The following scenarios are designed to help you understand when employers are required to report a nurse to CNO.
Reporting incapacity: Scenario One
Brenda, a nurse on an ICU, is suspected by her manager of having a drug abuse problem and of diverting medication from the unit for her own use.
Reasons for suspicion:
- she frequently asks co-workers to co-sign for wastage they have not witnessed
- she treats her clients with higher dosages of PRN pain medication than other nurses’ clients
- she takes lengthy breaks during shifts and above-average sick time
- she acts loud and boisterous one moment and withdrawn the next
Brenda’s partner has expressed concerns to the manager about Brenda’s health. When asked, Brenda denied that she has any health issues.
Does the facility operator have an obligation to report the manager’s concerns to the College?
Response
The facility operator must report to CNO because there are reasonable grounds to believe that Brenda is incapacitated. “Reasonable grounds” means that the belief is supported by reliable information, not just suspicion or gossip.
There are two components to the definition of incapacity in the Regulated Health Professional Act, 1991:
- the member must have a physical or mental condition and
- the condition must warrant restrictions (or a prohibition) on the member’s practice.
There are several indications that Brenda may have a health condition affecting her practice. The facility should determine whether these indicators suggest that Brenda meets both requirements of the definition of incapacitated in the legislation.
Brenda does not need to admit that she is incapacitated. Nor does the facility operator have to “prove” the concerns are true before the obligation to report arises.
Reporting incapacity: Scenario Two
Paul, a nurse at a retirement facility, is being treated for bipolar disorder. The owner of the facility has never had any concerns with Paul’s practice, conduct, or his relationships with his nursing colleagues or clients.
Paul has had some short-term absences, which were supported by his physician, but he has always returned to work in good health.
Is the facility operator required to report Paul’s condition, even though there have been no practice issues?
Response
The facility operator is not required to report Paul’s condition to CNO.
There are two components to the definition of incapacity in the Regulated Health Professional Act, 1991:
- the member must have a physical or mental condition and
- the condition must warrant restrictions (or a prohibition) on the member’s practice.
Paul’s health condition has not affected his nursing practice. Paul also removes himself from practice when necessary. Therefore, the facility likely has no reason to believe that he is incapacitated as defined in the legislation, and they are not required to report him to CNO.
Reporting incompetence: Scenario One
Stacy is a new graduate nurse working in the general medicine unit. She has been working on a probationary basis for the past three months.
During this time, Stacy has made several serious medication errors. Despite going through remediation and working buddied shifts with senior nurses, Stacy recently made another medication error.
Stacy takes accountability for her errors and states that she sometimes has difficulty concentrating. Her employer decides to terminate Stacy due to her unsafe practice, but they do not want to report her to CNO out of fear that it may jeopardize her nursing career.
What should the employer do?
Response
Stacy’s employer is required to alert CNO that Stacy is not practicing safely and report details about her termination.
Under the Regulated Health Professions Act, 1991, employers are obligated to report to CNO the termination or the intent to terminate a nurse’s employment for reasons of professional misconduct, incapacity or incompetence.
It is important to recognize that the mandatory reporting is not intended to punish nurses, but to ensure public safety while supporting nurses to return to safe practice where possible.
Reporting sexual abuse: Scenario One
A patient told the day shift nurse that the night nurse, Andrew, had touched her inappropriately while providing care. The day shift nurse informed the manager. Andrew was immediately put on leave pending an investigation.
This is the first complaint a patient has ever made about Andrew’s practice or conduct in nearly a decade at the facility. Andrew’s performance reviews say that he is an excellent nurse who is a strong advocate for his patients.
Does the employer have to report Andrew before their internal investigation is completed? What if the employer’s investigation finds no cause for concern?
Response
The incident must be reported within 30 days, even if the employer’s investigation is not complete.
All members of regulated health professions, including employers and nurses, have an obligation to report to the relevant regulatory body if there are grounds to believe that a patient has been sexually abused by a health care professional.
This means that if you have received information from any source that a patient described a specific incident of sexual abuse, you must report the incident to CNO within 30 days.
The obligation to report doesn’t depend on the outcome of the facility or employer investigation. The report should be made as soon as possible. Reporting to CNO does not mean that you are determining that sexual abuse has occurred; you are reporting that it may have occurred.
CNO has an obligation to assess and determine the appropriate response to the reported information, in the public interest.
Reporting sexual abuse: Scenario Two
An Executive Director of a community hospital recently discovered that a nurse on the step-down cardiac unit has started a relationship with her patient. The Executive Director has obtained screenshots of their interactions on social media. The nurse and the patient both deny this relationship.
What is the Executive Director’s accountability as this nurse’s employer and the facility operator?
Response
In this case, the Executive Director has a legal obligation to report to CNO that a nurse has sexually abused a client.
According to the Protecting Patients Act, 2017 (Bill 87), any sexual contact between a nurse and a patient — or a former patient within one year following the end of the therapeutic nurse-client relationship — is sexual abuse. It does not matter whether the patient consented to the sexual acts. This accountability is also outlined in the Code of Conduct.
Facility operators and other regulated health professionals are accountable for reporting incidents of sexual abuse to CNO within 30 days.
Non-mandatory reporting: Scenario One
A nursing home administrator received several complaints from patients and staff that Nurse Jim is rude and disrespectful. Jim is otherwise competent in his clinical practice.
The nursing home administrator asks Jim to complete a learning plan and review the Professional Boundaries and Nurse-Client Relationships practice standard. The employer has no intention of terminating Jim.
Is the nursing home administrator obligated to report Jim’s unprofessional behaviour to CNO?
Response
In this case, the nursing home administrator may choose to file a non-mandatory report to CNO.
In situations where reporting is not obligatory, it is sometimes difficult to decide whether to report concerns to CNO.
Employers are responsible for determining whether remediation is warranted and should assess the outcomes. However, if concerns remain, it may be appropriate to submit a report to CNO.
Rude and disrespectful behaviour does not fall under the requirements of mandatory reporting (unless the nurse has been terminated). But Jim’s behaviour does not align with nurses’ accountabilities to conduct themselves in ways that promote respect for the profession and provide the best possible care for patients. These accountabilities are outlined in the Code of Conduct.
All reports, including non-mandatory reports, are reviewed by CNO. We will assess the level of risk the reported incidents could pose to the public and determine an appropriate regulatory response.
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