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What must be reported?

Facility operators at organizations where nurses practice are required to report to CNO when there is reason to believe that a nurse has sexually abused a patient, or is incompetent, or incapacitated.

Employers are required to report the termination of, or the intent to terminate, employment or privileges for reasons of professional misconduct, incompetence or incapacity.

Reporting ensures that CNO is alerted if there is a concern that a nurse is not practising safely. It allows CNO to take action to protect the public.

The Reporting Guide for more details on mandatory reporting obligations and potential outcomes.

File a report now if you have concerns related to a nurses professional conduct or capacity.

What happens when a report is received?

When CNO receives a report from an employer or facility operator, an initial investigation is completed. With your report, CNO can evaluate the level of risk associated with the nurse's behaviour and take the appropriate steps to protect the public. Information gathered from the initial investigation, and the results of the risk tool, are reviewed by CNO’s Executive Director along with any information about the nurse CNO may have previously received. Based on this information, the Executive Director determines an appropriate regulatory response.

Not every report results in a formal investigation. Other outcomes can include a member’s formal agreement that they will comply with certain terms, a meeting with a CNO representative or Executive Director, or a direction for the nurse to engage in specific remedial activities that address the gap in practice.

Executive Director Investigations

The Executive Director will appoint an investigator after determining there are reasonable and probable grounds to believe that a member has committed an act of professional misconduct or is incompetent. CNO’s Investigations Process Guide provides detailed information about this type of investigation and the role of the investigator.

A CNO investigator may contact an employer during an investigation to request documentation or to obtain information through a witness interview. The types of documents typically requested include health records, facility policies and procedures, audit trails and internal investigation documentation. Employers and other witnesses to the incident, which may include employees, may be interviewed to provide both general practice setting information and specific information on the issues raised in the complaint. Anyone who is interviewed are expected not to discuss the incident(s) with one another.

All components of the investigation are kept confidential because this is required by our legislation.

CNO health inquiries

A facility operator must provide a written report to CNO when there are concerns about a nurse’s ability to practice safely as a result of a possible physical or mental condition or disorder.

The Health Inquiry and Fitness to Practise processes fact sheet explains the processes.

Complaints

The public has the right to express their concerns to CNO about nurses and, by law, CNO must respond to every complaint received about nursing care.

Certain types of complaints can be resolved using an alternative dispute resolution (ADR) process. This is a process where the person who made the complaint, the nurse and CNO come to an agreement to resolve a concern. When the complaint is inappropriate for ADR or if the resolution is unsuccessful, the complaint goes through the investigation process.
Please read CNO’s Addressing Complaints: Process Guide for detailed information about how CNO handles complaints.

File a complaint now if you have concerns related to a nurse's professional conduct.

Complaints investigation

The scope of a complaints investigation is defined by the issues and concerns identified in the complaint. CNO’s Investigations Process Guide describes the process by which information is received, assessed and investigated.

Similar to the reports investigation, a CNO investigator may contact an employer during the complaints investigation to request documentation or to obtain information through a witness interview. The types of documents typically requested include health records, facility policies and procedures, audit trails and internal investigation documentation.

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

Confidentiality considerations

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

Inquiries, complaints and reports committee

The Inquiries, Complaints and Reports Committee (ICRC) reviews public complaints and reports of concern about nurses’ practice, conduct or health.

Read the ICRC web page to learn more about:

• Specified Continuing Remediation and Education Programs
• Remediation Program and Caution Orders
• Referrals to other statutory committees
• Interim Orders
• Committee members
• Year-end report

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Fitness to Practise Committee 

The Fitness to Practise Committee determines whether a nurse is “incapacitated”, as defined in the legislation, and if so, what action may be necessary to protect the public. 

Read the Fitness to Practise Committee web page to learn more about: 

• Incapacity 
• Committee members 
• Fitness to Practise rules and practice directions

Discipline Committee hearings 

The Discipline Committee holds hearings in cases where nurses have been referred by the ICRC because of the serious nature of the alleged professional misconduct and/or incompetence. 

Refer to the Discipline Committee web page to learn more about:

• Hearings 
• Testifying as a witness 
• Decision outcomes 
• Committee members 
• Committee rules and guidelines
  

Agreement or undertaking

An agreement or undertaking is a formal promise a nurse gives to CNO that they will comply with certain terms. CNO’s Monitoring team ensures that nurses maintain their compliance with the terms of the agreements or undertakings. 

Undertakings that are public are noted on the nurse’s profile on CNO’s public register, Find a Nurse.

CNO’s Monitoring team ensures that nurses are following through with the decisions from CNO’s statutory committees and undertakings.

Examples of outcomes that are monitored include: 

• agreements or undertakings between a nurse and CNO; 
• nurses whose certificates of registration have been surrendered, suspended or revoked; 
• nurses whose certificates of registration are subject to terms, conditions or limitations; and 
• completion of Specified Continuing Remediation and Education Programs (SCERP) and/or attendance at cautions. 

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

Examples of common terms imposed on a nurse’s certificate of registration that employers may have involvement with: 

1. The nurse may not engage in independent practice or work for an agency.
   A nurse may not be employed in any position where their practice, performance and/or conduct cannot be directly observed and monitored on an ongoing basis. This includes 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 setting where they have access or are exposed to controlled substances/narcotics. 
3. The nurse must inform CNO of all nursing employers.
   The nurse is required to notify CNO of all nursing employer(s) they are working for. 
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 before they return to practice so that the employer can make the appropriate arrangements in preparation for the nurse’s return to work. 
5. The nurse requires workplace monitoring. 
   Workplace monitoring requirements are specified in each nurse’s order, 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. When choosing workplace monitors, consideration should be given to potential conflicts of interest, such as personal relationships between colleagues or seniority of the nurse being monitored. Generally, the monitor is not required to shadow the nurse at all times, but is required to be available to the nurse during their shift for consultation and observation. If a nurse is required to be shadowed at all times, this will be specifically noted as ‘direct supervision’. 
6. The nurse must be supervised by another member of CNO. 
   Employers must ensure that the supervisor assigned to the nurse for consultation and observation is a member in good standing. The supervisor does not need to shadow the nurse at all times unless this is specified in the term as ‘direct supervision’. 
7. The nurse must inform her employer that they are the subject of a CNO investigation. The nurse must also obtain a written statement from their employer confirming they have been informed and they agree to notify CNO’s Director of Professional Conduct if the nurse has breached the standards of practice of the profession. 
   The nurse is required to inform employer(s) that they are being investigated by CNO due to reported concerns. The nurse is not required to inform their employer of what the concerns are or any information about the progress of the investigation. The employer must sign a form that is returned to CNO confirming their knowledge of the investigation and stating that the nurse has fulfilled their reporting obligation. The employer(s) will also agree to report any ongoing concerns to CNO. 

How to contact the monitoring team

Email: monitoring@cnomail.org

Find a Nurse is an easy-to-use online Register that provides information to the public and employers about nurses in Ontario. Definitions of the information contained on Find a Nurse are available here. 

CNO maintains information on the public register in accordance with the Health Professions Procedural Code (Schedule 2) of the Regulated Health Professions Act, 1991 (RHPA) and CNO By-Law 44.1. 

Employers that hire nurses are expected to check Find a Nurse to confirm a nurse’s ability to practice in Ontario. 

Nurses are required to annually renew their registration in order to practice, and employers should confirm all nurses employed continue to be registered. 

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

Employer notification of updates to practice information on find a nurse

Employers are notified by CNO of any updates to a nurse’s profile in Find a Nurse when: 

• a nurse has been referred to the Discipline Committee; 
• a nurse’s certificate of registration is suspended or revoked; 
• a nurse becomes subject to public terms, conditions or limitations relating to their employment; or 
• when a nurse voluntarily surrenders their certificate of registration to CNO. 

This information is provided to the employer’s Human Resources department. If a Human Resources department does not exist, a senior executive (Executive Director or Director of Care) of the organization is notified. Employer(s) will receive verbal notification by telephone and/or written notification through regular mail or email. 

Employers wanting to designate a specific individual to receive these notifications should provide the individual’s name, title and contact information to the Monitoring team by email to monitoring@cnomail.org. Contact information should include a confidential telephone and fax numbers (including extension), mailing address and/or email address. 

Other than what is available on Find a Nurse, CNO is not able to provide any information to employer(s) without the nurse’s written consent.

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

Am I required to report a nurse who is not complying with the vaccination policy at my institution?

CNO's mandate is to protect the public. We achieve this by partnering with employers, facility operators, nurses and those who work with nurses. Patient safety is a collective responsibility.

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 assist you in making your decision whether to report a nurse to us. The CNO reporting guide speaks to your legal reporting obligations as well as to your professional accountability to report when you believe a nurse poses a serious risk to patient safety.

You can visit CNO’s website or review the reporting guide.

Why is CNO calling me requesting information about a nurse’s practice?

CNO is legally obligated to follow up on every report or complaint received about a nurse regardless of its source. We contact current or recent employers to gather information and obtain a complete picture of a nurse’s practice so that CNO’s Executive Director can determine what the appropriate regulatory response is.

If CNO calls me about a nurse, does that mean the nurse is under investigation?

No. If a CNO investigator calls to make general inquiries about a nurse, it does not necessarily mean that the nurse is under investigation.

If CNO contacts me about a nurse’s practice, should I be concerned? Are the patients at my facility safe?

CNO is unable to disclose any specific information regarding the nature of the information 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.

Can I be sued by a nurse for violating their privacy and confidentiality by providing information to CNO?

Section 85.6 of the Regulated Health Professions Act, 1991states “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 require further information about your obligations, please consult with your legal counsel.

I submitted a mandatory report form to CNO, but have not received any information about the progress of the matter. Why can’t CNO provide more information to me?

ll of the information related to a mandatory report is kept confidential in accordance with legislation. A CNO investigator will contact you, or your organization to gather additional information if required. All documentation relevant to the reported matter should be kept by you in accordance with your organizational policies and as required by legislation.

I have been contacted by CNO to assist in identifying a nurse in relation to a complaint. Should I inform the nurse?

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. The College expects all parties to keep discussions about ongoing processes confidential.

My employee has told me they are under investigation or has been referred to the Fitness to Practise but is not subject to any terms, conditions or limitations. How can I know they are safe to practice while waiting for the outcome of this matter?

The Inquiries, Complaints and Reports Committee (ICRC) has the authority to impose an interim suspension or restrictions on a nurse’s certificate of registration at any time while under investigation. The ICRC considers all of the information that has been gathered during an investigation. If the ICRC 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 order an interim suspension or terms conditions and limitations to be imposed until the outcome is decided. No additional information can be provided to the employer other than what is available on the public register.

I discovered on the public register that my employee’s certificate of registration is subject to terms, conditions or limitations. However, the nurse has not reported this to me. What should I do?

When a nurse’s certificate of registration becomes subject to terms, conditions or limitations, the nurse is required to ensure they are practising 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 are employing a nurse whose certificate of registration is subject to terms, conditions or limitations and you have information suggesting the nurse is not practising in accordance with those terms, please contact CNO’s Monitoring team at monitoring@cnomail.org.

My employee has asked me to sign an Agreement to confirm they are practising in accordance with the terms, conditions and imitations imposed on their certificate of registration. Why do I have to sign this Agreement? What are my obligations? What are the obligations of the nurse?

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, ensuring the nurse has no access to narcotics or has a workplace monitor in place. CNO may contact the nurse’s designated supervisor by telephone or in writing to obtain information if necessary. Although employers are requested to support nurses with these terms, the responsibility to comply with the terms rests with the nurse.

I employ a nurse with a history of substance use/abuse. How can I ensure they are practising safely?

As an employer, you are accountable to ensure all nurses are practising safely at all times. If terms are imposed on a nurse’s certificate of registration, it is your obligation to ensure you have made appropriate arrangements in the workplace to support the nurse’s practice. You are also required to report concerns about practice or behaviour to CNO.

Will I be notified when a nurse’s certificate of registration is no longer suspended or subject to terms, conditions and limitations?

No. CNO will not conduct employer notifications when a suspension or terms, conditions or limitations are removed from a nurse’s certificate of registration. Employers can view 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 their employer.