College of Nurses of Ontario v. Hall, 2024 ONCNO 118261 — College of Nurses of Ontario Discipline Committee | minicounsel

PANEL: Michael Hogard, RPN Chairperson Donna May, RPN Member Michael Schroder, NP Member Lalitha Poonasamy Public Member

BETWEEN:

COLLEGE OF NURSES OF ONTARIO ) JOSEPH BERGER for ) College of Nurses of Ontario

and - )

ROLF HALL ) NO REPRESENTATION for Registration No. AG274101 ) Rolf Hall ) KIMBERLEY ISHMAEL ) Independent Legal Counsel ) Heard: April 26, 2024

DECISION AND REASONS

This matter came on for hearing before a panel of the Discipline Committee (the “Panel”) of the College of Nurses of Ontario (the “College”) on April 26, 2024, 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 Rolf Hall.

The Panel considered the submissions of College Counsel and the Member 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 Rolf Hall.

The Allegations

The allegations against Rolf Hall (the “Member”) as stated in the Notice of Hearing dated March 25, 2024 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 Practical Nurse at Santé Manitouwadge Health located in Manitouwadge, Ontario, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession as follows:

a. on or around February 27, 2022, while assisting with care for Patient [A]:

i. you turned the Patient aggressively; and/or

ii. yelled “shut up” to the Patient on one or more occasions; and/or

b. on or around February 27, 2022, you were overhead by your colleague(s) saying “I could fucking kill him” in reference to Patient [B];

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 Practical Nurse at Santé Manitouwadge Health located in Manitouwadge, Ontario, you abused Patient [A] verbally, physically, and/or emotionally on or around February 27, 2022 when you:

a. turned the Patient aggressively; and/or

b. yelled “shut up” to the Patient on one or more occasions; 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 Practical Nurse at Santé Manitouwadge Health located in Manitouwadge, 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:

a. on or around February 27, 2022, while assisting with care for Patient [A]:

i. you turned the Patient aggressively; and/or

ii. yelled “shut up” to the Patient on one or more occasions; and/or

b. on or around February 27, 2022, you were overhead by your colleague(s) saying “I could fucking kill him” in reference to Patient [B].

Member’s Plea

The Member admitted the allegations set out in paragraphs #1(a)(i), (ii), (b), #2(a), (b) and #3(a)(i), (ii) and (b) 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 admissions were voluntary, informed and unequivocal.

Agreed Statement of Facts

College Counsel and the Member advised the Panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts, which reads, unedited, and without the exhibits referenced therein, as follows:

THE MEMBER

Rolf Hall (the “Member”) registered with the College of Nurses of Ontario (“CNO”) as a Registered Practical Nurse on July 31, 2017.
Member was employed by Manitouwadge Health located in Manitouwadge, Ontario (the “Facility”). The Member worked at the Facility as a full-time nurse on the long-term care unit, with occasional shifts on the acute unit. He worked both day and evening shifts.

INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT

Patient A

(“Patient A”) was 91 years old at the time of the incident.
On February 27, 2022, a Registered Nurse (“RN”) was providing care to Patient A. Patient A had been incontinent of stool. The RN asked the Member to help her roll Patient A onto his side so that she could perform a brief change and clean Patient A.
When the Member rolled Patient A over, he did so with such force that Patient A’s legs came out of the bed and Patient A almost fell off the bed. Patient A screamed and became very agitated.
When Patient A screamed, the Member told Patient A loudly to “shut up” multiple times.
The RN reported that she had never seen a nurse be so aggressive with a patient in her 23 years of nursing.

Patient B

On February 26, 2022, another RN was on her way to the nursing station when she overheard the Member swearing and saying “I’m going to fucking kill him.”
Once the Member and the RN were both at the nursing station, the RN saw that the Member was red in the face and very angry. The RN determined that the Member was referring to [ ] (“Patient B”), who was asking to be transferred to the commode, and the Member was frustrated because there were not two people available to assist at that time.
For the rest of the shift, the RN provided care to Patient B as she worried that the Member may have another outburst.
The incident was also witnessed by an individual who was visiting his mother at the Facility. The individual witnessed the Member exit Patient B’s room in an agitated state, yelling and swearing. The individual approached the Member and told him to “take a deep breath.”

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.

CNO’s Code of Conduct provides, in relation to the principle requiring nurses to respect the dignity of patients and treat them as individuals, that nurses treat patients with care and compassion.
CNO’s Code of Conduct further provides, in relation to the principle requiring nurses to maintain patients’ trust by providing safe and competent care, that:

Nurses seek advice and collaborate with the health care team to uphold safe patient care; and

Nurses are accountable to, and practice under relevant laws and CNO’s standards of practice.

In addition, CNO’s Code of Conduct provides, in relation to the principle requiring nurses to maintain public confidence in the nursing profession, that nurses are accountable for their own actions and decisions.
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 and indicators that illustrate how the standard may be demonstrated pertaining to accountability, continuing competence, ethics, knowledge, knowledge application, leadership and relationships.
CNO’s Professional Standards provides, in relation to the accountability standard statement, that nurses are accountable to the public and responsible for ensuring their practice and conduct meets the legislative requirements and the standards 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 ensuring their practice is consistent with CNO’s standards of practice and guidelines as well as legislation.
CNO’s Professional Standards further provides, in relation to the ethics standard statement, 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 leadership standard statement, that nurses demonstrate their leadership by providing, facilitating and promoting the best possible care/service to the public. In addition, nurses demonstrate 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].

Furthermore, CNO’s Professional Standards provides, in relation to the relationship standard statement and the therapeutic nurse-patient relationship, that nurses demonstrate empathy and caring in all relationships with patients, families and significant others and it is the responsibility of the nurse to establish and maintain the therapeutic relationship. Nurses 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, with accompanying indicators, 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 the therapeutic communication standard statement, 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. Nurses meet 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 the patient-centred care standard statement, that nurses work with the patient to ensure that all professional behaviours and actions meet the therapeutic needs of the patient. Nurses meet the standard by:

recognizing that the [patient’s] well-being is affected by the nurse’s ability to effectively establish and maintain a therapeutic relationship; and
reflecting on how stress can affect the nurse-[patient] relationship, and appropriately managing the cause of the stress so the therapeutic relationship isn’t affected.

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. The intent of the nurse does not justify a misuse of power within the nurse-[patient] relationship.

CNO’s TNCR Standard also provides, in relation to the protecting the patient from abuse standard statement, that nurses protect patients from harm by ensuring that abuse is prevented or stopped and reported. Nurses demonstrate having met 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; and
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, CNO’s TNCR Standard provides that physical abuse includes, but is not limited to, pushing, using force and handling a patient in a rough manner. CNO’s TNCR Standard further provides that verbal and emotional abuse includes, but is not limited to, swearing, an inappropriate tone of voice such as expressing impatience, and intimidation including threatening gestures/actions.
Attached as Exhibit “C” is a copy of CNO’s TNCR Standard which was in force at the time of the incidents.

ADMISSIONS OF PROFESSIONAL MISCONDUCT

The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 1(a)(i), 1(a)(ii) and 1(b) of the Notice of Hearing in that he contravened a standard of practice of the profession or failed to meet the standard of practice of the profession, as described in paragraphs 3 to 29 above.
The Member admits and acknowledges that he contravened CNO’s Code of Conduct, Professional Standards and TNCR Standard when he:

turned Patient A aggressively and yelled “shut up” to Patient A on one or more occasions; and
was overheard by his colleague(s) saying “I could fucking kill him” in reference to Patient B.

The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 2(a) and 2(b) of the Notice of Hearing in that he abused Patient A verbally, physically and emotionally, as described in paragraphs 3 to 7 and 26 to 29 above.
The Member admits that he committed the acts of professional misconduct as alleged in paragraphs 3(a)(i), 3(a)(ii) and 3(b) of the Notice of Hearing, and in particular his conduct was dishonourable and unprofessional, as described in paragraphs 3 to 29 above.

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 as set out in paragraphs 30 to 33 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 verbal plea inquiry. The Member’s plea was voluntary and informed.

College Counsel submitted that allegations #1(a)(i), (ii) and (b) are supported by the Agreed Statement of Facts, which contained evidence of the relevant College standards of practice, as well as the Member’s admissions that those standards were contravened.

With regard to allegations #2(a) and (b), College Counsel submitted that the parties agreed that the Member’s conduct toward Patient A constituted physical and verbal abuse.

With regard to allegations #3(a)(i), (ii) and (b), College Counsel submitted that the parties agreed that the Member’s conduct was relevant to the practice of nursing, as it occurred in the workplace with patients, and was dishonourable and unprofessional.

College Counsel submitted that the Member’s conduct was unprofessional as it demonstrated a disregard for his professional obligations. The Member’s conduct was dishonourable as the Member knew or ought to have known that his conduct fell below the standards of a professional and, by yelling at a patient and handling a patient in a rough manner, involved an element of moral failing.

College Counsel submitted that the agreement, to characterize the conduct as dishonourable and unprofessional, was part of a resolution reached between the College and the Member and the Member’s conduct was not an example of the most serious or most egregious conduct for which the description disgraceful is reserved.

The Member was provided an opportunity by the Panel to make submissions on liability but declined to do so.

Decision

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

Having considered the evidence and the onus and standard of proof, the Panel finds that the Member committed acts of professional misconduct as alleged in paragraphs #1(a)(i), (ii), (b), #2(a), (b) and #3(a)(i), (ii) and (b) of the Notice of Hearing. With respect to allegations #2(a) and (b), the Panel finds that the Member verbally, physically and emotionally abused Patient A. As to allegations #3(a)(i), (ii) and (b), the Panel finds that the Member engaged in conduct that would reasonably be regarded by members of the profession to be dishonourable and unprofessional.

Reasons for Decision

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

Allegations #1(a)(i), (ii) and (b) in the Notice of Hearing are supported by paragraphs 3-29 and 30-31 in the Agreed Statement of Facts. The Member, while assisting a Registered Nurse co-worker to provide care to Patient A, turned Patient A aggressively and yelled at Patient A to “shut up”. The Code of Conduct provides that “Nurses treat patients with care and compassion”. Similarly, the College’s Professional Standards provides that “Nurses demonstrate empathy and caring in all relationships with clients”. The College’s Therapeutic Nurse-Client Relationship Standard (“TNCR Standard”) outlines that nurses meet the standard by “not exhibiting physical, verbal and non-verbal behaviours toward a client that demonstrate disrespect for the client”. The Member breached the Code of Conduct, the Professional Standards, and the TNCR Standard by aggressively turning and yelling “shut up” to Patient A while assisting a Registered Nurse co-worker to provide care to Patient A. The Member breached the College’s Code of Conduct, the Professional Standards, and the TNCR Standard by saying “I’m going to fucking kill him” in relation to Patient B, when he asked to be transferred to the commode which was overheard by another Registered Nurse.

Allegations #2(a) and (b) in the Notice of Hearing are supported by paragraphs 3-7, 26-29 and 32 in the Agreed Statement of Facts. While assisting a Registered Nurse co-worker to perform care on Patient A, a 91 year old male who was incontinent of stool, the Member physically and emotionally abused Patient A when he aggressively turned Patient A with enough force that he screamed, became agitated and almost fell out of bed. In response to Patient A’s scream, the Member verbally abused Patient A as he told Patient A loudly to “shut up” multiple times.

Allegations #3(a)(i), (ii) and (b) in the Notice of Hearing are supported by paragraphs 3-29 and 33 in the Agreed Statement of Facts. The Panel finds that the Member’s conduct was clearly relevant to the practice of nursing. The Member’s conduct in saying “I want to fucking kill him” in reference to Patient B was unprofessional as it demonstrated a serious and persistent disregard for his professional obligations in breaching the College’s Code of Conduct, the Professional Standards and the TNCR Standard.

The Panel also finds that the Member’s conduct was dishonourable. It demonstrated an element of moral failing through abusing Patient A physically, emotionally and verbally by aggressively rolling Patient A during care provision and telling Patient A to ”shut up” multiple times. The Member knew or ought to have known that his conduct was unacceptable and fell below the standards of a professional.

Penalty

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

Requiring the Member to appear before the Panel to be reprimanded within 3 months of the date that this Order becomes final.
Directing the Executive Director to suspend the Member’s certificate of registration for 2 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, 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 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.
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 repeated as it involved 2 different patients;
The Member’s conduct involved physical and verbal abuse of a patient; and
The Member’s conduct risked harming a vulnerable elderly individual.

The mitigating factor in this case was:

The Member has taken responsibility for his actions and demonstrated remorse by admitting to his actions and entering into an Agreed Statement of Facts and a Joint Submission on Order with the College.

The proposed penalty provides for general deterrence through the 2-month suspension of the Member’s certificate of registration, which will signal to the membership that there are serious consequences for this type of misconduct.

The proposed penalty provides for specific deterrence through the oral reprimand and the 2-month suspension of the Member’s certificate of registration. The oral reprimand will allow the Member to hear how his conduct is perceived by both the public and fellow nurses and, along with the suspension, sends a signal to the Member that his misconduct was unacceptable.

Remediation and rehabilitation are addressed through a minimum of 2 meetings with a Regulatory Expert and review of the College’s publications which will allow the Member an opportunity to reflect on his misconduct and alter his practice accordingly.

Overall, the public is protected through the 12 months of employer notification which will allow for a heightened level of employer oversight on the Member’s return to nursing practice.

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. Pottruff (Discipline Committee, 2006): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order and involved a member slapping a patient on the exposed thigh and shouting at a patient. The penalty included an oral reprimand, a 2-month suspension of the member’s certificate of registration, completion of a self-directed learning package and 2 meetings with a College Practice Consultant, and for an 18 month period following the member’s return to practice, a requirement to communicate in writing the names and addresses of any employer and to provide any written performance appraisals completed by the member’s employers to the Director.

CNO v. Unger (Discipline Committee, 2017): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order and involved a member immobilizing a patient by pushing the patient into a wall, forcing a patient into a chair by grabbing their wrists and saying “you will listen to me”. The penalty included an oral reprimand, a 2-month suspension of the member’s certificate of registration, 2 meetings with a Nursing Expert and 18 months of employer notification.

CNO v. Moore (Discipline Committee, 2021): This case proceeded by way of an Agreed Statement of Facts and a Joint Submission on Order and involved a member speaking to a patient in an inappropriate tone of voice and attempting to put shoes on a patient in an aggressive manner. The penalty included an oral reprimand, a 2-month suspension of the member’s certificate of registration, 2 meetings with a Regulatory Expert and 9 months of employer notification.

The Member was provided with an opportunity to make submission on penalty but declined to do so.

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 2 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, and
Therapeutic Nurse-Client Relationship;

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.
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 met through the oral reprimand and the 2-month suspension of the Member’s certificate of registration. General deterrence is met through the 2-month suspension of the Member's certificate of registration, which will illustrate to the membership that there are serious consequences for this type of misconduct. Rehabilitation and remediation are achieved by a minimum of 2 meetings with a Regulatory Expert and review of the College’s publications which will assist with transitioning the Member back to ethical nursing practice. Public protection is achieved through the 12 months of employer notification which will provide 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 as demonstrated by the cases submitted and referred to by College Counsel.

I, Michael Hogard, 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.