Director”) regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 months from the date the Member obtains an active certificate of registration in a practicing class. 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 7 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 CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms:
Code of Conduct,
Professional Standards, and
Therapeutic Nurse-Client Relationship;
iv. Before the first meeting, the Member reviews and completes the CNO’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;
v. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses’ Workbook;
vi. 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 patients, 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;
vii. 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;
viii. If the Member does not comply with any one or more 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 12 months from the date the Member returns to the practice of nursing, 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. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:
that they received a copy of the required documents, and
that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession;
c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.
- All documents delivered by the Member to the CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.
Penalty Submissions
Submissions were made by College Counsel.
The aggravating factors in this case were:
The Member worked in a Long Term Care setting with vulnerable patients who have multiple complex needs and are highly dependent on staff;
The Member’s comments towards these vulnerable patients were cruel and were over a short period of time;
The Member’s conduct showed a lack of empathy and respect for patients;
The Member’s comments had an effect on a patient causing the patient to have tears in her eyes;
The Member’s conduct towards [Patient D] when she confronted the patient attempting to leave, was inappropriate as she responded by forcefully holding onto the patient’s walker which caused the patient to become agitated and to bang her walker on the floor;
The Member’s conduct created a risk of harm to both the physical and emotional wellbeing of the patients;
The Member’s conduct raises questions about her ability to work collaboratively with the team, as is demonstrated by her inappropriate comments towards [the Colleague];
The Member failed to listen to her Preceptor’s concerns when she told her to stop and instead persisted in her conduct;
The Member’s conduct undermines the public’s confidence in the nursing profession.
The mitigating factors in this case were:
The Member, by agreeing to the Agreed Statement of Facts and the Joint Submission on Order, has accepted accountability and responsibility for her conduct;
The Member has no prior discipline history with the College.
The proposed penalty provides for general and specific deterrence through:
The oral reprimand;
The 5-month suspension;
The proposed penalty provides for remediation and rehabilitation through:
- Two meetings with a Regulatory Expert which allows the Member to reflect on professional standards and other requirements.
Overall, the public is protected because of the:
Requirement of 12-month employer notification;
Restrictions on the Member’s independent practice.
College Counsel submitted cases to the Panel to demonstrate that the proposed penalty fell within the range of similar cases from this Discipline Committee.
CNO v. Fu (Discipline Committee, 2020). The member failed to meet the standards of practice by yelling at the patient, disregarding the care plan and making comments towards the patient. The member was given a penalty which included an oral reprimand, a 2-month suspension, 2 meetings with a Regulatory Expert and 9 months of employer notification.
CNO v. Klein (Discipline Committee, 2019). The member worked on a mental health inpatient unit where he failed to meet the standards of practice, specifically the TNCR Standard, when the member made inappropriate and abusive comments towards a vulnerable patient. The member was given a penalty which included an oral reprimand, a 5-month suspension, 2 meetings with a Regulatory Expert and 18 months of employer notification.
CNO v. Lento (Discipline Committee, 2017). The member admitted to a pattern of abusive behaviour towards 4 patients. The member failed to meet the standards of practice, specifically the TNCR Standard, when the member made fun of a patient’s eye injury and made inappropriate comments towards a patient after an episode of bed wetting. The member was given a penalty which included an oral reprimand, a 5-month suspension, 2 meetings with a Nursing Expert and 24 months of employer notification.
The Member was provided with the opportunity to make submissions as to penalty and made no substantive submissions to the Panel.
Penalty Decision
The Panel accepts the Joint Submission on Order and accordingly orders:
The Member is required to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
The Executive Director is directed to suspend the Member’s certificate of registration for 5 months. This suspension shall take effect from the date the Member obtains an active certificate of registration in a practicing class and shall continue to run without interruption as long as the Member remains in a practicing class.
The Executive Director is directed to impose the following terms, conditions and limitations on the Member’s certificate of registration:
a) The Member will attend a minimum of 2 meetings with a Regulatory Expert (the “Expert”) at her own expense and within 6 months from the date the Member obtains an active certificate of registration in a practicing class. If the Expert determines that a greater number of sessions are required, the Expert will advise the Director of Professional Conduct (the “Director”) regarding the total number of sessions that are required and the length of time required to complete the additional sessions, but in any event, all sessions shall be completed within 12 months from the date the Member obtains an active certificate of registration in a practicing class. 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 7 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 CNO publications and completes the associated Reflective Questionnaires, online learning modules, decision tools and online participation forms:
Code of Conduct,
Professional Standards, and
Therapeutic Nurse-Client Relationship;
iv. Before the first meeting, the Member reviews and completes the CNO’s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses’ Workbook;
v. At least 7 days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses’ Workbook;
vi. 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 patients, 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;
vii. 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;
viii. If the Member does not comply with any one or more 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 12 months from the date the Member returns to the practice of nursing, 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. Ensure that within 14 days of the commencement or resumption of the Member’s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm:
that they received a copy of the required documents, and
that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession;
c) The Member shall not practice independently in the community for a period of 12 months from the date the Member returns to the practice of nursing.
- All documents delivered by the Member to the CNO, the Expert or the employer(s) will be delivered by verifiable method, the proof of which the Member will retain.
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 a 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 Joint Submission on Order meets the goals of penalty, including the overarching goal of protection of the public. The 5-month suspension is appropriate due to the multiple inappropriate comments made by the Member to multiple patients.
General deterrence of 5 months suspension followed by 12 months employer notification and no independent practice sends a signal to the membership to refrain from committing this or similar conduct. Specific deterrence of oral reprimand and 2 meetings with a Nursing Expert sends a signal to the Member. The five months suspension of the Member’s certificate of registration, followed by a 12-month employer notification and no independent practice for 12 months addresses the principle of public protection and ensures that the Member will not repeat this conduct.
The penalty is in line with what has been ordered in previous cases.
I, Dawn Cutler, 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.