June 06, 2024

New practice standard for discontinuing or declining care

CNO has a new practice standard: Discontinuing or Declining to Provide Care. The standard was developed to help nurses understand their accountabilities when it comes to refusal of care or discontinuing nursing service. It was approved by Council on June 6.

CNO has a new practice standard: Discontinuing or Declining to Provide Care. The standard was developed to help nurses understand their accountabilities when it comes to refusal of care or discontinuing nursing service. It was approved by Council on June 6.

Every nurse is responsible to understand and practice professional expectations when it comes to discontinuing or declining to provide care to patients. To assist with that understanding, CNO wrote a practice standard that adopted a broad principle-based framework. The framework sets out clear accountabilities that align with expectations found in the Code of Conduct and the professional misconduct regulations under the Nursing Act, 1991. This framework will help nurses navigate challenging practice situations they may face. This streamlined approach moved away from case scenarios to create a standard focused on principles and accountabilities for nurses.

“Nurses have a duty to provide care that is accessible, inclusive, culturally safe and free from discrimination,” said Catriona Mill, RN, Manager of Practice Quality.

That means nurses cannot abandon or neglect patients to whom they have a duty to provide care. In cases where nurses need to discontinue care, the new standard explains how nurses ensure patients have ongoing access to care that complies with relevant legislation, professional standards of practice and service agreements.

“This new standard provides clarity on what nurses need to know so they can ensure the safety of their patients and meet their professional accountabilities,” said Mill.

This new standard was developed in consultation with nurse and health care partners, who requested clarity on the subject in easy-to-understand language. It replaces the Refusing Assignments and Discontinuing Nursing Services guideline that was retired in 2023. The difference between the guideline and the new standard is that while the guideline provided practice considerations, the standard describes professional accountabilities applicable to all nurses in all practice settings. The new document also includes links to other standards and practice resources and a glossary with key terms.

Read the new standard now

About CNO

The College of Nurses of Ontario (CNO) is the regulator of the nursing profession in Ontario. It is not a school or a nursing association. CNO acts in the public interest by:

  • assessing qualifications and registering individuals who want to practice nursing in Ontario.
  • setting the practice standards of the profession that nurses in Ontario are expected to meet.
  • promoting nurses' continuing competence through a quality assurance program.
  • holding nurses accountable to those standards by addressing complaints or reports about nursing care.

The College was founded in 1963. By establishing the College, the Ontario government was acknowledging that the nursing profession had the ability to govern itself and put the public's well-being ahead of professional interests.

For the latest information, please see our Nursing Statistics page.

Anyone who wants to use a nursing-related title — Registered Nurse (RN), Registered Practical Nurse (RPN) or Nurse Practitioner (NP) must become a member of CNO.

Frequently Asked Questions

Go to the public Register, Find a Nurse, to conduct a search for the nurse. Contact us if you can't find the person you are looking for.

All public information available about nurses is posted in the public Register, Find a Nurse, which contains profiles of every nurse in Ontario. Publicly available information about nurses include their registration history, business address, and information related to pending disciplinary hearings or past findings.

Unregistered practitioners are people who are seeking employment in nursing or holding themselves out as being able to practice nursing in Ontario, but who are not qualified to do so. They are not registered members of CNO. Only people registered with CNO can use nursing-related titles or perform certain procedures that could cause harm if carried out by a non-registered health professional. CNO takes the issue of unregistered practitioners seriously. See Unregistered Practitioners for more information.

To ensure procedural fairness for both the patient (or client) and the nurse, the Regulated Health Professions Act requires that information gathered during an investigation remain confidential until the matter is referred to the Discipline Committee or Fitness to Practise Committee. CNO will not disclose any information that could identify patients (or clients) or compromise an investigation. See Investigations: A Process Guide for more information.

Information obtained during an investigation will become public if the matter is referred to a disciplinary hearing. If a complaint is not referred to a hearing, no information will be available publicly.

See CNO's hearings schedule, which is updated as hearing dates are confirmed. Hearings at CNO are open to the public and the media. For details on how to attend a hearing, contact the Hearings Administration Team.

A summary of allegations and the disciplinary panel outcomes can be found on the public Register, Find a Nurse. Full decisions and reasons are also available.

Where a disciplinary panel makes a finding of professional misconduct, they have the authority to reprimand a nurse, and suspend or revoke a nurse's registration. Terms, conditions and limitations can also be imposed on a nurse's registration, which restricts their practice for a set period. Nurses can also be required to complete remedial activities, such as reviewing CNO documents and meeting with an expert, before returning to practice.

For detailed information see the Sexual Abuse Prevention section.

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