May 2019

A new way to assess risk

Addressing concerns about a nurse’s behaviour is one of the ways CNO protects the public. When an employer, patient, or another health professional tells us that they have a concern about the conduct or competence of a nurse, we begin by assessing the alleged conduct to determine how risky the nurse’s behaviour is to patients.  

Assessing risk is a complex process and we must consider a wide range of factors. To support this work, we developed a tool that will make it easier for us to complete our assessment. You can view the new Risk Analysis Tool at Creating this tool is part of our ongoing effort to enhance our professional conduct procedures.

When we created the tool, we also added a few new factors based on recent research. For example, we added factors to help identify nurses who intentionally cause serious harm. This addition came from research we conducted to improve our processes and support the Long-Term Care Homes Public Inquiry.

When using the new tool, the investigator will:

  • consider the nurse’s conduct, including the nurse’s intent, behaviour and response, and professional conduct history

  • identify the level of risk and whether the nurse’s behaviour was deliberate, reckless, put patients at risk, or was a result of human or system error

  • balance evidence-informed risk factors against mitigating factors

  • consider the public’s interest, including the risk of the nurse repeating the action and causing patient harm

Using the results, the investigator can more accurately determine the level of risk a nurse has to public safety and make a recommendation to CNO’s Executive Director. These recommendations vary depending on the seriousness of the conduct. A nurse with low-risk behaviour may receive a letter of notice and direction from CNO asking them to review specific practice standards and guidelines. High-risk behaviour can lead to a formal hearing to determine if the nurse’s conduct breached practice standards.  

If you would like to know more about this process, read “What does the College do when it receives a report?” in our Mandatory Reporting: A process guide for employers, facility operators and nurses.

You can learn more about our investigation process and the factors we consider when deciding how to address information we receive about nurses at

December 2019: the Mandatory Reporting Guide has been replaced by the Reporting Guide

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