DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO
PANEL: David Edwards, RPN Chairperson Natalie Montgomery Public Member Lalitha Poonasamy Public Member Michael Schroder, NP Member Patricia Sullivan, RN Member
BETWEEN:
COLLEGE OF NURSES OF ONTARIO ) ALYSHA SHORE for ) College of Nurses of Ontario -and- ) KAREN ELIZABETH BROSSO ) VANESSA YANAGAWA for Registration No.: 9329392 ) Karen Elizabeth Brosso ) PATRICIA HARPER ) Independent Legal Counsel ) Heard: January 29, 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 January 29, 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 Karen Elizabeth Brosso.
The Panel considered the submissions of the Parties and 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 Karen Elizabeth Brosso.
The Allegations
The allegations against Karen Elizabeth Brosso (the “Member”) as stated in the Notice of Hearing dated October 14, 2020 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 you were employed as a Registered Nurse at Perth Community Care Centre in Perth, Ontario (the “Facility”), you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession when you behaved unprofessionally towards patients with respect to the following incidents in, on or between 2017 to 2019:
a. you were involved in photographing and/or videotaping [Patient A] including lying on [Patient A]’s bed joking about “who was boss” and/or laughing as [Patient A] talked about bowel movements;
b. you stated something to the effect of “I wish she’d fucking die already” regarding [Patient B];
c. you stated something to the effect of “here comes klepto” and/or “well klepto what did you steal this time” regarding [Patient C];
d. you stated something to the effect of “I doubt it, you’re fat enough already” to [Patient D] after he requested more dinner;
e. you stated something to the effect of “I’ve had enough of you already and I’m sick of listening so be quiet, I don’t want to hear another word from you” to [Patient E] after she asked for assistance going to bed; and/or
f. you stated something to the effect of “come on, it’s time to get that fat ass of yours out of bed” to [Patient F] when she did not want to get out of bed for dinner; and/or
- 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 you were employed as a Registered Nurse at the Facility, you verbally, physically, and/or emotionally abused patients with respect to the following incidents:
a. you were involved in photographing and/or videotaping [Patient A] including lying on [Patient A]’s bed joking about “who was boss” and/or laughing as [Patient A] talked about bowel movements;
b. you stated something to the effect of “I wish she’d fucking die already” regarding [Patient B];
c. you stated something to the effect of “here comes klepto” and/or “well klepto what did you steal this time” regarding [Patient C];
d. you stated something to the effect of “I doubt it, you’re fat enough already” to [Patient D] after he requested more dinner;
e. you stated something to the effect of “I’ve had enough of you already and I’m sick of listening so be quiet, I don’t want to hear another word from you” to [Patient E] after she asked for assistance going to bed; and/or
f. you stated something to the effect of “come on, it’s time to get that fat ass of yours out of bed” to [Patient F] when she did not want to get out of bed for dinner; and/or
- 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, while you were employed as a Registered Nurse at the Facility, 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 with respect to the following incidents:
a. you were involved in photographing and/or videotaping [Patient A] including lying on [Patient A]’s bed joking about “who was boss” and/or laughing as [Patient A] talked about bowel movements;
b. you stated something to the effect of “I wish she’d fucking die already” regarding [Patient B];
c. you stated something to the effect of “here comes klepto” and/or “well klepto what did you steal this time” regarding [Patient C];
d. you stated something to the effect of “I doubt it, you’re fat enough already” to [Patient D] after he requested more dinner;
e. you stated something to the effect of “I’ve had enough of you already and I’m sick of listening so be quiet, I don’t want to hear another word from you” to [Patient E] after she asked for assistance going to bed; and/or
f. you stated something to the effect of “come on, it’s time to get that fat ass of yours out of bed” to [Patient F] when she did not want to get out of bed for dinner.
Member’s Plea
The Member admitted the allegations set out in paragraphs 1(a), (b), (c), (d), (e), (f), 2(a), (b), (c), (d), (e), (f), 3(a), (b), (c), (d), (e), 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’s Counsel advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads, unedited, as follows:
THE MEMBER
Karen Elizabeth Brosso (the “Member”) obtained a diploma in nursing from St. Lawrence College in 1993.
The Member registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) on June 9, 1993.
The Member was employed as an RN at Perth Community Care Centre (the “Facility”) from September 7, 2005 to January 28, 2019. The Member’s employment was terminated following the Facility’s investigation into the incidents described below.
THE FACILITY
- The Facility is a long-term care home and has capacity for 121 patients. There are approximately 60 beds on each floor, with one RN and one Registered Practical Nurse (“RPN”) on duty on each floor.
INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT
[Patient A]
[Patient A] had severe dementia.
During a shift, the Member laid on [Patient A]’s bed and, while trying to encourage [Patient A] to go to the dining room, she joked about “who was boss” and laughed as [Patient A] talked about needing to have a bowel movement.
Other staff, including [Colleague A], RPN, and Personal Support Workers (“PSWs”) were present during the interaction. [Colleague A], using her own phone, took photographs of [Patient A] and videotaped the interaction.
In addition, while in the nursing office, [Colleague A] took photographs of [Patient A] using the app Snap Chat to give the patient dog ears. The Member was present when these photographs were taken. Occasionally, staff would entertain the patients at the Facility in this manner.
On or about January 11, 2019, [Colleague A], showed a newly hired RN, [Colleague B], the two videos and a photograph involving [Patient A]. [Colleague B] reported this to management. The first video showed the Member and [Patient A] lying fully clothed on top of [Patient A]’s bed playing with the Member’s keys, shaking them and making jokes about who was the boss. The second video showed [Patient A] joking and laughing about patients using the word “poop”.
According to a colleague, [Colleague C], PSW, the Member and [Patient A] and [Patient A]’s family were very close.
If the Member were to testify, she would state that any videos or photographs were taken without her knowledge or encouragement.
[Patient B]
[Patient B] has severe dementia.
During a shift, the Member commented to [Colleague D], “I wish she would just fucking die already!” in reference to [Patient B].
[Colleague D] reported that the Member did not like [Patient B], who used the elevator a lot and [Patient B]’s use of the elevator appeared to bother the Member.
[Patient C], [Patient D], [Patient E] and [Patient F]
- During various shifts, [Colleague E], PSW and Behavioural Support of Ontario, observed incidents involving the Member and [Patient C], [Patient D], [Patient E] and [Patient F], as described below.
[Patient C] had hoarding tendencies. [Colleague E] overheard the Member say “here comes klepto” as [Patient C] walked down the hall. When [Patient C] arrived in the front common area, the Member said to [Patient C] “well klepto what did you steal this time?” [Patient C] said, “I have never stolen anything in my life.” In response, the Member stated “Bull, you do it all the time”.
[Colleague E] overheard [Patient D] ask the Member for more food in the dining room. The Member asked him what he said and again [Patient D] repeated his request for more meat. The Member responded, “I highly doubt it as you are already fat enough”.
[Patient E] was sitting in the common area and asked the Member if someone could take her to bed. [Colleague E] witnessed the Member walk over to [Patient E], point her finger at [Patient E] and say “I’ve had enough of you, I am sick of listening to you now be quiet, I don’t want to hear another word from you”.
[Patient F] did not want to get out of bed for dinner. [Colleague E] saw the Member go over to [Patient F]’s room and overheard her say, “it is time to get that fat ass of yours out of bed”.
- If the Member were to testify, she would state that she cared for the patients and most of these comments were taken out of context and/or were not intended to be hurtful.
CNO STANDARDS
CNO’s Professional Standards provides that each nurse is accountable to the public and responsible for ensuring her or his practice and conduct meets legislative requirements and the standards of the profession. A nurse demonstrates this standard by providing, facilitating, advocating and promoting the best possible care for patients.
CNO’s Professional Standards further provides, in relation to the Ethics standard, that ethical nursing includes acting with integrity, honesty and professionalism in all dealings with the patient and other health care team members.
CNO’s Professional Standards also provides, in relation to the Relationships standard, that each nurse establishes and maintains respectful, collaborative, therapeutic and professional relationships and a nurse demonstrates this standard by demonstrating respect and empathy for, and interest in patients.
CNO’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) places the responsibility for establishing and maintaining the therapeutic nurse-patient relationship on the nurse. The TNCR Standard provides that the nurse-patient relationship is built on trust, respect, empathy, professional intimacy and requires the appropriate use of power.
The TNCR Standard further provides that nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish and terminate the nurse-patient relationship. A nurse meets the standard by:
a. being aware of her/his verbal and non-verbal communication style and how [patients] might perceive it;
b. modifying communication style, as necessary, to meet the needs of the [patient];
c. recognizing that all behaviour has meaning and seeking to understand the cause of a [patient’s] unusual comment, attitude or behaviour; and
d. reflecting on interactions with a [patient] and the health care team, and investing time and effort to continually improve communication skills.
- The TNCR Standard also requires nurses to protect the patient from harm by ensuring that abuse is prevented or stopped and reported. With respect to protecting the patient from abuse, a nurse demonstrates having met the standard by:
a. not engaging in behaviours toward a [patient] that may be perceived by the [patient] and/or others to be violent, threatening or intending to inflict physical harm; and
b. not exhibiting physical, verbal and non-verbal behaviours toward a [patient] that demonstrate disrespect for the [patient] and/or are perceived by the [patient] and/or others as abusive.
In addition, the TNCR Standard provides examples of abusive behaviours. Verbal and emotional abuse includes sarcasm, intimidation including threatening gestures/actions, teasing or taunting, insensitivity to the patient’s preferences, swearing and an inappropriate tone of voice, such as one expressing impatience.
The Member admits and acknowledges that her conduct towards [Patient A], [Patient B], [Patient C], [Patient D], [Patient E] and [Patient F], was a breach of CNO’s Professional Standards and TNCR Standard. The Member further admits and acknowledges that her conduct amounted to verbal and emotional abuse.
ADMISSIONS OF PROFESSIONAL MISCONDUCT
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 1 (a), (b), (c), (d), (e) and (f) of the Notice of Hearing in that she contravened a standard of practice of the profession or failed to meet the standards of practice of the profession, as described in paragraphs 5 to 24 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2 (a), (b), (c), (d), (e) and (f) of the Notice of Hearing in that she verbally and emotionally abused patients, as described in paragraphs 5 to and 24 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 3 (a), (b), (c), (d), (e) and (f) of the Notice of Hearing, and in particular her conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 5 to 24 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), (b), (c), (d), (e), (f), 2(a), (b), (c), (d), (e), (f), 3(a), (b), (c), (d), (e) and (f) of the Notice of Hearing. With respect to allegations #2(a), (b), (c), (d), (e) and (f), the Panel finds that the Member verbally and emotionally abused a patient. As to allegations #3(a), (b), (c), (d), (e) 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.
Allegation #1(a) in the Notice of Hearing is supported by paragraphs 6, 7, 8, 9, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Agreed Statement of Facts. During a shift, the Member laid on [Patient A]’s bed and joked about “who was boss” while encouraging the Patient to go to the dining room. The Member laughed as [Patient A] talked about needing to have a bowel movement. The Member was present when an RPN took photographs and videotaped the interaction.
Allegation #1(b) in the Notice of Hearing is supported by paragraphs 13, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Agreed Statement of Facts. During a shift, the Member commented to a BSO Support Lead, “I wish she would just fucking die already!” in reference to[Patient B].
Allegation #1(c) in the Notice of Hearing is supported by paragraphs 15, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Agreed Statement of Facts. A PSW overheard the Member say “here comes klepto” as [Patient C] walked down the hall. When [Patient C] arrived in the front common area, the Member stated to [Patient C], “well klepto what did you steal this time?”. [Patient C] said, “I have never stolen anything in my life.” In response, the Member stated, “Bull, you do it all the time”.
Allegation #1(d) in the Notice of Hearing is supported by paragraphs 15, 17, 18, 19, 20, 21, 22, 23, 24, and 25 in the Agreed Statement of Facts. A PSW overheard [Patient D] ask the Member for more food in the dining room. The Member asked him what he said, and again [Patient D] repeated his request for more meat. The Member responded, “I highly doubt it as you are already fat enough”.
Allegation #1(e) in the Notice of Hearing is supported by paragraphs 15, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Agreed Statement of Facts. [Patient E] was sitting in the common area and asked the Member if someone could take her to bed. A PSW witnessed the Member walk over to [Patient E], point her finger at [Patient E] and say, “I’ve had enough of you, I am sick of listening to you now be quiet, I don’t want to hear another word from you”.
Allegation #1(f) in the Notice of Hearing is supported by paragraphs 15, 17, 18, 19, 20, 21, 22, 23, 24 and 25 in the Agreed Statement of Facts. [Patient F] did not want to get out of bed for dinner. A PSW saw the Member go over to [Patient F]’s room and overheard her say, “it is time to get that fat ass of yours out of bed”.
With respect to allegations 1(a), (b), (c), (d), (e) and (f) in the Notice of Hearing, as admitted by the Member, her conduct was a breach of both the College’s Professional Standards and TNCR Standard.
Allegation #2(a) in the Notice of Hearing is supported by paragraphs 6, 7, 8, 9, 22, 23, 24 and 26 in the Agreed Statement of Facts. During a shift, the Member laid on the [Patient A]’s bed and joked about “who was boss” while encouraging the Patient to go to the dining room. The Member laughed as [Patient A] talked about needing to have a bowel movement. The Member was present when an RPN took photographs and videotaped the interaction.
Allegation #2(b) in the Notice of Hearing is supported by paragraphs 13, 22, 23, 24 and 26 in the Agreed Statement of Facts. During a shift, the Member commented to a BSO Support Lead, “I wish she would just fucking die already!” in reference to [Patient B].
Allegation #2(c) in the Notice of Hearing is supported by paragraphs 15, 22, 23, 24 and 26 in the Agreed Statement of Facts. A PSW overheard the Member say “here comes klepto” as Patient [Patient C] walked down the hall. When Patient [Patient C] arrived in the front common area, the Member said to Patient [Patient C], “well klepto what did you steal this time?”. Patient [Patient C] said, “I have never stolen anything in my life”. In response, the Member stated, “Bull, you do it all the time”.
Allegation #2(d) in the Notice of Hearing is supported by paragraphs 15, 22, 23, 24 and 26 in the Agreed Statement of Facts. A PSW overheard [Patient D] ask the Member for more food in the dining room. The Member asked him what he said, and again [Patient D] repeated his request for more meat. The Member responded, “I highly doubt it as you are already fat enough”.
Allegation #2(e) in the Notice of Hearing is supported by paragraphs 15, 22, 23, 24 and 26 in the Agreed Statement of Facts. [Patient E] was sitting in the common area and asked the Member if someone could take her to bed. A PSW witnessed the Member walk over to [Patient E], point her finger at[Patient E] and say, “I’ve had enough of you, I am sick of listening to you now be quiet, I don’t want to hear another word from you”.
Allegation #2(f) in the Notice of Hearing is supported by paragraphs 15, 22, 23, 24 and 26 in the Agreed Statement of Facts. [Patient F] did not want to get out of bed for dinner. A PSW saw the Member go over to [Patient F]’s room and overheard her say, “it is time to get that fat ass of yours out of bed”.
With respect to allegations 2(a), (b), (c), (d), (e) and (f) in the Notice of Hearing, the Panel was satisfied that the Member’s conduct constituted verbal and emotional abuse of patients.
Allegations #3(a), (b), (c), (d), (e) and (f) in the Notice of Hearing are supported by paragraphs 6, 7, 8, 9, 13, 15, 17, 18, 19, 20, 21, 22, 23, 24 and 27 in the Agreed Statement of Facts. The Member was present during the photography and videography of inappropriate nurse-client interactions. The Member repeatedly made inappropriate comments to both patients and colleagues. The Panel finds that the Member’s conduct was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations. The Member ought to have known that taking photos and/or videos of patients was unacceptable and that her comments made to patients failed to meet the College’s Professional Standards and TNCR Standard.
The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of moral failing as the Member emotionally and verbally abused a number of vulnerable patients through her inappropriate comments. The Member knew or ought to have known that her conduct was unacceptable and fell well below the standards of a professional.
Finally, the Panel finds that the Member’s conduct was disgraceful as it shames the Member and, by extension, the profession. The Member was a charge nurse at a long-term care home and was expected to exemplify herself as a leader amongst her RPN and PSW colleagues. The Member emotionally and verbally abused multiple vulnerable patients with her inappropriate comments. The 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’s Counsel 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 3 months. This 3-month suspension shall take effect from March 1, 2021 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 that this Order becomes final. If the Expert determines that a greater number of session 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 that this Order becomes final. To comply, the Member is required to ensure that:
i. The Expert has expertise in nursing regulation and has been approved by 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 (where applicable):
Professional Standards,
Code of Conduct, 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.
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 that the conduct was serious in that it involved a breach of the standards and abuse of multiple patients on different occasions. There was potential harm to patients that stemmed from the Member’s abusive conduct. This conduct brings discredit to the profession at large and shows a disregard for the Member’s professional obligations.
The mitigating factors in this case were that the Member has cooperated with the College and that by agreeing to the Agreed Statement of Facts and Joint Submission on Order, the Member has accepted responsibility for her conduct. The Member has shown remorse. The Member has been working at another facility without any issue. The Member has no prior discipline history with the College.
The proposed penalty provides for general deterrence through the three-month suspension as it will generally deter the membership from engaging in this type of misconduct.
The proposed penalty provides for specific deterrence through an oral reprimand which will communicate to the Member the disapproval of her misconduct. The suspension will also deter the Member from engaging in misconduct in the future. The employer notification supports specific deterrence as well.
The proposed penalty provides for remediation and rehabilitation through the minimum of two meetings with a Regulatory Expert as it will assist the Member with learning from her mistakes and allow her to reintegrate into nursing.
The proposed penalty provides for public protection through providing the Member a significant penalty which should deter her and the profession at large from engaging in similar misconduct.
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. Proulx (Discipline Committee, 2019). This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. In this case, the member worked as an RPN in a long-term care facility. The member took photos of patients and shared the photos over Snapchat. This case also involved the member falsifying information on a job application. The panel made findings of professional misconduct. The penalty ordered was an oral reprimand, a 5-month suspension, two meetings with a Regulatory Expert and 18-month employer notification. The penalty terms were identical to those before this Panel except that the suspension was 5 months and the employer notification period was 18 months. The nature of the allegations are more serious as the member herself took the photos and disclosed the photos to other colleagues.
CNO v. Klein (Discipline Committee, 2019). This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. This case involved inappropriate comments that were found to be abusive to patients. It involved patients in a mental health unit who were very vulnerable. There were multiple incidents. One incident involved a female patient lying naked on her bed crying and the member telling the patient to get herself dressed. The penalty ordered was an oral reprimand, a 5-month suspension, two meetings with a Regulatory Expert and 18 months of employer notification. The allegations are more serious and all the comments were made directly to the patients.
CNO v. Agustin (Discipline Committee, 2019). This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. This case involved an RPN working in a hospital setting. There were findings of the member making inappropriate and abusive comments in respect of the patient. The member found the patient had soiled himself and spoke to the patient in an angry and raised tone. The Member used the words “Oh there is shit everywhere”. The member was found to have hit the patient with a slipper or shoe and failed to document the incident. The penalty ordered was an oral reprimand, a 4-month suspension, two meetings with a Nursing Expert and 18 months of employer notification. Although this case involved only one patient, the conduct was more serious in that there was physical abuse by the member.
The Member’s Counsel agreed with the submissions of College Counsel and also submitted that the mitigating factors in this case include:
The Member has had a long unblemished nursing career of over 27 years;
This is the first time that the Member has been the subject of a complaint or report;
The Member has not had a prior finding of misconduct with the College;
The Member has undertaken self-reflection;
The Member has reviewed many of the College’s practice documents;
The Member has admitted to her mistakes and has demonstrated accountability.
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 3 months. This 3-month suspension shall take effect from March 1, 2021 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 that this Order becomes final. If the Expert determines that a greater number of session 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 that this Order becomes final. To comply, the Member is required to ensure that:
i. The Expert has expertise in nursing regulation and has been approved by 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 (where applicable):
Professional Standards,
Code of Conduct, 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.
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 and accepts the submission of College Counsel in this regard. Members of the profession will be reminded that unprofessional language directed to clients and verbal and emotional abuse of clients will not be tolerated. 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.