Taking action

Going through the resolution process has enabled me to express my concerns and give closure to my grievance. The stages of the process reassured me that there is a platform for nurses to revisit their professional code of practice and conduct. Nan Kadarnauth, a member of the public who participated in CNO’s resolution option after raising a complaint about nursing care

In addition to registering people to practise as nurses in Ontario and supporting nurses in their practice, CNO holds nurses accountable to working to nursing standards.

We treat very seriously every complaint from the public and every report from employers or health care professional. Every issue is assessed to determine its risk to the public and appropriate next steps.

A complaint from a member of the public can be handled in two ways:

Resolution: During this voluntary process, the nurse and the member of the public making the complaint work with CNO to develop an acceptable resolution that addresses the issues and promotes quality nursing care.

Investigation: When resolution is not suitable, CNO investigates the complaint. This investigation may include obtaining health records, interviewing the complainant and witnesses, and giving the nurse an opportunity to respond in writing.

Public protection is the focus of these activities. We continually look for ways to improve every stage of this process — from how the public and employers can provide information to us, to how discipline decisions are made and shared. In 2016, in the interest of positively impacting public safety, we sought public and other stakeholder feedback on a number of major issues; we made improvements to the information available and how this information is shared; and we actively participated in finding ways to help prevent the sexual abuse of patients by health care workers.

Maintaining your trust

Your health care and that of your family will most likely involve a nurse at some point. You expect that interaction to result in safe, quality care. CNO is here to provide what you need to make informed decisions about your care.

During 2016, CNO and nursing were in the media significantly more than in prior years, primarily due to several high-profile legal cases. Our annual public survey conducted at the end of 2016, found that 92 per cent of those surveyed trust nurses to provide them with safe care.

Nursing remains one of the most trusted professions. This is as it should be; Ontario’s 160,000 nurses continue to show they are committed to providing quality, ethical care. At CNO, our decisions and daily activities are guided by our goal to continue to meet your expectations and maintain your confidence in nurses.

To achieve that goal, the survey also asks about the respondent’s last interaction with a nurse. In 2016, the survey results highlighted three areas where improvements are most needed:

  • involving you in decisions about your own care
  • having nurses explain their role in your care
  • ensuring nurses providing your care introduce themselves to you.

These areas for improvement will be part of CNO’s upcoming communications to you and to nurses.

Making informed decisions

With our partners, we’re building a system to share nurses’ registration information across Canada. It will enhance nurse mobility and give the public confidence that a nurse who practised in B.C. is safe to practise in Ontario, or elsewhere in Canada.
Cynthia Johansen, Registrar/CEO of the College of Registered Nurses of British Columbia (CRNBC)

Every nurse registered in Ontario has a profile on Find a Nurse, an easy-to-use online Register that provides information to the public about nurses in the province. You can search for information about nurses using their first or last names, facility names or registration numbers.

A set of transparency principles guides decision-making about what information is and is not made public. The principles help balance public protection with fairness for nurses and complainants, and the strict confidentiality requirements by which CNO is legally bound.

We provide this information to help you make informed decisions about your health care. It also gives employers information they need to ensure a nurse is registered to work in Ontario, plus any restrictions they may have on their practice. We continue to rely on feedback from the public and other stakeholders to keep us abreast of what information is necessary for their decision-making.

To maintain all stakeholders’ confidence, we also seek to be clear, open and forthright about our processes and decision-making, and to find the best ways for all parties to share information. In 2016, we made a number of information-related advancements designed to improve public safety:

  • Nurse Renewal Check (formerly Automated Annual Verification of Renewal): Employers are obligated to confirm that nurses they employ are entitled to practise nursing in Ontario. CNO provides a service for anyone needing to check accurately and efficiently the membership status of nurses they employ on a full-time, part-time, casual or contractual basis. In 2016, after rebranding the program, CNO began to more actively promote it.
  • Unregistered practitioners: Occasionally, CNO receives reports that individuals who are not nurses may be seeking employment in nursing or holding themselves out as people qualified to practise in Ontario as an RN, RPN or NP. We maintain a list on our website of such people who have come to our attention. In 2016, we changed this list title from "Illegal Practitioners" to "Unregistered Practitioners" to clarify the message. Moving from the term "illegal" to the less-restrictive term "unregistered" increases the list of names we can add to the page in an effort to protect the public.
  • Information on sexual abuse of a patient: We updated information on sexual abuse issues by adding a focus on what constitutes sexual abuse beyond the legal definition, and how to contact CNO to report such abuse.

Sharing nursing information across Canada

Increasingly, nurses are moving across provinces and territories to work, and must seek registration at their new location. Having Canada’s various regulators share registration and discipline information about nurses will make the registration process more efficient. In addition, it will aid public protection by ensuring that the regulator in the nurse’s new location is aware of any risk issues with the nurse.

In 2015, as part of the Canadian Council of Registered Nurse Regulators, CNO began working to find a way to share such information. For this to succeed, all regulators need a common way to identify each nurse uniquely. In 2016, we led a successful test of a usable unique identifier in British Columbia and Ontario. We expect to begin a pilot of this system in 2017 and to implement it fully by 2020.

Preventing sexual abuse of patients

Sexual relations between a nurse and patient are always unethical and abusive, and are a serious breach of trust.

CNO recognizes the grievous harm and lasting effect sexual abuse by a nurse can have on a patient. When receiving care from a nurse, the nurse should be professional, respectful, knowledgeable, skillful and ethical. We continually seek ways to improve how we can act sensitively, respectfully, fairly and quickly to complaints of any such misconduct by a nurse.

In 2016, we received the recommendations of the Minister's Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, 1991 (RHPA). After reviewing it thoroughly, we provided our feedback to the Ministry of Health and Long-Term Care. Following this, the Ministry introduced Bill 87, the Protecting Patients Act, 2016, which received its first reading in December. This act proposes changes to the legislation governing health care regulators, the RHPA.

If passed, some changes to the RHPA would include:

  • defining "patient" to include former patients for a period of one year
  • allowing the Minister to specify how regulators perform their functions dealing with complaints, reports and discipline matters involving sexual abuse
  • expanding the list of acts of sexual abuse that result in mandatory revocation of a health care worker’s ability to practise
  • increasing access to patient therapy and counselling
  • when requested by the Minister, regulators would provide reports and information that may contain personal information or personal health information to allow the Minister to determine if a regulator is fulfilling its duties
  • giving the Minister more control over the composition CNO’s statutory committees, quorum and member qualifications.

The Bill also includes a number of amendments related to transparency previously adopted by CNO’s Council, which resulted in more information about members being made available on the public register, Find a Nurse.

CNO expressed its clear commitment to protecting patients from sexual abuse during the review by the Sexual Abuse Task Force and when the Minister announced Bill 87. We support the intent and the overall objectives of Bill 87.

We’re committed to ensuring each complaint of sexual abuse of a patient receives a high-priority investigation and to giving sensitive and respectful support throughout the process to those who have been abused. We will continue to work with the Ministry to do what is needed to eliminate all such abuse.

For more information on sexual abuse, including what to do if you suspect sexual abuse by a nurse, see www.cno.org/en/sexual-abuse/.
Nurses should continue to report to the appropriate regulatory college if they believe that a health care professional has sexually abused a client. You can find more information about this and other mandatory requirements in the Mandatory Reporting guide.