Enforcement

 

The College's commitment to the public that concerns about practice and conduct are addressed.

In 2013, the College received 285 public complaints about nurses and 993 reports. Reports come from a variety of sources, including employers, nurses, other health care practitioners and law enforcement. 

The College follows up on complaints and reports. Outcomes are highlighted in the Statistics section.

I did not want the person to lose her job. I wanted her to know and understand that as a member of the health care team she should treat everyone with respect. After all, she is in a position that treats patients when they are most vulnerable. - Public feedback about the complaints resolution process.

Listening to the public and nurses

The College addresses complaints in two ways – through the resolution process or an investigation. The resolution process allows the member of the public who made a complaint (the "complainant"), the nurse and the College to work together in addressing the issues in the complaint. It allows nurses to demonstrate accountability for their practice and supports them in making practice improvements. An investigation is launched if the issues in a complaint are not suitable for the resolution process, or if the nurse or complainant doesn't agree to a resolution. Investigations are neutral and objective, and involve the College's investigator interviewing witnesses and compiling documentation, such as client health records.

In 2013, the College asked for feedback on the complaints process from complainants and nurses involved in the process. The purpose was to find ways to improve how the College handles complaints. 

Complainants and nurses who participated in a complaints resolution told us:

  • resolution helps protect the public (69 per cent of complainants)
  • resolution holds nurses accountable for their practice (85 per cent of nurses)
  • resolution led to improved nursing practice (75 per cent of nurses).

Both members of the public and nurses were less satisfied when the complaint was investigated rather than handled through a resolution. Over one-half of the complainants and nurses were dissatisfied with how long it took to finish the investigation and over one-half of complainants did not feel they were kept informed of the progress of the investigation.

These comments will help the College identify where improvements can be made.

I don't think the CNO took my complaint seriously and didn't review the written complaint thoroughly so that they understood what had occurred. – Public feedback about the complaints investigation process I understand that nurses must be accountable for their actions and meet the highest standard of care to protect the public, but it is still a very exhausting and lengthy process before a decision is made. – Nurse feedback about the complaints investigation process

Increasing access to hearing outcomes

The College and other health care regulators work together to share information and expertise, and explore new approaches to enforcement. For example, in 2013:

  • The College, the College of Physicians and Surgeons of Ontario and the Royal College of Dental Surgeons of Ontario co-hosted a training session for individuals who act as expert witnesses at College hearings. Expert witnesses assist the panel of the Discipline Committee adjudicating a matter in a fair, objective and neutral way, and their evidence relates only to matters within their area of expertise, such as nursing ethics or a specific aspect of nursing practice. The session provided experts with strategies to assist them in providing the most relevant written reports and oral evidence. Better testimony from expert witnesses assists Discipline and Fitness to Practise panels in making good decisions. 

  • Understanding why some nurses repeat previous behaviors for which they have already faced discipline is essential to developing strategies to reduce risk. The College is working with nursing regulators from other provinces and countries on a research project to identify the factors that indicate someone who has been reported to the College will run into similar problems again. A report on the project is expected in 2014.
It was very upsetting to know that someone had made a complaint, but it did make me more aware of my nursing practice and I used it as a learning process. It also made me review the nursing practice standards and realize how important they are to my practice. – Nurse feedback about the complaints resolution process

Monitoring supports public safety

When needed to protect the public, a committee of the College will apply terms, conditions or limitations (terms) on a nurse's certificate of registration. For example, the Discipline Committee may prohibit a nurse from giving medications to clients for a period of time and require the nurse to complete remedial activities before this condition is lifted. Some terms relate to actions a nurse must take to remain in practice. For example, a nurse who is found to have a substance use problem may be required to participate in a treatment program and provide the College with proof of participation or completion.

  • Many of the matters being monitored by the College relate to members who have a health condition (i.e., an addiction or mental health issue) that is affecting their ability to practise safely. Monitoring these issues can be complex and last from three to five years. 

  • All terms are posted in nurses' profiles on Find a Nurse, the College's public register. They are available to the public and to current and potential employers.

    I understand that nurses must be accountable for their actions and meet the highest standard of care to protect the public, but it is still a very exhausting and lengthy process before a decision is made. – Nurse feedback about the complaints investigation process
  • It is important that nurses and employers understand how terms protect the public and how they are monitored. In 2013, the College worked to build awareness about monitoring and how it protects the public through features in the College’s magazine The Standard, and documents about the monitoring process for nurses who have terms that are being monitored.

In 2013, 1,072 nurses were being monitored by the College.

Access to information

The results of Discipline Committee hearings are available on the College's website. Full-text versions of disciplinary panel decisions and reasons are also included on a nurse's profile in Find a Nurse. Because discipline decisions help nurses and others understand what actions and practices are not acceptable and why, summaries of the decisions and reasons are also published in The Standard, the College's magazine for nurses. Back issues are available on the website.

To allow greater access to discipline decisions, the College is now posting them on the Canadian Legal Information Institute’s website (CanLii). Decisions on CanLii are available to anyone and can be searched using key words. 

Number of matters monitored by the College in 2013 Registration: 16 Quality Assurance: 24 Inquiries, Complaints and Reports: 240 Discipline matters: 218 Fitness to Practise matters: 574