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Code of Conduct FAQs
How is this Code different from the Canadian Nurses Association’s (CNA) Code of Ethics?
CNO’s Code of Conduct (Code) describes the conduct and behaviours expected of Ontario nurses. There are some ethical values that support statements throughout the document. The Code is a provincial document and that means it reflects the legal framework in Ontario.
As CNO’s mandate is to protect the public, we asked the public for their feedback to inform the development of the Code. CNO’s Code of Conduct reflects what the public’s expectations are of the nurses who provide care to them and their loved ones.
How is the Code different from other practice standards?
The Code is a practice standard that all nurses are accountable to yet is written for the public. It includes the public’s perspective and reflects their expectations. It is written clearly so it is easily understood by a variety of stakeholders.
How does the Code align with other practice documents?
The Code is an overarching practice standard. Other standards, such as Therapeutic Nurse-Client Relationship, Revised 2006 and Documentation, Revised 2008, assist in the Code’s application. Practice guidelines, such as Conflict Prevention and Management and Independent Practice, address specific practice-related issues and topic areas. Nurses are expected to guide their practice using the Code with other standards, guidelines and educational tools.
Refer to the Mapping Code of Conduct to CNO Standards and Guidelines to learn which sections of CNO practice documents the Code relates to.
My employer has a Code of Conduct. As a nurse, which Code am I accountable?
You are accountable to both CNO and your employer. You are responsible for ensuring your practice and conduct aligns with standards of practice set out by CNO and your employee accountabilities and expectations.
If you have questions about your specific role and your employer’s code of conduct, consult with your employer to clarify. If you have questions about CNO’s Code of Conduct, send us your question.
How did CNO develop the Code?
CNO developed the Code using such evidence sources:
- A literature review
- A review of other regulators’ codes of conduct
- Feedback from the Ontario Public
- An analysis of Professional Conduct data
- A review of other documents, for examples the Ontario Human Rights Code and Truth and Reconciliation Commission Report recommendations.
We conducted an extensive literature review to identify the public’s expectations of nurses. We also reviewed national and international Codes of Conduct from other professions and industries. We engaged the Ontario public through focus groups and surveys, integrating their feedback into the Code. Commonly breached practice standards were analyzed and reviewed.
In addition to the public, we sought feedback from a variety of stakeholders, including:
- nursing employers
- nursing associations
- nursing unions
Why did CNO choose to adapt the Nursing Council of New Zealand’s Code of Conduct?
CNO’s review of other nursing codes of conduct identified similarities among codes. Since findings from CNO’s literature review suggested developing one from scratch would produce a similar document to those existing, CNO welcomed the opportunity to collaborate and engage with another nursing regulator.
The Nursing Council of New Zealand’s (NCNZ’s) Code of Conduct best reflected the majority of current evidence and aligned with Ontario’s regulatory framework. It is written keeping the public at the forefront. NCNZ supported and approved using their code as a foundation, and CNO’s adaptations reflected Ontario’s regulatory framework and the public’s needs.
The Code states that “if nurses fail to meet this standard, CNO may take action.” What action will CNO take?
The Code is a practice standard. The Regulated Health Professions Act, 1991 requires nurses to adhere to standards in carrying out their professional responsibilities. CNO places these reasonable expectations on nurses to ensure nurses provide responsible, safe and quality patient care. Breaching, contravention or failure to meet these standards is considered professional misconduct. CNO will assess the information and determine what action should be taken, including an investigation. CNO may take action pending the results of the investigation and the circumstances surrounding the incident.
To learn more about the types of conduct that are defined as professional misconduct, read the Professional Conduct: Professional Misconduct reference document.
I am a member of the public. I feel my nurse did not meet the Code’s expectations. What do I do next?
Discuss your concerns directly with the nurse, their employer, manager, or the organization’s Patient Relations department. If your concerns are not addressed, you can make a complaint about the nurse’s conduct to CNO.
CNO’s guide, Addressing Complaints at the College of Nurses of Ontario, contains important Complaints process information.
Why are specific terms in the Code bolded?
Bolded terms found in the Code are defined in the glossary.
I saw there are several translated versions of the Code. Which one are nurses accountable to?
Because Ontario is culturally diverse, we translated the Code into multiple languages (including Mandarin, Cantonese, Punjabi, Spanish and Tagalog) so more members of the public can read it. However, as with all of our resources, nurses will only be accountable to the English or French versions of the Code.
The Code has two expectations referencing social media. As a nurse, what are my accountabilities when using social media?
You are accountable for meeting the following key expectations when using social media:
- Understanding the benefits and risks of social media use
- Using the same level of professionalism in online interactions as you would in face-to-face interactions
- Protecting patient confidentiality in all communications
- Setting and maintaining privacy in all communications
- Maintaining professional boundaries with patients when communicating online
- Using caution when identifying yourself as a nurse online
- Protecting individual and professional integrity
- Understanding employer policies related to social media use
- Being accountable for actions on social media
For more information on social media use by nurses, you may find the following resources helpful:
- Social Media Use: Common Expectations for Nurses
- Social Media Webcast: Reflect Before You Post
- Ask Practice: Communicating with clients online
- Professional Standards, Revised 2002
- Therapeutic Nurse-Client Relationship, Revised 2006
- Confidentiality and Privacy: Personal Health Information
The Code states that “Nurses do not engage in any sexual relationship with patients while caring for them. This legislation stays in effect for one year after the end of the nurse-patient relationship.” What law states this?
The Regulated Health Professions Act, 1991 states that an individual is a patient for a period of one year following the end of the therapeutic nurse-patient relationship. A nurse is in a position of power over a patient, by virtue of having professional knowledge and skill that a patient must rely on for their well-being. In addition, a nurse has access to patients' personal health information. Because of this, any sexual relationship with a patient is abuse and can lead to a finding of professional misconduct. It does not matter if the patient agreed to the sexual acts.
The Code states that “nurses do not accept gifts from patients, unless it harms the professional relationship with patients”. In rare situations where the refusal may be harmful, what are my accountabilities before accepting gifts from patients?
Nurses are expected to establish and maintain appropriate professional boundaries with patients. This includes accepting gifts from patients. There may be situations when accepting gifts from patients is appropriate, such as accepting a gift basket for all staff members at the time of a patient’s discharge from a unit. In situations where refusing a gift may harm the professional relationship with a patient, nurses are expected to consider and reflect on the following questions before accepting a gift:
- Have I consulted with my broader healthcare team, such as my manager before accepting the gift?
- What does my organizational policy state about accepting gifts from patients?
- Did I or the broader healthcare team ask for this gift?
- Is the patient mentally competent?
- What is the patient’s intent and expectation in offering the gift?
- Have I considered the appropriate timing of this gift (after discharge from a unit versus Valentines Day)?
- Is there a potential for other patients to have negative feelings if I accept this gift (patients who may not be able to or choose not to give gifts)?
- Have I considered the monetary value and appropriateness of the gift?
You can read more about this on page 8 of the Therapeutic Nurse-Client Relationship, Revised 2006 standard and in our Ask Practice FAQ.
The Code states that “nurses declare any conflict of interest that could affect their judgment. This includes a nurse’s personal, financial or commercial interest”. What does “conflict of interest” mean?
A conflict of interest exists when a nurse’s personal, financial or commercial interests could improperly influence their professional judgment or conflict with their duty to act in the best interest and care of their patients.
A nurse using their registration status to recommend and endorse specific products or services without providing information about other options is an example of a conflict of interest. Another example is a nurse soliciting business from their patients for a relative’s business.
It is important to keep in mind the power imbalance in the nurse-patient relationship and the trust that the public places in the nursing profession to act in its best interest. The practice standard Therapeutic Nurse-Client Relationship, Revised 2006 contains a detailed discussion of the use of trust and power in the relationship.
You can also read more about this on page 12 of the Professional Conduct: Professional Misconduct reference document.