College of Nurses of Ontario v. Susan Clarke, 2023 ONCNO 149353 — College of Nurses of Ontario Discipline Committee | minicounsel

PANEL: Mary MacNeil, RN Chairperson Sandra Larmour Public Member Donna May, RPN Member Michael Schroder, NP Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO Alysha Shore for College of Nurses of Ontario

and -

SUSAN CLARKE Registration No. 0191916 Monica Tessier for Susan Clarke Patricia Harper Independent Legal Counsel

Heard: July 18, 2023

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 July 18, 2023, 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 the publication or broadcasting of the name(s) of the patient(s), or any information that could disclose the identity(ies) of the patient(s), referred to orally or in any documents presented at the Discipline hearing of Susan Clarke.

The Panel considered the submissions of the College Counsel and Member’s Counsel and decided that there be an order preventing public disclosure and banning the publication or broadcasting of the name(s) of the patient(s), or any information that could disclose the identity(ies) of the patient(s), referred to orally or in any documents presented at the Discipline hearing of Susan Clarke.

The Allegations

College Counsel advised the Panel that the College was requesting leave to withdraw the allegations set out in paragraphs #1(f) and #3(b) in the Notice of Hearing dated May 31, 2023. The Panel granted this request. The remaining allegations against Susan Clarke (the “Member”) 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 Chatham-Kent Health Alliance – Public General Hospital Campus in Chatham, Ontario, you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession as follows:

(a) on, at, or between February 15 to April 6, 2021, with respect to Patient [A], after the patient fell, you asked the patient “why the fuck did you let go, now what are you going to do?” or words to that effect;

(b) on, at or between March 1 to March 16, 2021, with respect to Patients [B], [C], [D], and [E], you:

a) failed to do consistent rounding on the patients;

b) failed to attend to the patients with saturated underwear;

c) failed to regularly turn the patients; and/or

d) spoke to the patients in an inappropriate manner;

a) aggressively pulled back the patient’s wheelchair while the patient was in it and asked the patient “How are you going to fucking drive a truck when you can’t fucking walk” or words to that effect; and/or

b) flashed your middle finger in the patient’s direction;

(d) on or about April 15, 2021, with respect to Patient [G], you:

a) failed to physically assist the blind patient in locating the washroom, despite the patient asking for help; and/or

b) yelled instructions to the patient as to which way to walk to the washroom;

(e) on or about April 15, 2021, you told an RPN colleague, under your breath, to “just fucking kill her for me” or words to that effect, referring to Patient [G];

(f) [Withdrawn]; and/or

(g) on or about April 24, 2021, with respect to Patient [K], you failed to consistently attend to, treat, and/or document the patient’s urinary incontinence;

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 Chatham-Kent Health Alliance – Public General Hospital Campus in Chatham, Ontario, you abused patients verbally, physically, and/or emotionally, as follows:

(a) on, at, or between February 15 to April 6, 2021, with respect to Patient [A], after the patient fell, you asked the patient “why the fuck did you let go, now what are you going to do?”;

(b) on, at or between March 1 to March 16, 2021, with respect to Patients [B], [C], [D] and [E], you neglected the patients, including by failing to do consistent rounds, change the patients who were in saturated underwear; and/or regularly turn the patients; and/or

b) flashed your middle finger in the patient’s direction;

(d) on or about April 15, 2021, with respect to Patient [G], you:

a) neglected the blind patient when you failed to physically assist her in locating the washroom, despite the patient asking for help; and

b) yelled instructions to the patient as to which way to walk to the washroom; and/or

(e) on or about April 24, 2021, with respect to Patient [K], you failed to consistently attend to and treat the patient’s urinary incontinence;

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(13) of Ontario Regulation 799/93, in that, while employed as a Registered Nurse at Chatham-Kent Health Alliance – Public General Hospital Campus in Chatham, Ontario, you failed to keep records as required as follows:

(a) on or about April 15, 2021, with respect to Patients [H], [I], and [J], you failed to document assisting these patients with activities of daily living;

(b) [Withdrawn];

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 Chatham-Kent Health Alliance – Public General Hospital Campus in Chatham, Ontario, 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, as follows:

(b) on, at or between March 1 to March 16, 2021, with respect to Patients [B], [C], [D], and [E], you:

a) failed to do consistent rounding on the patients;

b) failed to attend to the patients with saturated underwear;

c) failed to regularly turn the patients; and/or

d) spoke to the patients in an inappropriate manner;

b) flashed your middle finger in the patient’s direction;

(d) on or about April 15, 2021, with respect to Patient [G], you:

a) failed to physically assist the blind patient in locating the washroom, despite the patient asking for help; and/or

b) yelled instructions to the patient as to which way to walk to the washroom;

(e) on or about April 15, 2021, you told an RPN colleague, under your breath, to “just fucking kill her for me” or words to that effect, referring to Patient [G];

(f) on or about April 15, 2021, with respect to Patients [H], [I], and [J], you failed to assist the patients with activities of daily living and/or failed to document same; and/or

(g) on or about April 24, 2021, with respect to Patient [K], you failed to consistently attend to, treat, and/or document the patient’s urinary incontinence.

Member’s Plea

The Member admitted the allegations set out in paragraphs #1(a), (b)a), b), c), d), (c)a), b), (d)a), b), (e), (g), #2(a), (b), (c)a), b), (d)a), b), (e), #3(a), #4(a), (b)a), b), c), d), (c)a), b), (d)a), b), (e), (f) and (g) 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

Susan Clarke (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Nurse (“RN”) in the Temporary Class on July 3, 2001, and in the General Class on July 25, 2001. The Member was suspended for non-payment from March 11, 2010, to October 22, 2010. The Member entered the Non-Practising Class from January 23, 2014, until September 17, 2014, when she returned to the General Class.
CNO’s Inquiries, Complaints and Reports Committee imposed interim terms, conditions and limitations on the Member’s certificate of registration on July 7, 2021, and the Member is currently entitled to practice with restrictions.
The Member was employed as a part-time RN at Chatham-Kent Health Alliance – Public General Hospital Campus in Chatham, Ontario (the “Facility”) from May 4, 2020 to May 4, 2021 when her employment was terminated as a result of the incidents described below.

THE FACILITY

The Member worked on the Complex Continuing Care Unit (the “Unit”).
The Unit provides care to patients who cannot be managed outside of the Facility as they typically require an Alternate Level of Care. The patients are not acutely ill but have chronic conditions that are too complex to be cared for in other settings such as long-term care. The patients include those who have significant wounds and dressing issues, are non-weight bearing, non-verbal as well as those with dementia or cognitive disorders.
There are 31 patients on the Unit. During the day shift, the nurse-patient ratio is 1:5 with 1 RN, 2 Registered Practical Nurses (“RPN”) and 1 Personal Support Worker (“PSW”). During the night shift, the nurse-patient ratio is 1:7 with 2 RPNs and 1 RN float.
The Member worked a mix of day shifts from 0700 to 1900 hours and night shifts from 1900 to 0700 hours. During day shifts, the Member usually had patient assignments. During the night shifts the Member typically served as a float/resource person.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Patient [A]

Patient [A] was 90 years old at the time of the incident and was living with advanced dementia.
On a date between February 15 and April 5, 2021, A.J., RPN, (“Colleague A.J.”) and the Member were assisting Patient [A] with walking to her bedroom door to get into her wheelchair.
The Member and Colleague A.J. each put one of their arms under Patient [A]’s arms for support. As Patient [A] reached the wheelchair, she kicked it from under her. The Member braced herself against the bathroom door handle with one of her arms and let go of the other arm that was supporting Patient [A]. As a result, Patient [A] fell to the ground along with Colleague A.J.
Colleague A.J. reported that the Member then stood over Patient [A] and asked, “why the fuck did you let go, now what are you going to do”, or words to that effect. If the Member were to testify, she would say that she does not recall swearing and she would never have meant to come across as aggressive or demeaning when speaking to Patient [A]. The Member would further testify that she is sincerely apologetic for disrespecting Patient [A].
The Member and Colleague A.J. together got Patient [A] back into the wheelchair.

Patients [B], [C], [D] and [E]

In March 2021, L.G., Clinical Manager, (“Colleague L.G.”) received a number of emails from staff on the Unit expressing concern with the Member’s practice and conduct as detailed below.
Incontinent patients on the Unit are changed several times a day.
On or around March 8, 2021, the Member failed to complete consistent rounding and attend to Patient [C] and Patient [B] who were found with saturated underwear.
A.S., RN, (Colleague A.S.) found Patient [C] and Patient [B], in their chairs in soiled briefs at the start of her shift.
With respect to Patient [C], his brief and hospital pants were soaked.
Regarding Patient [B], when Colleague A.S. went to move Patient [B] back to his bed, his brief and pants were soaked and stool was dried onto his skin.
On a date between March 1 and 16, 2021, the Member spoke to a patient in an inappropriate manner and stated words to the effect of, “you’re not a child, stop acting like a child”.
On a date between March 1 and 16, 2021, the Member failed to do consistent rounding, attend to Patient [D]’s saturated underwear and regularly turn Patient [E].
With respect to Patient [D], C.A., RPN, (“Colleague C.A.”) identified at the start of her shift that Patient [D] was saturated down to the bed.
Patient [E] was a palliative patient and needed to be turned every two hours to ensure he did not develop pressure sores. Colleague C.A. observed that Patient [E] did not appear to be turned during the Member’s shift as he was stiff and in pain when she did her rounds.
If the Member were to testify, she would state that she would never have intentionally left her patients’ needs unattended and the thought of a patient being left in a state of discomfort is highly distressing for the Member. If the Member were to testify, she would state she is deeply and sincerely apologetic for causing Patients [C], [B], [D] and [E] any discomfort.

Patient [F]

Patient [F] was 83 years old at the time of the incident and was living with dementia and acting out behaviours in addition to other comorbidities. Patient [F] could at times be aggressive.
On April 2, 2021, Patient [F] was in a wheelchair pulling himself alongside a railing to move his wheelchair. He began to try and rip the railing out of the wall and made statements about driving a truck or car. If the Member were to testify, she would say that Patient [F] said “I am going to drive my fucking truck out of this fucking place!” or words to that effect. Patient [F] was formerly a truck driver.
The Member aggressively pulled back Patient [F]’s wheelchair to get him to let go of the railing. It was reported that the Member then asked Patient [F] “How are you going to fucking drive a truck when you can’t fucking walk?” or words to that effect. In response, Patient [F] said if the Member would get him to his truck, he would happily be on his way.
If the Member were to testify, the Member would state she does not recall swearing when responding to Patient [F]. The Member would further testify that she is sincerely apologetic for disrespecting Patient [F].
Patient [F] subsequently complained that his hands were hurting from the Member tugging to get him off the railing. If the Member were to testify, she would state that she would never have wanted Patient [F] to be hurt while she was getting him to let go of the railing.
Later that same day, Patient [F] interjected in a conversation amongst staff. It was reported by the Member’s colleagues that the Member flashed her middle finger at Patient [F]. It is not clear whether Patient [F] saw this given the angle of where he was located and the distance from the nursing station. If the Member were to testify, she would say that she does not recall flashing her middle finger at Patient [F]. If the Member were to testify, she would express her remorse for disrespecting Patient [F].

Patient [G]

On April 15, 2021, the Member worked on the Unit from 0700-1900 hours. Patient [G] is blind and often requires assistance with getting to the washroom.
During the shift, the Member failed to physically assist Patient [G] when she needed to go to the washroom.
Rather than physically assisting Patient [G], the Member would yell directions at Patient [G] while sitting at the nursing station.
S.B., RPN, (“Colleague S.B.”) ultimately brought Patient [G] to the washroom.
Later in the same shift, Colleague S.B. was walking down the hallway for her break. As the Member passed by her, she heard the Member say under her breath something to the effect of “just fucking kill her for me” in a quiet and frustrated tone. Colleague S.B. asked who the Member was talking about, and the Member responded “[ ]” referring to Patient [G]. If the Member were to testify, she would say that she does not remember saying this, but recalls that she would sometimes get frustrated with Patient [G]. If the Member were to testify, she would also express deep remorse for having disrespected Patient [G].

Patients [H], [I], and [J]

On April 15, 2021, the Member was assigned to provide care to Patients [H], [I], and [J].
The Member documented voiding for each of these incontinent patients as follows:

Patient [H] voided at 09:15 and 13:12 hours;
Patient [I] voided at 10:16 and 14:07 hours; and
Patient [J] voided at 10:21 and 14:50 hours.

The Member, however, failed to document assisting with activities of daily living, which includes diapering and peri care, for Patients [H], [I], and [J] during this shift.

Patient [K]

Patient [K] was 80 years old at the time of the incident and had various comorbidities such as diabetes, hypertension and skin cancer. Patient [K] did not have cognitive impairment.
On April 23 and 24, 2021, the Member failed to consistently attend to, treat, and/or document Patient [K]’s urinary incontinence.
The Member worked the day shift. K.S.J., RN, (“Colleague K.S.J.”) worked the night shift and took over the Member’s patient assignments. On both nights, when Colleague K.S.J. came on shift, she found Patient [K] saturated in urine including his brief and bedsheets. Patient [K] advised Colleague K.S.J. that he was wet and had not seen a nurse in a while.
On April 23, 2021, the Member documented that Patient [K] was incontinent at 10:28, 13:57 and 18:49 hours. On April 24, 2021, the Member’s last note on Patient [K]’s record was at 11:50 hours, including her documentation regarding incontinence. Her shift ended at 19:00 hours.

CNO STANDARDS

Code of Conduct

CNO’s Code of Conduct is a standard of practice describing the accountabilities all Ontario nurses have to the public. The Code of Conduct consists of six principles including nurses respect the dignity of patients and treat them as individuals, nurses work together to promote patient well-being, nurses maintain patients’ trust by providing safe and competent care, nurses work respectfully with colleagues to best meet patients’ needs, nurses act with integrity to maintain patients’ trust and nurses maintain public confidence in the nursing profession.
With respect to the principle that nurses respect the dignity of patients and treat them as individuals, CNO’s Code of Conduct provides that nurses treat patients with care and compassion.
Regarding the principle that nurses maintain patients’ trust by providing safe and competent care, CNO’s Code of Conduct provides:

Nurses use appropriate knowledge, skill and judgment when assessing the health needs of patients;
Nurses respond and are available to patients when working;
Nurses maintain complete, accurate and timely documentation in their practice; and
Nurses are accountable to, and practice under, relevant laws and CNO’s standards of practice.

Attached as Exhibit “A” is a copy of CNO’s Code of Conduct which was in force at the time of the incidents.

Professional Standards

CNO’s Professional Standards provides an overall framework for the practice of nursing and a link with other standards, guidelines and competencies developed by CNO. It includes seven broad standard statements pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.
CNO’s Professional Standards provides, in relation to the accountability standard, that nurses are accountable to the public and responsible for ensuring their practice and conduct meets the legislative requirements and the standard of the profession. Nurses are responsible for their actions and the consequences of those actions as well as for conducting themselves in ways that promote respect for the profession. Nurses demonstrate this standard by actions such as ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.
CNO’s Professional Standards 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 further provides, in relation to the leadership standard, that nurses demonstrate their leadership by providing, facilitating and promoting the best possible care/service to the public. In addition, a nurse demonstrates the standard by role-modelling professional values, beliefs and attributes and collaborating with patients and the health care team to provide professional practice that respects the rights of patients.
CNO’s Professional Standards also provides, in relation to the relationship standard and the therapeutic nurse-patient relationship, that a nurse demonstrates this standard by demonstrating respect and empathy for, and interest in patients and recognizing the potential for patient abuse.
Attached as Exhibit “B” is a copy of CNO’s Professional Standards which was in force at the time of the incidents and has since been retired.

Therapeutic Nurse-Client Relationship

CNO’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) contains four standard statements which describe nurses’ accountabilities with respect to therapeutic communication, patient-centred care, maintaining boundaries and protecting the patient from abuse. The TNCR Standard provides that the nurse-patient relationship is built on trust, respect, empathy, professional intimacy and requires the appropriate use of power inherent in the care provider’s role.
CNO’s TNCR Standard provides, in relation to therapeutic communication, 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:

Being aware of her/his verbal and non-verbal communication style and how [patients] might perceive it;
Modifying communication style, as necessary, to meet the needs of the [patient];
Recognizing that all behaviour has meaning and seeking to understand the cause of a [patient’s] unusual comment, attitude or behaviour; and
Reflecting on interactions with a [patient] and the health care team, and investing time and effort to continually improve communication skills.

CNO’s TNCR Standard provides, in relation to patient-centred care, that nurses work with the patient to ensure that all professional behaviours and actions meet the therapeutic needs of the patient. A nurse meets the standard by:

Gaining an understanding of the [patient’s] abilities, limitations and needs related to his/her health condition and the [patient’s] needs for nursing care or services; and
Recognizing that the [patient’s] well-being is affected by the nurse’s ability to effectively establish and maintain a therapeutic relationship.

CNO’s TNCR Standard defines abuse as:

[T]he 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.

CNO’s TNCR Standard provides that verbal and emotional abuse includes, but is not limited to, sarcasm, intimidation, threatening gestures/actions, teasing or taunting and an inappropriate tone of voice such as expressing impatience.
CNO’s TNCR Standard also provides that neglect includes, but is not limited to, denying care, ignoring and withholding needed aids or equipment.
CNO’s TNCR Standard requires nurses to protect the patient from harm by ensuring that abuse is prevented or stopped and reported. A nurse meets the standard by:

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;
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; and
Not neglecting a patient by failing to meet or withholding his/her basic assessed needs.

Attached as Exhibit “C” is a copy of CNO’s TNCR Standard which was in force at the time of the incidents.

Documentation

CNO’s Documentation Standard provides that nurses are accountable for ensuring their documentation of patient care is accurate, timely and complete. A nurse meets the standard by:

Ensuring documentation is a complete record of nursing care provided and reflects all aspects of the nursing process, including assessment, planning, intervention (independent and collaborative) and evaluation;
Documenting in a timely manner and completing documentation during, or as soon as possible after, the care or event;
Ensuring that relevant [patient] care information is captured in a permanent record.

Attached as Exhibit “D” is a copy of CNO’s Documentation Standard which was in force at the time of the incidents.
With respect to Patient [A], the Member admits and acknowledges that she breached CNO’s Code of Conduct, Professional Standards and TNCR Standard when after Patient [A] fell, she asked Patient [A], “why the fuck did you let go, now what are you going to do?” or words to that effect.
Regarding Patients [B], [C], [D], and [E], the Member admits and acknowledges that she breached CNO’s Code of Conduct, Professional Standards and TNCR Standard when she failed to do consistent rounding on the patients, failed to attend to the patients with saturated underwear, failed to regularly turn the patients and spoke to the patients in an inappropriate manner.
With respect to Patient [F], the Member admits and acknowledges that she breached CNO’s Code of Conduct, Professional Standards and TNCR Standard when she aggressively pulled back Patient [F]’s wheelchair while Patient [F] was in it and asked Patient [F] “How are you going to fucking drive a truck when you can’t fucking walk” or words to that effect and when the Member flashed her middle finger in Patient [F]’s direction.
Regarding Patient [G], the Member admits and acknowledges that she breached CNO’s Code of Conduct, Professional Standards and TNCR Standard when she failed to physically assist Patient [G] in locating the washroom, despite Patient [G] asking for help, yelled instructions to Patient [G] as to which way to walk to the washroom and told an RPN colleague, under her breath, to “just fucking kill her for me” or words to that effect, referring to Patient [G].
With respect to Patients [H], [I], and [J], the Member admits and acknowledges that she breached CNO’s Documentation Standard when she failed to document assisting these patients with activities of daily living.
Regarding Patient [K] the Member admits and acknowledges that she breached CNO’s Code of Conduct, Professional Standards, and TNCR Standard, when she failed to consistently attend to and treat Patient [K]’s urinary incontinence.

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 (g) in that she failed to consistently attend to and treat Patient [K]’s urinary incontinence 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 8 to 67 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 2(a), (b), (c), (d) and (e) of the Notice of Hearing in that she abused patients verbally and emotionally, as described in paragraphs 8 to 34, 38 to 41 and 55 to 59 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraph 3(a) of the Notice of Hearing in that she failed to keep records as required, as described in paragraphs 35 to 37 and 60 to 61 above.
The Member admits that she committed the acts of professional misconduct as alleged in paragraphs 4(a), (b), (c), (d), (e), (f) of the Notice of Hearing in that she failed to document assisting Patients [H], [I] and [J] with activities of daily living and 4(g) in that she failed to consistently attend to and treat Patient [K]’s urinary incontinence, and in particular her conduct was disgraceful, dishonourable and unprofessional, as described in paragraphs 8 to 67 above.

OTHER

With the leave of the Panel of the Discipline Committee, CNO withdraws the remaining allegations in the Notice of Hearing, which are as follows:

1(f);
3(b).

Submissions on liability were made by College Counsel.

College Counsel asked the Panel to accept the Agreed Statement of Facts, as well as the Member’s admissions to all the allegations, except for those withdrawn, as set out in paragraphs 68-71 of the Agreed Statement of Facts and, on the basis of those facts and admissions, make findings of professional misconduct with respect to the allegations in the Notice of Hearing. College Counsel submitted that the Panel has taken the Member’s plea and conducted a written and verbal plea inquiry, which was voluntary, informed, and made on the advice of experienced Counsel. College Counsel submitted that based on the Agreed Statement of Facts, which specifically describes the facts in relation to the allegations, the Panel has enough evidence to find that the Member committed professional misconduct as set out in all of the allegations in the Notice of Hearing.

With respect to allegations #1(a), (b)a), b), c), d), (c)a), b), (d)a), b), (e) and (g), the Agreed Statement of Facts outlines the relevant parts of the College standards that the Member is alleged to have breached and this evidence allows the Panel to make findings of professional misconduct that the Code of Conduct, the Professional Standards, the Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) and the Documentation Standard were breached. The Member’s conduct of speaking to patients inappropriately, failing to consistently round on patients, failing to turn patients, failing to attend to their saturated briefs and failing to accurately document is a breach of the standards of practice.

With respect to allegations #2(a), (b), (c)a), b), (d)a), b) and (e), College Counsel submitted that the Member’s conduct amounts to both verbal and emotional abuse of the patients. The manner in which the Member spoke to the patients constitutes emotional and verbal abuse. The neglect of the patients by the Member constitutes emotional abuse.

With respect to allegations #4(a), (b)a), b), c), d), (c)a), b), (d)a), b), (e), (f) and (g), College Counsel submitted that the Panel must be satisfied that the Member’s conduct is relevant to the practice of nursing. College Counsel submitted that the Member’s conduct was relevant to the practice of nursing as it relates to direct patient care. The Panel also must be satisfied that members of the profession would find the Member’s conduct to be disgraceful, dishonourable or unprofessional. The Member has admitted that her conduct is disgraceful, dishonourable and unprofessional. College Counsel submitted that the Member’s conduct is unprofessional in that her conduct displayed a serious and persistent disregard for her professional obligations. The Member’s conduct is dishonourable as she knew or ought to have known that her conduct fell below the standards of a professional. The Member’s conduct of inappropriate communication and neglect involves an element of moral failing. The Member’s conduct was also disgraceful in that her abusive conduct brought shame on herself and by extension, the profession.

College Counsel submitted the following cases to establish that the Member’s conduct amounted to disgraceful, dishonourable and unprofessional conduct:

CNO v. Goy (Discipline Committee, 2021): This case proceeded by way of an Agreed Statement of Facts. The allegations relate to inappropriate communications with multiple patients. There were allegations that the member failed to use proper de-escalation techniques. The panel made findings that the member’s conduct breached the Professional Standards and the TNCR Standard. The panel found that the member’s conduct involved verbal, physical and emotional abuse. The panel found the conduct to be disgraceful, dishonourable and unprofessional. The conduct is similar to the case before this Panel.

CNO v. Hope (Discipline Committee, 2021): This case proceeded by way of an Agreed Statement of Facts. This case involved physical harm by the member when she applied a blood pressure cuff tightly. The tight blood pressure cuff resulted in bruising to the patient’s arm. The member dismissed the patient’s complaints. The member was insensitive and intimidating in her communication with the patient. The member also used an inappropriate tone with two other patients. The panel found the member’s conduct breached the Professional Standards and the TNCR Standard. The panel found that the conduct involved verbal, physical and emotional abuse. The panel found the conduct to be disgraceful, dishonourable and unprofessional.

CNO v. Mymryk (Discipline Committee, 2020): This case proceeded by way of an Agreed Statement of Facts. The conduct involved the member using an inappropriate tone and making rude and inappropriate comments to patients. The member forced a patient to eat and threw a glass at a patient. The member refused to change soiled pants of a patient. The panel found that the member had breached the Professional Standards and the TNCR Standard. The panel found that the conduct involved verbal, physical and emotional abuse. The panel found the conduct to be disgraceful, dishonourable and unprofessional.

Submissions on liability were made by the Member’s Counsel.

The Member’s Counsel agreed with College Counsel’s submissions regarding the Agreed Statement of Facts and the applicability of the three cases.

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)a), b), c), d), (c)a), b), (d)a), b), (e), (g), #2(a), (b), (c)a), b), (d)a), b), (e), #3(a), #4(a), (b)a), b), c), d), (c)a), b), (d)a), b), (e), (f) and (g) of the Notice of Hearing. With regard to allegations #2(a), (b), (c)a), b), (d)a), b) and (e), the Panel finds that the Member verbally and emotionally abused the patients. As to allegations #4(a), (b)a), b), c), d), (c)a), b), (d)a), b), (e), (f) and (g), the Panel specifically finds with respect to allegation #4(f) that the Member failed to document assisting Patients [H], [I] and [J] with activities of daily living, and with respect to allegation #4(g) that the Member failed to consistently attend to and treat Patient [K]’s urinary incontinence. 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), (b)a), b), c), d), (c)a), b), (d)a), b), (e) and (g) in the Notice of Hearing are supported by paragraphs 8-68 in the Agreed Statement of Facts. The Member admitted that while employed as a part-time Registered Nurse (“RN”) at Chatham-Kent Health Alliance – Public General Hospital Campus she breached the Code of Conduct, the Professional Standards and the TNCR Standard. The Code of Conduct standard of practice outlines that nurses must respect the dignity of patients by exhibiting care and compassion. The Member showed a lack of care and compassion in her practice by making several disparaging comments to patients and failing to regularly attend to patients’ incontinence needs.

The Professional Standards, in relation to the Ethics standard, outlines that nurses demonstrate professionalism and integrity during their interactions with patients. The Member displayed a lack of integrity and professionalism by repeatedly making abrasive comments directed toward patients and failing to meet the basic care needs of patients such as repositioning, incontinent brief changes and pericare.

The TNCR Standard outlines that nurses must be aware of their communication style and how patients may perceive it. The Member used a communication style toward her patients that was rude, inconsiderate and would reasonably be perceived by patients to be unwelcome and hurtful.

With respect to the Member’s failure to document activities of daily living on Patients [H], [I] and [J], the Documentation Standard outlines that documentation ought to be accurate and complete to form a true depiction of the nursing care provided. The Member’s documentation was incomplete and not accurate on April 15, 2021 as she failed to document brief changes and pericare that she provided to Patients [H], [I] and [J].

Allegations #2(a), (b), (c)a), b), (d)a), b) and (e) in the Notice of Hearing are supported by paragraphs 8-34, 38-41, 55-59 and 69 in the Agreed Statement of Facts. The Member admitted that she verbally and emotionally abused several vulnerable patients. With respect to allegation #2(a), the Member admitted that after Patient [A] fell, she stated “why the fuck did you let go, now what are you going to do?” or words to that effect. The Member used profane language with an elderly and vulnerable patient and also insinuated that Patient [A] was responsible for the fall. The Panel considered this to be verbal and emotional abuse. With respect to allegation #2(b), the Member admitted that she failed to do consistent rounding, failed to attend to saturated incontinent briefs, failed to regularly turn/reposition and spoke to patients in an inappropriate manner. The Panel considered the way the Member neglected obvious patient care needs to be a form of verbal and emotional abuse. With respect to allegations #2(c)a) and b), the Member admitted that she aggressively pulled back Patient [F]'s wheelchair and stated “How are you going to fucking drive a truck when you can’t fucking walk” or words to that effect and later that same day, the Member flashed her middle finger at Patient [F] when Patient [F] interjected in a conversation amongst staff. The Member used profane language and her comments were demeaning and disrespectful towards Patient [F]. The Panel considered this to be verbal and emotional abuse.

Although the Member admitted that her conduct constituted both verbal and emotional abuse, the Panel had concerns that the Member’s conduct may have constituted physical abuse given that Patient [F] experienced hand pain subsequent to the Member aggressively pulling back Patient [F]’s wheelchair to get him to let go of the railing. The Panel provided an opportunity to both parties to make submissions on why the conduct would not be considered physical abuse.

College Counsel acknowledged that the conduct was “on the line” of being physical abuse. However, College Counsel submitted that an expert opinion would be required to ascertain whether this conduct has reached the threshold to be considered physical abuse. College Counsel submitted that Patient [F] did not possess the cognitive capacity required to be interviewed.

The Member’s Counsel submitted that the conduct would not rise to the level of physical abuse in the same way that the conduct amounted to both verbal and emotional abuse. The Member’s Counsel submitted that the Panel should take into account the context, referring to Patient [F]’s attempt to rip the railing off of the wall, as to why the Member aggressively pulled back Patient [F]’s wheelchair to get him to let go of the railing.

Independent Legal Counsel (“ILC”) provided advice to the Panel that the Member, through the Agreed Statement of Facts, has only admitted to verbal and emotional abuse. ILC advised the Panel that Agreed Statement of Facts are carefully negotiated between the parties and may not reflect every fact in the case.

The Panel carefully considered the submissions of both parties and the advice received from ILC and agreed that, taking into account the context of the conduct, there may have been a situation of potential compromised safety for Patient [F] which would have justified the Member having somewhat abruptly removed Patient [F]’s hands from the railing. The Panel also considered the process by which both parties reached an agreement through the Agreed Statement of Facts and in light of the facts within the Agreed Statement of Facts, determined that there was insufficient evidence to make a finding of physical abuse.

With respect to allegations #2(d)a) and b), the Member admitted that she failed to physically assist Patient [G] to the washroom despite Patient [G]’s request for help and that she yelled instructions to Patient [G] as to which way to walk to the washroom. The Panel considered this to be verbal and emotional abuse. With respect to allegation #2(e), the Member admitted that she failed to attend to and treat Patient [K]’s urinary incontinence. The Panel considered this to be emotional abuse in that she grossly neglected Patient [K]’s care needs.

Allegation #3(a) in the Notice of Hearing is supported by paragraphs 35-37, 60-61 and 70 in the Agreed Statement of Facts. The Member was assigned to Patients [H], [I] and [J] on April 15, 2021. Although the Member documented that each patient had two incontinent voids during her shift, the Member failed to document activities of daily living which would have consisted of changing each patient’s brief and the associated pericare. The Member admitted and acknowledged that the lack of documentation with respect to activities of daily living support that the Member failed to keep records as required by the Code.

Allegations #4(a), (b)a), c), c), d), (c)a), b), (d)a), b), (e), (f) and (g) in the Notice of Hearing are supported by paragraphs 8-67 and 71 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct in making abrasive comments to patients, failing to meet the basic care needs of patients and failing to document activities of daily living for 3 patients was clearly relevant to the practice of nursing. It was unprofessional as it demonstrated a serious and persistent disregard for her professional obligations in contravention of the College’s Code of Conduct, the Professional Standards, the TNCR Standard and the Documentation Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of moral failing and a lack of integrity and empathy by using rude and abrasive communication with multiple patients. The Member knew or ought to have known that her conduct was unacceptable and fell 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’s conduct toward multiple patients constituted verbal and emotional abuse. She demeaned patients verbally and through her actions, including by leaving patients for prolonged periods of time in an undignified state of wearing urine statured incontinent briefs. Her 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 6 months. This suspension shall take effect from the date that this Order becomes final 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 the Member’s own expense and within 6 months from the date that this Order becomes final. If the Expert determines that a greater number of sessions are required, the Expert will advise CNO 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 CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, 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 and decision tools (where applicable):

Code of Conduct,
Professional Standards,
Therapeutic Nurse-Client Relationship, and
Documentation.

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

v. At least 5 days before the first meeting, or within another timeframe approved by the Expert, the Member provides the Expert with a copy of the completed Reflective Questionnaires 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 their report to CNO, 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 the Member’s 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 the Member’s 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 the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO 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;

iii. Provide the Member’s 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;

iv. 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 CNO, in which it will confirm:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

c) For a period of 12 months from the date the Member returns to the practice of nursing, the Member must meet with a Registered Nurse who is employed at the same employer as the Member and who is pre-approved by CNO (“Mentor”) to discuss the Member’s efforts to ensure that her patient care is meeting the standards of practice of the profession. The Member must meet with the Mentor at such frequency as determined by the Mentor, but at least monthly. In order for the Mentor to be pre-approved by CNO, the Member must:

i. Provide the proposed mentor 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;

ii. Provide CNO with a copy of the proposed mentor’s résumé and a report confirming the following:

that the proposed mentor has received a copy of the documents identified in 3(c)(i),
their employer is aware of the proposed mentor’s intention to act as a mentor for the Member and has no concerns; and
that the proposed mentor agrees to notify CNO and the Member’s employer immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

d) When the meetings have ended, the Mentor will provide CNO with a report containing the dates the Member attended the meetings with the Mentor and discussed patient care and/or the standards of practice.

e) 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 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’s conduct was serious;
The Member’s conduct occurred with vulnerable patients who were highly dependent on their nurses for their basic needs to be met;
The Member’s conduct occurred on multiple occasions with multiple different patients which is suggestive of a pattern;
The Member failed to complete the most basic of nursing duties;
The Member’s conduct amounted to verbal and emotional abuse of a number of patients;
The Member’s conduct involved a significant number of incidents. The events were not isolated or the result of one bad day at work; and
The Member’s conduct brought discredit and shame on the profession.

The mitigating factors in this case were:

The Member has no prior discipline history with the College;
The Member has been a nurse for a significant number of years;
The Member has taken responsibility and accountability for her conduct by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College; and
The Member has expressed her remorse and regret.

The proposed penalty provides for general deterrence through the 6-month suspension of the Member’s certificate of registration, which will signal to the membership that the College takes abusive conduct seriously and that there are significant consequences for engaging in this type of behaviour.

The proposed penalty provides for specific deterrence through the oral reprimand and the 6-month suspension of the Member’s certificate of registration, which will deter the Member from engaging in similar misconduct in her future practice.

The proposed penalty provides for rehabilitation and remediation through a minimum of 2 meetings with a Regulatory Expert and review of relevant College publications. These activities will help the Member return to the ethical practice expected of nurses.

Overall, the public is protected through the 12 months of employer notification, the 12 months of mentorship and the 12 months of no independent practice in the community.

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

CNO v. Goy (Discipline Committee, 2021): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member made inappropriate comments to and about 4 patients. The member forcefully held down a patient’s walker even after she was told to stop by one of her colleagues. The panel made findings that the member abused the patients verbally, physically and emotionally. The penalty included an oral reprimand, a 5-month suspension of the member’s certificate of registration, a minimum of 2 meetings with a Regulatory Expert, 12 months of employer notification and 12 months of no independent practice in the community.

The case before this Panel includes 12 months of mentorship which College Counsel submitted the College has more recently asked for where there is a pattern of misconduct present.

CNO v. Mymryk (Discipline Committee, 2020): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order. The member yelled at and spoke inappropriately towards patients. The member pushed a wheelchair with excessive force, threw a glass, forced a patient to eat and refused to change a patient’s brief. The allegations related to 4 different patients. The panel made findings that the member abused patients verbally, physically and emotionally. The penalty included an oral reprimand, a seven-month suspension of the member’s certificate of registration, a minimum of two meetings with a Regulatory Expert, 24 months of employer notification and 24 months of no independent practice in the community.

The suspension of the Member’s certificate of registration is one month less in the case before this Panel as there was no physical abuse present.

Submissions were made by the Member’s Counsel.

The Member’s Counsel submitted that the Joint Submission on Order appropriately reflects the goals of penalty.

The 6-month suspension of the Member’s certificate of registration will achieve general deterrence as it will demonstrate a strong message to the membership that this conduct is not acceptable.

Specific deterrence is met by the 6-month suspension of the Member’s certificate of registration and the oral reprimand. The suspension will allow the Member an opportunity to reflect on her actions. The oral reprimand will assist the Member with gaining insight into how her actions are perceived by the public and fellow members of the profession.

The 12 months of employer notification, the 12 months of no independent practice in the community and the 12 months of mentorship will allow the Member to re-enter the nursing profession with greater insight and guidance with respect to her practice accountabilities. Remediation is achieved through the 2 meetings with a Regulatory Expert and the review of the College’s publications.

Public protection is achieved through the 2 meetings with a Regulatory Expert and the 12 months of mentorship which will equip the Member with the knowledge and skills to re-enter ethical nursing practice.

The mitigating factors in this case are:

The Member has been a nurse for over 20 years;
The Member is remorseful and understands where she went wrong; and
The Member has accepted responsibility for her actions through her admissions and by entering into an Agreed Statement of Facts and a Joint Submission on Order with the College thus saving the College time, resources and the need to call witnesses.

The Member’s Counsel agreed with the cases put forward by College Counsel as the cases support the penalty as set out in the Joint Submission on Order.

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 6 months. This suspension shall take effect from the date that this Order becomes final 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:

i. The Expert has expertise in nursing regulation and has been approved by CNO in advance of the meetings;

ii. At least 5 days before the first meeting, or within another timeframe approved by the Expert, 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 and decision tools (where applicable):

Code of Conduct,
Professional Standards,
Therapeutic Nurse-Client Relationship, and
Documentation.

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 their report to CNO, 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 the Member’s behaviour;

b) For a period of 12 months from the date the Member returns to the practice of nursing, the Member will notify the Member’s employers of the decision. To comply, the Member is required to:

i. Inform any employer of the decision prior to commencing or prior to resuming employment in any nursing position;

ii. Ensure that CNO 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;

iii. Provide the Member’s 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;

iv. 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 CNO, in which it will confirm:

that they received a copy of the required documents, and
that they agree to notify CNO immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

i. Provide the proposed mentor 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;

ii. Provide CNO with a copy of the proposed mentor’s résumé and a report confirming the following:

that the proposed mentor has received a copy of the documents identified in 3(c)(i),
their employer is aware of the proposed mentor’s intention to act as a mentor for the Member and has no concerns; and
that the proposed mentor agrees to notify CNO and the Member’s employer immediately upon receipt of any information that the Member has breached the standards of practice of the profession.

e) 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 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. Specific deterrence is achieved through the 6-month suspension of the Member’s certificate of registration as this will deter the Member from engaging in similar misconduct on her return to practice. The oral reprimand also contributes to specific deterrence as the Member will gain insight into how her conduct is perceived by members of the profession and the public. General deterrence is achieved through the 6-month suspension of the Member’s certificate of registration as this will send a message to the membership that there are serious consequences for engaging in similar misconduct. Remediation and rehabilitation are achieved through a minimum of 2 meetings with a Regulatory Expert and review of the College’s publications as this will give the Member a chance solidify her understanding of the misconduct and amend her practice in order to not allow similar misconduct to occur again. The public is protected through the 12 months of employer notification, the 12 months of mentorship and the 12 months of no independent practice in the community, which will provide for a heightened level of employer oversight on the Member’s return to practice.

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

I, Mary MacNeil, 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.