Present:

L. Haugh, Chair
M. Bestwick
I. Bajnok
D. Barber
S. Burnell-Jones
K. Campbell
F. Cole
K. Cook
D. Dietrich
D. Fox
R. Graham

L. Hall
B. Hill
E. Howe
P. Howe
S. Ireland
S. Keating
V. Kerr
R. Kitson
K. Lawrence
L. Lillie
M. McGinn

M. A. Murray
B. Noble
D. Norling
R. Rupert
J. Sanger
A. Taylor
M. Taylor
M. Ternovan
D. Trouten
B. Weichel
K. Wetherall
S. Young

Unable to Attend:

J. Attwood
C. Charlton A.

Cunningham
E. Greenwood

S. Richardson

Staff:

A. Coghlan
C. Campbell

H. Crawford
J. Hofbauer, Recorder

P. Reinhart
G. Siskind

AGENDA

The agenda had been circulated in advance and two items were added at the request of a Council member.

A Council member requested clarification around a matter discussed at the closed session of Council in December, requiring a brief closed session.

Motion 1

Moved by A. Taylor, seconded by P. Howe,

That Council be closed at 4:30 p.m. on Tuesday, March 18th for discussion of personnel matters in accordance with Section 7(2)(d) of the Regulated Health Professions Act.

CARRIED

Motion 2

Moved by M. Ternovan, seconded by B. Weichel,

That Council accept the agenda for the March 2003 meeting, with the addition of the closed session on March 18th (for minutes, see confidential appendix).

CARRIED

MINUTES

Minutes of the December 2002 Council meeting had been circulated. On page 278, wording was changed to clarify the nature of the Finance Committee's review in relation to information for financial decision-making.

An amendment was suggested to page 277 regarding the discussion about the percentage budget increase. It was suggested that the minutes of the Finance Committee be consulted for wording. Decision regarding approval of the minutes was deferred pending consultation of the Finance Committee minutes.

PREPARATORY STIPEND

In December, Council asked that preparatory stipend for the Discipline and Quality Assurance committees be reconsidered. L. Haugh reviewed the process for making the recommendations, noting the input of the committees about the time involved and review of the Compensation Sub-Committee.

Motion 3

Moved by M. Taylor, seconded by K. Wetherall,

That Section 2(b) of the Stipend Policy for elected Council and committee members regarding preparatory stipend be revised to include:

vii) Discipline Committee motion preparation on personal time - 1 hour stipend for every 30 pages of required reading.
viii) Quality Assurance Committee - 30 minutes for every Practice Review case.

CARRIED

Council supported the recommendation, confirming that there was strong rationale. It was noted that the fiscal implications are estimated at about $6,300 based on the level of activity in 2002. While not included in the 2002 budget, sufficient funds exist in contingency to meet this additional expense. It was clarified that the new policy takes effect immediately.

EVALUATION

Council reviewed the summary of evaluations of the December Council meeting. L. Haugh highlighted some changes that are being made as a result of comments from the evaluations, including:

• New forms to assist the Vice-Presidents with recording the speakers list;
• Careful review of all motions for clarity, completeness, and active voice; and
  
• A change in evaluation form to remove the term "Climate" and provide a section for "General Comments" instead.

L. Haugh had received a number of calls from Council members concerned about the tone of the comments in the evaluation. She noted that the evaluations had been summarized in the past and Council had supported a change to verbatim reports for transparency. There was some concern, however, that members of Council are now using the form as a mechanism for criticism of others rather than constructive comments to facilitate process improvement. There was discussion about whether the process should shift to a summary of the evaluation responses. Council members agreed that the verbatim reports of the evaluations will be continued at this time.

Council members confirmed that evaluation is an important process and that the purpose of the process is to share suggestions for improvement. It was suggested that, in the future, the tool be reviewed to see if it can be more objective. In addition, it was suggested that content analysis be used to review a year of raw data from the evaluations and capture themes.

L. Haugh reported that the Executive identified that the Council's values provide a strong framework for constructive Council functioning. New Rules of Order cards have been distributed with the values printed on the reverse.

CODE OF CONDUCT

At the request of D. Trouten, Council discussed a proposal for the development and adoption of a Code of Conduct. D. Trouten introduced the motion and her rationale. She noted that a Code of Conduct addresses behaviour and is a fundamental building block of governance that is lacking at the College. She identified that it is not unusual for a board of directors to adopt a Code of Conduct.

Motion 4

Moved by D. Trouten, seconded by P. Howe,

That Council develop and adopt an individual and group Code of Conduct for Council members that establishes clear standards of ethical and respectful conduct in the interaction of Council members and the process of discussion and decision-making within Council and its committees.

L. Haugh highlighted the work done by Council to date in relation to governance and behaviour.

There was considerable support at Council for the need for a Code of Conduct. While it was acknowledged that many components may already exist, it was thought that a Code of Conduct would pull together all the components into one clear document and address any gaps in the current materials. It would serve as a foundation for Council and committee interaction.

A number of Council members identified the need for mechanisms to address breaches of the Code of Conduct.

Clarification was requested about the applicability of the Code to committee members.

Amendment to Motion 4

Moved by D. Trouten, seconded by M. Ternovan,

That Motion 4 be amended to include reference to committee members.

It was clarified that the process of developing the Code of Conduct needs to include the review of existing governance materials.

CARRIED

Amended Motion 4

The following motion had been duly moved and seconded,

That Council develop and adopt an individual and group Code of Conduct for Council and committee members that establishes clear standards of ethical and respectful conduct in the interaction of Council and committee members and the process of discussion and decision-making within Council and its committees.

CARRIED

Council discussed the mechanism for developing the Code of Conduct. It was suggested that a small sub-committee be established to develop the Code. It was identified that there is considerable interest in the issue at Council and expertise among Council members that needs to be utilized.

There was discussion about the time required to complete the task. It was identified that the issues are fresh and it would be best to bring a draft Code to June Council to allow for the participation of existing Council members. Council identified its belief that the timeframe was workable given the expeditious establishment of a group to undertake the process.

Motion 5

Moved by D. Trouten, seconded by A. Taylor,

That the Code of Conduct be developed by a sub-committee of Council for circulation to Council members by the end of May and consideration by Council no later than the Council meeting of June 2003.

Some concern was expressed about the absence of a specific requirement and timeframe for input by Council members.

Amendment to Motion 5

Moved by D. Trouten, seconded by D. Norling,

That motion 5 be amended by inclusion of a provision "that Council members submit issues they believe need to be addressed in the Code by April 11, 2003".

CARRIED

Amended Motion 5

The following motion had been duly moved and seconded,

That the Code of Conduct be developed by a sub-committee of Council for circulation to Council members by the end of May and consideration by Council no later than the Council meeting of June 2003, and that Council members submit issues they believe need to be addressed in the Code by April 11, 2003.

CARRIED

Some concern was expressed about the process used in tabling motions brought forward by a Council member. In particular, there was concern about the Executive putting forward alternative recommendations. The Executive will consider the process for the future.

There was discussion about the formation of the Sub-Committee. It was noted that the usual process is for the Executive to recommend members from among volunteers.

Motion 6

Moved by A. Taylor, seconded by P. Howe,

That the Code of Conduct Sub-Committee be immediately formed by those compensable, representative members of Council so volunteering in providing their names to Deborah Trouten, as interim Chair, before the close of the Council meeting on Tuesday, March 18, 2003, with the sub-committee having the power to co-opt additional participants as it may periodically see fit.

There was some concern that the usual process of recommendation by the Executive from among volunteers was not being followed.

Amendment to Motion 6 Moved by A. Taylor, seconded by P. Howe,

That Motion 6 be amended by replacing "Deborah Trouten as the Interim Chair" with the "the Executive Committee".

CARRIED

Amended Motion 6

The following motion had been duly moved and seconded,

That the Code of Conduct Sub-Committee be immediately formed by those compensable, representative members of Council so volunteering in providing their names to the Executive Committee before the close of the Council meeting on Tuesday, March 18, 2003, with the sub-committee having the power to co-opt additional participants as it may periodically see fit.

DEFEATED

Motion 6 was defeated due to concern about the potential budget implications of the "power to co-opt additional participants". It was identified that the motion establishing the Sub-Committee included a requirement for collection of input from Council members, and it was clarified that this should also include committee members.

It was agreed to follow the normal process of establishing special committees of Council. Anyone wishing to volunteer was asked to submit her or his name to the Executive by the end of the day. The Executive will bring recommendations to Council on March 19th.

PROFESSIONAL STANDARDS

S. Avey-Morrison highlighted the process for development of the revised Standards of Professional Practice and highlighted the significant changes in the revision. She presented highlights of the Regional Education Session on the Professional Standards for Council.

MINUTES

Council returned to a review of the December minutes. In addition to the amendment already made to page 278, the last paragraph under "Operating and Capital Budget" on page 277 was replaced with "The Finance Committee discussed the process of approving a budget increase guideline in the fall. It was confirmed that the percentage budget guideline is not relevant and will no longer be included in the budget process."

Motion 7

Moved by S. Burnell-Jones, seconded by K. Cook,

That the minutes of the Council meeting of December 11 and 12, 2002 be approved as amended.

CARRIED

STRATEGIC OBJECTIVES

As part of its responsibility in monitoring achievement of the strategic objectives, Council receives regular updates on the action plans and indicators.

In March, Council received a 2002 year-end report of the indicators as well as 2003 targets and new indicators. It was identified that some of the indicators may be too ambitious, but that they represent targets. In some instances, not meeting indicators may mean that other processes have improved. For example, if the renewal process is expedited, fewer members will need to check the status of their renewal on the web site or telephone IVR. Experience over time is needed to be able to track trends and develop accurate indicators.

It was noted that the call centre indicators include both actual and adjusted totals. The adjusted indicators are measuring whether we are working at our capacity based on the number of calls that can be taken with the available resources. This will help CNO assess options for improving service, such as increasing staff to meet short-term needs or providing other options (IVR, website).

Council received an update on the action plan and reports related to the following:

• Fostering relationships with nurses;
  
• The development and implementation of a targeted strategy which engages the public and identifies new ways for the public to interact with and learn about the College and on strengthening the corporate image of the College with stakeholders through the creation and implementation of a public relations plan; and
  
• The development of a service delivery framework.

There was some discussion about the lack of focus of the initiatives on current members. Many ongoing activities and resources, such as the REN and Communiqué, are focused on members. Students provide a unique opportunity as they are about to become members, have a high level of interest, and recent surveys show they do not understand self-regulation.

B. Campbell highlighted the key findings of the Environmental Scan, noting the implications for CNO.

Website

J. Sy and D. Jones presented the redesigned website. The purpose of the new design is to:

• Support CNO's objective to excel in the development, utilization and provision of CNO knowledge;
  
• Enhance CNO's ability to evolve to provide on-line processes (e.g., address change); and
  
• Be easy to use and clearly organized.

The website reflects CNO's mission, vision and strategic objectives. The organization of the site was highlighted. New features include: a search engine that can search files and provide reports on issues for users and an on-line polling feature which will be used in March for a Quality Practice readership poll.

CNO can now update the site in-house which allows for more timely updates and provides control over the timing of content and design changes.

The site has been designed to allow interactive features to be added. An interactive Guide for International Applicants seeking to practice in Ontario will allow for personal assessment of credentials and identification of what the applicant might need to do to be registered. Staff are exploring an on-line register, document purchasing, and eventually on-line registration.

There was some concern expressed about the accessibility of personal contact information for Council members on the website. Council members will have an opportunity in June to specify what contact information is included on the web site and what is included in Communiqué.

COMMITTEE APPOINTMENT

The Executive had appointed F. Cole to the Quality Assurance Committee to fill a vacancy.

Motion 8

Moved by K. Lawrence, seconded by K. Wetherall,

That Council ratify the appointment of Fay Cole, public member, to the Quality Assurance Committee until June 2003.

CARRIED

SCRUTINEERS

The Executive appoints scrutineers for the election of Council officers. Where possible, scrutineers are selected from among outgoing Council members.

Motion 9

Moved by R. Kitson, seconded by L. Lillie,

That Council ratify the appointment of Paul Howe, Kathy Lawrence and Jayne Sanger as scrutineers for the June 2003 election of officers.

CARRIED

JOINT PROVINCIAL NURSING COMMITTEE

L. Haugh presented an update on the activities of the Joint Provincial Nursing Committee. As well as representing CNO on JPNC, L. Haugh is a representative of public health on the Implementation Indicator Monitoring Committee which is working on a report on how effective JPNC has been in implementing the objectives of Nursing Task Force Report.

L. Haugh reported on JPNC's fall strategic planning session. Four key objectives were identified and are being further developed by various sub-committees.

RECESS

Council recessed at 5 p.m. on March 18th .

Wednesday, March 19, 2003

AGENDA

Appointment of the members of the Code of Conduct Sub-Committee was added to the agenda as "Other Business".

ANNUAL REPORTS OF STATUTORY COMMITTEES

As part of their accountability for meeting the statutory mandate of the College, statutory committees present annual reports to Council. Council was informed that there is work currently being done on improving the quality and focus of committee reports and the new format will begin with 2003 reports.

Executive Committee

L. Haugh highlighted the report of the statutory activity of the Executive. She noted an increasing use of informal resolutions and provided some examples.

Mandatory reports of terminations continue to rise, which is a reflection of the effectiveness of CNO's efforts to inform employers of their obligations to report terminations.

Client Relations Committee

V. Kerr presented the report of the Client Relations Committee. She noted that the activities in the past year focused in overseeing the abuse prevention program and administering the funding program.

The findings of a survey evaluating the use of the abuse prevention program "One is One Too Many" were highlighted. The findings were positive, with CNO seen as a credible resource on abuse prevention. The abuse prevention program remains a useful educational tool to prevent abuse of clients.

Complaints Committee

P. Howe highlighted the report of the Complaints Committee. He noted that despite an increase in the number of cases, the College is meeting the required timeframes. This year, for the first time, the Complaints Committee made referrals to the Quality Assurance Committee, with three cases referred.

It was noted that a decrease in appeals to the Health Professions Appeal and Review Board may reflect complainants and members finding greater satisfaction in the process.

Discipline Committee

M. Taylor noted that there has been an increase in the number of cases, and an increase in use of Agreed Statements of Facts and Joint Submissions on Penalty. 76% of cases were finalized in 2002 and there has been an increase in the number of decisions finalized within 60 days of closure of hearings.

Fitness to Practise Committee

S. Young highlighted the report of the Fitness to Practise Committee. The committee endorses the informal resolution process that facilitates resolution of concerns without formal hearings. The results of the three hearings held in 2002 were highlighted.

Quality Assurance Committee

K. Lawrence highlighted the report of the Quality Assurance Committee. Practice Review was the major focus in 2002. The committee was pleased to report that CNO has recovered 90% of the development costs of the Practice Setting Consultation Program through licensing agreements.

Registration Committee

R. Rupert highlighted the annual report of the Registration Committee. He noted that there has been a steady increase in the number of applications for the general class over past 4 years. The source of the RN application pool has changed significantly over the past five years with an increase in international applicants.

The Registration Committee reviewed 522 applications, with the largest number of decisions related to waiving exemptible registration requirements (e.g., citizenship). The Health Professions Appeal and Review Board reviewed 7 applications and confirmed the Registration Committee's decision in all cases.

RN(EC)

Each year, Council reviews the lists of drugs, laboratory and diagnostic tests that can be ordered by RN(EC)s. The lists are revised to facilitate RN(EC) access to first line treatments and are developed through a highly consultative and evidence based process.

Council is reviewing the lists at this time for approval for publication.

Motion 10

Moved by M. Ternovan, seconded by M. McGinn,

That Council approve the proposed additions/changes to the RN(EC) Drug and Laboratory/Diagnostics lists (Appendix 1 to the briefing note) for publication in the June Communiqué.

CARRIED

The proposed changes will be published in the June Communiqué and will return to Council, with a report on feedback, for decision in October.

REGULATIONS

Concern was expressed about the time needed for the approval of regulations. This issue was raised when L. Haugh and A. Coghlan met with the Minister of Health and Long-Term Care. CNO staff have met with the Ministry in an attempt to clarify issues and expedite passage of regulations. The Ministry is working with a group of representatives from the Federation on streamlining the process for submission and approval of regulations.

HEALTH PROFESSIONS CORPORATIONS BY-LAW

Changes in the Regulated Health Professions Act require Colleges to pass By-Laws related to the establishment of Health Professions Corporations. It was noted that this is anticipated to have impact on very few members.

The By-Law was reviewed in detail. The processes that will need to be addressed include development of forms and changes to the public register.

The Executive is recommending approval of the By-Law and the Finance Committee is recommending the fees in the By-Law.

Motion 11

Moved by D. Fox, seconded by R. Rupert,

That Council approve the By-Law for Health Profession Corporations (as per attachment 3 to the briefing note).

CARRIED

The By-Law comes into effect immediately. Approval of the By-Law will be reported in Communiqué.

EXECUTIVE DIRECTOR UPDATE

A. Coghlan shared the highlights of a national forum hosted by CNO on the Impact of Globalization on Registration.

EXECUTIVE COMMITTEE

L. Haugh highlighted the notes of the Executive Committee meetings of December 17, 2002, January 23, 2003, February 19, 2003 and March 7, 2003.

There was a question regarding committee quorum and whether a member appointed by the Executive is a full member of the committee prior to Council ratification. A legal opinion will be sought for clarification.

Some members expressed concern about the content of ONA correspondence with Council members, other members identified that they were comfortable with the correspondence. The officers will discuss the correspondence with ONA at the next liaison.

FINANCE COMMITTEE

S. Keating highlighted the report of the Finance Committee meeting of February 27th.

The Finance Committee will be discussing the issues related to the information required for financial decision-making in April and will make recommendations to Council in June. In the interim, the financial statements presented to Council are in the format used prior to December. The unaudited year-end financial statements were highlighted.

D. Trouten had requested addition of a motion regarding financial information on the Council agenda.

Motion 12

Moved by D. Trouten, seconded by K. Cook,

That the quarterly financial statements, the annual financial statements, and any budgets shall be included with the draft agenda and documentation forwarded to Council members no fewer than seven days prior to a Council meeting at which these matters may be considered.

CARRIED

D. Trouten noted that the stewardship of resources is a core responsibility of Council members and it is an important role of Council to evaluate fiscal management of the College. In October and December, she did not believe that Council had adequate information to make decisions.

There was some discussion about the need for the motion, since it is current practice that financial background is sent out at least one week in advance of the Council meeting. It was identified that passage of the motion will shift current practice to policy.

CODE OF CONDUCT
SUB-COMMITTEE

L. Haugh presented the Executive Committee's recommendation for membership of the Sub-Committee on Code of Conduct. She noted that the Executive used a membership structure similar to other recent ad hoc committees, with equal numbers from each category. In deciding among volunteers, the Executive considered the other activities of all volunteers and selected those who had less opportunity for involvement.

Motion 13

Moved by K. Cook, seconded by B. Noble,

That Council appoint the following to the Sub-Committee on Code of Conduct:

Denise Dietrich, David Fox, Sandra Ireland, Lory Lillie, Dawn Norling and Deborah Trouten.

Some concern was expressed that all volunteers who were interested in participation and have expertise should be appointed to the sub-committee.

Amendment to Motion 13

Moved by D. Trouten, seconded by S. Ireland,

That motion 13 be amended to include the following additional volunteers: S. Burnell-Jones, E. Greenwood, P. Howe, S. Keating, M. A. Murray, Angus Taylor and Marsha Taylor.

DEFEATED

The amendment was defeated because members felt the size of the working group was appropriate and a mechanism for input from Council members has been included in the process. Council was concerned about the short time frame and identified that smaller groups function more effectively. Council identified its trust in the members selected to do a good job on behalf of the full Council.

Motion 13

The following motion had been duly moved and seconded,

That Council appoint the following to the Sub-Committee on Code of Conduct:

Denise Dietrich, David Fox, Sandra Ireland, Lory Lillie, Dawn Norling and Deborah Trouten.

CARRIED

NEXT MEETING

The last meeting of the current Council will be held on Wednesday, June 4th. The Annual Meeting will be held on June 5 at 9am, followed by the first meeting of the newly constituted Council.

CONCLUSION

Council concluded at 3:30 p.m.