Sexual Abuse of Patients

For nurses and their patients, the term “sexual abuse” has a specific legal meaning defined under the Regulated Health Professions Act, 1991.

Sexual abuse of a patient occurs when a nurse:

• has physical sexual relations with a patient
• touches a patient in a sexual manner (for example, touching a patient’s genitals when it is not required in caring for the patient)
• behaves in a sexual manner toward a patient (for example, touching a patient’s shoulder or hand unnecessarily and in a manner that implies a sexual interest in the patient)
• makes remarks of a sexual nature to a patient (for example, commenting on the size of a patient’s breasts or genitals)

Patient sexual abuse is different from the criminal act of sexual assault, which refers to a sexual act without consent. In the context of a nurse-patient relationship, it does not matter if the patient consents; it is always sexual abuse.

In the nurse-patient relationship, nurses hold a position of power by virtue of having:

• professional knowledge and skills patients rely on for their well-being
• access to patients' bodies
• access to patient’s personal health information

Maintaining professional boundaries is always the nurse’s responsibility. This includes physical boundaries. Because of the power imbalance that exists between the patient and the nurse, any sexual or romantic relationship a nurse has with a patient is abuse and professional misconduct.

A nurse is also not allowed to engage in a sexual or romantic relationship with a patient for one year after the end of the professional relationship with the patient. For example, if a nurse begins a romantic relationship with an individual to whom they provided care to six months ago, the nurse’s conduct would be sexual abuse.

There are serious consequences for breaking the law by engaging in sexual acts with a patient, including the nurse losing their ability to practice nursing in Ontario.

If you, a family member or acquaintance have been, or are being, sexually abused by a nurse, you can:

• immediately request that the abuse stop;
• report the abuse to the nurse’s manager or to another official at the health care facility and request that the nurse no longer provide you or the patient care (when you report abuse to a health professional or facility, they are required to make a formal complaint to CNO; however, they will not include your name without your permission)
• contact CNO yourself at PublicComplaints@cnomail.org or 416-963-7503 to speak with one of our representatives (toll-free in Canada 1-877-963-7503) 
• you can also access community support  and information on sexual violence at any time. These supports are free and confidential.

The law requires employers or a health professionals to report incidences of suspected abuse. The patient’s name is not included in the report unless that patient gives written permission to be identified as the victim.

When CNO receives information of possible sexual abuse, it begins a formal investigation.

If the patient gives permission to be identified in the report, a CNO representative will:

• contact the patient to introduce themselves,
• answer any questions the patient may have about the process
• provide information about how the patient can access funding
• conduct an investigation

A thorough investigation includes interviewing witnesses and collecting supporting documents. From here, CNO’s Inquiries, Complaints and Reports Committee will review a detailed report of all the information collected on what happened.

If the committee has sufficient information to prosecute, the case will be referred to the Discipline Committee for a formal hearing where evidence is presented before a Discipline Committee panel. Depending on the circumstances of the case, the patient may be asked to testify. CNO staff will support the patient throughout this process.

At the hearing the nurse will have an opportunity to respond. Following the hearing, the Discipline Committee will make a formal decision.

There are consequences to patient sexual abuse. If the Discipline Committee finds the nurse guilty of sexual abuse, the nurse must attend a reprimand meeting and their certificate of registration may be revoked. This means the nurse will not be able to work as a nurse and care for patients for at least five years. At the end of the five years, the nurse will need to prove to the Discipline Committee that they are no longer a risk to the public before working as a nurse again.

CNO is aware that patient sexual abuse by a nurse causes significant harm. We will work sensitively with patients and help them understand the process, as well as provide resources for support.

Here are some ways CNO can help:

• Once CNO receives a complaint or report^[1] related to sexual abuse by a nurse, the patient can apply for funding to help pay for therapy to help them cope with the abuse’s impact. The process is confidential and funding is paid directly to the therapist. If needed, CNO staff can assist with the application. 
• If a matter goes to a hearing, CNO will provide the patient with the support they need to participate in the hearing. For example:
  • CNO can pay for the patient’s travel and accommodations 
  • CNO’s laywer can request that the patient testify behid a screen so they do not have to see other hearing participants 
  • CNO’s lawyer can request that the nurse, if self-represented, not be allowed to cross-examine the patient; only a lawyer can ask the patient questions

• CNO will protect the privacy of the patient. While discipline hearings are open to the public, CNO’s lawyer can request a publication ban of the patient’s name to protect their privacy. Information about eligibility for therapy funding.

Fact sheet for individuals considering applying for funding.

Fact sheet about participating in CNO’s sexual abuse investigation and discipline process: What to expect. 

Nurses are expected to abide by a Code of Conduct. The Code of Conduct outlines the behaviour you can expect from your nurse. Nurses must:

• introduce themselves and their role
• treat patients with care and compassion
• keep patient information confidential
• get consent and clearly communicate to patients the details of care
• maintain boundaries with their patient including:
  • no sexual relations with patients (this expectation is to be upheld for a full year after the professional nurse-patient relationship ends)
  • declining a request from a patient to be connected on social media
  • declining a gift from a patient

Here are some guiding questions to consider as you reflect on your nurse’s behaviour:

• How does your nurse’s behaviour align with the expectations outlined in the Code of Conduct?
• Does the nurse’s behaviour make you feel safe?
• Does the nurse’s behaviour make you feel like you are being treated with care and compassion?

If you answer “no”, please review “What should I do if I suspect sexual abuse?” section

For more information about sexual abuse of a patient, you can contact the CNO at PublicComplaints@cnomail.org or 416-963-7503 to speak with one of our representatives (toll-free in Canada 1-877-963-7503).

• Participating in CNO’s sexual abuse investigation and discipline process: What to expect 
  
• Therapy funding for patients who have experienced sexual abuse by nurses: Information for individuals considering making an application 
• Code of Conduct
• CNO Research on Sexual Abuse of Patients by Nurses
• File a complaint with CNO
• To Zero: Independent Report of the Minister's Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, 1991