Employers of nurses play an important role in working with the College of Nurses of Ontario (CNO) to protect the public by promoting safe nursing practice.

This page provides information for employers about their role and responsibilities when:

  • they are required to file a report about a nurse they employ or want to file a non-mandatory report
  • there are concerns about a nurse's ability to practice nursing safely
  • a nurse they employ is named in a report or complaint to CNO
  • a nurse has terms, conditions or limitations imposed on their certificate of registration or may no longer practice

Filing a report

Reporting supports patient safety and public trust in nursing care. When a report is made, it alerts CNO that there may be a concern about a nurse's practice. This allows us to take appropriate steps to protect the public. In certain circumstances, employers have a legal obligation to submit a report to CNO.

Please visit these pages to learn about when you should file a report, and how to do that.

Complaints about a nurse

Anyone has the right to express their concerns to CNO about a nurse. By law, CNO must respond to every complaint we receive.

Visit these pages to learn more about the complaint process.

Investigation of reports or complaints: Employer and witness interviews

After a report is filed with CNO, the Registrar will appoint an investigator if she believes on reasonable and probable grounds that a nurse has committed an act of professional misconduct or is incompetent.

After CNO receives a complaint, the scope of an investigation is defined by the issues and concerns in the complaint.

CNO’s Investigations Process Guide describes CNO's process for receiving, assessing and investigating information about a report or complaint.

An investigator may contact an employer during a report or complaint investigation to request documentation or to obtain information through a witness interview.

The types of documents requested depend on the nature of the report or complaint. Some commonly requested documents include:

  • health records
  • facility policies and procedures
  • audit trails
  • internal investigation documentation

Employers may be interviewed to provide both general practice setting information and specific information on the issues raised in the report or complaint.

The investigator may interview employers, employees and other witnesses who can provide relevant information about the issues, events or practice setting. Those who are interviewed are instructed not to discuss the information they provided with one another or other potential witnesses, to maintain the integrity of their evidence and the investigation process.

Confidentiality of complaint and report processes

Information related to a CNO complaint or report is kept confidential as required by legislation. A CNO investigator will contact you if more information is required. Employers are expected to keep the details of all correspondence with the investigator confidential.

Following through on the outcomes of report and complaint processes

At the end of the report or complaint process, CNO’s Monitoring team ensures that nurses are following the requirements of statutory committee decisions and agreements and undertakings. The Monitoring team follows up on matters addressed by the Inquiries, Complaints and Reports Committee, which oversees all CNO investigations, as well as matters involving the Registration, Quality Assurance, Discipline and Fitness to Practise committees.

Monitoring team staff become involved when, for example: 

  • a nurse has an agreement or undertaking to complete remedial activities
  • a nurse has an agreement to practice subject to terms, conditions or limitations, or to cease practice, until certain conditions are met
  • the Inquiries, Complaints and Reports Committee has required the nurse to complete a specified continuing education or remediation program (SCERP) and/or attend for a caution
  • a CNO committee has directed terms, conditions or limitations on, or suspension or revocation of, a nurse’s certificate of registration

Monitoring activities may include gathering documentation and conducting calls with the nurse, employers, health care professionals treating the nurse, supervisors and/or regulatory experts.

Employer responsibilities when a nurse has terms, conditions or limitations imposed on their certificate of registration

Here are some examples of common terms imposed on a nurse's certificate of registration that may affect you as their employer: 

  1. The nurse may not engage in independent practice and/or work for an agency.
    A nurse may not be employed in any position where their practice, performance and conduct cannot be directly observed and monitored on an ongoing basis. This may include self-employment, employment through an agency and community care nursing.
  2. The nurse may not access or administer controlled substances/narcotics.
    The nurse may not work in a role that can access or administer controlled substances/narcotics.
  3. The nurse must inform CNO of all nursing employers.
    The nurse is required to notify CNO of all nursing employers after starting or resuming employment in a nursing position. The employer must sign a form and return it to CNO. The form confirms that the nurse has fulfilled their reporting obligation and includes an agreement that the employer will notify CNO if they have new concerns.
  4. The nurse must inform their employer of the committee order or undertaking and what practice restrictions they are subject to.
    The nurse is required to notify their employer(s) of the terms imposed on their certificate of registration so that their employer can make the appropriate arrangements for the nurse's return to work.
  5. The nurse requires workplace monitoring and/or supervision. 
    Workplace monitoring and/or supervision requirements are specified in each nurse's decision, agreement or undertaking. The nurse must work with their employer to find a suitable position where monitoring arrangements can be made. The employer can help the nurse identify the appropriate environment and suitable workplace monitors.

The employer may be required to identify Workplace Supervisor(s) and Workplace Monitor(s). Workplace Supervisor(s) are the point of contact with CNO to ensure that we are advised quickly if it appears that the nurse is not practicing safely. Workplace Monitor(s) are colleagues who can observe changes in the nurse's practice or behaviour.

When identifying a suitable monitor or supervisor for the nurse, consider potential conflicts of interest, such as personal relationships between colleagues or relative seniority of the nurse being monitored. Generally, the monitor or supervisor is not required to stay with the nurse at all times but is required to be available to the nurse during their shift for consultation and observation. If the nurse's decision, agreement or undertaking requires that the nurse be observed at all times, this will be specifically noted as "direct supervision".

How to contact the monitoring team

Email: monitoring@cnomail.org

Public Register: Find a Nurse

Find a Nurse is an easy-to-use online register that provides information to the public and employers about nurses in Ontario.

When you hire nurses, you are expected to check Find a Nurse to confirm the nurse's ability to practice in Ontario. Nurses are required to renew their registration annually, and you should confirm that all nurses you employ continue to be registered. If you employ a large number of nurses, you can use CNO's Nurse Renewal Check to help with this process.

If there are any discrepancies in the information available on Find a Nurse, contact CNO so that information can be updated. 

Notifying employers about changes to a nurse's profile on Find a Nurse

CNO notifies employers of any updates to our public registry, Find a Nurse, for a nurse they employ when the nurse:

  • is referred to the Discipline Committee
  • has their certificate of registration suspended or revoked
  • has public terms, conditions or limitations placed on their certificate of registration or
  • voluntarily surrenders their certificate of registration to CNO or enters an undertaking to cease practice until certain conditions are met

We provide this information by phone and/or in writing to the employer's human resources department, or a senior executive (Executive Director or Director of Care) if there is no human resources department.

If you want to designate a staff member to receive these notifications, provide their name, title and contact information by email to monitoring@cnomail.org. Contact information should include confidential telephone and fax numbers (including extensions) and a mailing address and/or email address. 

CNO cannot provide any information to employers without the nurse's written consent, apart from what appears on Find a Nurse.

Employer FAQs

This section aims to answer some questions commonly asked by employers.

Being contacted by CNO

CNO is legally obligated to follow up on every complaint received about a nurse. We also receive both mandatory and voluntary reports from employers, health care professionals and others about nurses’ conduct. We often contact current or recent employers and consider this and other information to determine an appropriate response to a report.

If a CNO investigator calls to make inquiries about a nurse, it does not necessarily mean that the nurse is under investigation.

Because of the confidentiality requirements in our legislation, CNO cannot disclose any specific information regarding the nature of the information we received. Inquires at this stage are confidential between the nurse and CNO. However, all public outcomes are posted to the nurse’s profile on the public register, Find a Nurse.

Section 85.6 of the Regulated Health Professions Act, 1991 states: “No action or other proceeding shall be instituted against a person for filing a report in good faith under section 85.1, 85.2, 85.4 or 85.5.” If you are concerned about this, please consult with your legal counsel.

No. CNO has a clearly defined process for notifying a nurse that a complaint has been filed against them. CNO will provide them with information about the complaints process. We expect all those involved or contacted to keep discussions about ongoing processes confidential.

Employees under investigation

All of the information related to a mandatory report is kept confidential as required by legislation. A CNO investigator will contact you or your organization to gather additional information if we need it. You should keep all information relevant to the reported matter according to your organizational policies and as required by legislation.

If the Inquiries, Complaints and Reports Committee has enough information to believe that the nurse’s physical or mental state exposes, or will likely expose, patients to harm or injury, they can impose an interim suspension or interim terms, conditions or limitations on the nurse’s certificate of registration until the outcome is decided. They can do this at any time after CNO receives a complaint or report. Under the legislation’s confidentiality requirements, we cannot provide any information to you that is not available on the public register.

Employees with terms, conditions and limitations on their certificate of registration

When a nurse’s certificate of registration becomes subject to terms, conditions and limitations, the nurse must practice in accordance with those terms. This always includes providing information to their employer so that appropriate arrangements can be put in place. Failure to comply with the terms could be considered professional misconduct and needs to be reported to CNO. If you employ a nurse who you believe is not practicing in accordance with their terms, please contact CNO’s Monitoring team at monitoring@cnomail.org.

When a nurse becomes subject to employment-related terms that require monitoring, the employer will be asked to sign a form agreeing to support the nurse’s completion of the terms. For example, you may need to ensure that the nurse has no access to narcotics or has a workplace supervisor and monitor in place. CNO may contact the nurse’s designated supervisor by telephone or in writing to obtain information if necessary. Although we ask employers to support nurses with these terms, the nurse is accountable to comply with the terms.

No. CNO will not notify employers when a suspension or terms, conditions or limitations are removed from a nurse’s certificate of registration. You can find updated information on Find a Nurse. The nurse is advised about the removal of terms and may choose to provide a copy of CNO’s correspondence to you.

Safe practice concerns

As an employer, you are accountable to ensure that all nurses are practicing safely at all times. If terms are imposed on a nurse’s certificate of registration (such as ensuring that they don’t have access to controlled substances), you are obligated to make appropriate arrangements in the workplace to support the nurse’s practice. You are also required to report concerns about their practice or behaviour to CNO.

There are many reasons why an employer or facility operator would report a nurse to CNO. We encourage you to use our reporting guide to help you decide whether to report a nurse to us. The CNO reporting guide describes your legal reporting obligations as well as your professional accountability to report when you believe a nurse poses a risk to patient safety.