Guiding change

The CNO’s Council — its board of directors — sets the direction for regulating nursing in the province. Council members make decisions and recommendations based on evidence. They work to ensure safe nursing care and public trust.

In 2016, Council achieved this by:


President’s message

Our focus is firmly on the public's safety.

A theme throughout my time on CNO’s Council has been the need for more public and nurse engagement to guide our decision-making. I’m pleased to say that in 2016 we received unprecedented feedback on key issues from a variety of stakeholders, thanks in large part to the increased use of technology and social media. Such feedback ensures robust discussion around the Council table and provides an opportunity for you to have a direct influence on the outcomes.

Council was involved in reviewing and approving many initiatives in 2016 all of which had a strong impact on protecting the public interest. These included supporting the following areas:

  • Registration with CNO: Changes ensure appropriate mechanisms are in place to support safe nursing care as nurses begin their careers in Ontario.
  • The role of NPs: Changes that Council reviewed in 2016 (and which have since been implemented) allow NPs to provide full-spectrum care to their clients. This eliminates the need to access multiple health care practitioners, provides more continuity of care, and improves support and access for the people of Ontario.

In addition, in 2016, CNO began a comprehensive review of best practices around quality assurance. We are using evidence to develop a Quality Assurance Program that will promote nursing skills and competencies through continuous education, development and engagement throughout a nurse's career.

Council recognizes the need to lead change that reflects society's evolving expectations. It’s of the utmost importance that we be responsive and timely to current issues and trends. We know that our current governance model does not fully support these goals.

To that end, we developed a new vision for governance of CNO. Named Vision 2020 — after the year we’re looking to implement the major components of this vision — we’re now determining how to best position ourselves for the future. In the interim, as a result of the governance review, Council has already implemented changes to the way we govern, including formalizing a set of governance principles. As part of our upcoming governance changes, advisory groups will strengthen the link between the public and Council.

The governance review has put CNO at the forefront of change. Over the last year, I’ve had the privilege to represent Council on national and international levels. We’ve garnered great interest and support for our governance model from all corners of the world. I’m hopeful we’ll do the same with our review of the quality assurance process. What makes me most proud of my time on Council is knowing that we’re making the best possible decisions to ensure public protection in Ontario, and that we are also influencing discussion and decisions elsewhere.

In 2017, Council elected its first public member President in its 54-year history. With this move, Council sent a message to the public, government and all other stakeholders, affirming our commitment to our mandate to act in the public’s interest above all else — including competing professional interests. As Dalton Burger leads Council throughout the coming year, we can expect even greater accomplishments, while keeping the focus on your protection. 

Megan Sloan, RPN, RN
Council President


Governance Vision 2020

While we debated at length appropriate governance best practices for the College, the test we always used to determine if a practice was ‘appropriate or not’ was whether this practice would sustain and enhance public trust in the College. Don McCreesh, member of the task force to review Council’s governance

In 2016, Council approved a vision for how CNO should be governed by 2020. The proposed model is the result of extensive expert, evidence-based and best-practice review. It aims to promote public trust and support public confidence in nursing regulation.

This new vision will require some changes, including:

  • a 12-member board made up of six members of the public and six nurses (currently, Council is composed of 14 RNs, 7 RPNs and 14 to 18 public members).
  • board appointments that are based on members demonstrating governance competencies identified by the board (currently Council members who are nurses are elected by nurses, and public members are appointed by the government).
  • committees composed of public and professional members who are not on the board and who are appointed based on competencies related to each committee’s legislated function (currently committees are composed of Council and non-Council members).

We can only realize this vision with changes to current laws. However, Council is also looking for ways to modify aspects of governance that do not require legal changes. For example, we will seek to create a public advisory group.

Read more at Governance Vision 2020.


Committees

In addition to its governing Council, CNO also has several statutory committees. These committees are comprised of Council and non-Council members, who are nurses and members of the public. Each committee submits an annual report of its work.

By being involved on committees, the public member can provide a perspective that is different from the professionals. Once you get involved and gain insight into the enormity of the issues, the changing expectations of society, and the constant change in technology … you want to make sure that the public is well served.
Yvonne Blackwood, public member of CNO’s Council

Executive Committee (including Patient Relations Committee)

The Executive Committee provides leadership to Council, supports the efficient and effective functioning of Council and committees, and makes decisions between Council meetings.

In addition, Executive Committee members form the Patient Relations Committee. This committee reviews complaints made by the public and reports made by employers or nurses of verbal, physical, sexual and emotional abuse to patients, and of any boundary violations. A nurse crosses a boundary with a patient when their relationship changes from professional and therapeutic to unprofessional and personal.

In 2016, the number of sexual abuse reports and complaints CNO received doubled compared to the average number of reports between 2012 and 2015. The topic of sexual abuse of patients by health care professionals received significant attention in 2016. For example, the media heavily covered several sexual assault and harassment matters. In addition, the Ministry of Health and Long-Term Care released its Sexual Abuse Task Force Report.

Patient Relations Committee 2016 year-end report

Inquiries, Complaints and Reports Committee (ICRC)

You have the right to express to CNO your concerns about nurses; CNO is required to respond to all complaints about nursing care. The ICRC reviews and takes action on public complaints and other reports of concern about nurses’ practice, conduct or health. The committee assesses the information and the risk to the public, and then determines the outcome that would best serve the public.

A member of the public making a complaint can volunteer to be part of CNO’s resolution program. The purpose of this process isn’t to determine what happened or lay blame; it is to protect the public by improving nursing practice. It presents nurses with the chance to demonstrate accountability for their practice and provides you with an opportunity to work with CNO in resolving your complaint.

Very serious matters, such as complaints concerning physical or sexual abuse, are not suitable for the resolution process. In addition, we also consider a nurse’s history with CNO, and this may affect how we deal with a complaint.

In 2016, 34 per cent of all complaints made by the public were resolved through the resolution process, and 65 per cent were investigated. In addition, 51 issues were referred to the Discipline Committee, compared to an average of 31 in the previous four years. We know that maintaining the public’s confidence means addressing concerns in a way that the public and the profession can see. For example, community tolerance for the privacy of health information has changed, resulting in health professionals who access the electronic records of patients without a professional purpose receiving significant attention.

ICRC 2016 year-end report

Discipline Committee

Hearings at CNO are much like proceedings in a court of law. If the ICRC refers your complaint to the Discipline Committee, CNO will present evidence before a panel consisting of nurses and members of the public. The panel is independent of CNO, and the members’ role is similar to that of a jury. They hear evidence presented by both parties and make a ruling based on that evidence.

The Discipline Committee protects the public by determining whether nurses have committed professional misconduct or are incompetent, and, if so, determining the action that will best protect the public. Depending on the matter, the panel’s action can range from requiring the nurse to pay a fine to revoking the nurse’s ability to practise.

In 2016, the types of matters heard included those relating to sexual abuse (7 matters); physical/verbal/emotional abuse (7 matters); accessing health information without patients’ consent (7 matters); and general breaches of standards (17 matters). In 2016, 12 nurses had their registration revoked.

Discipline decisions are available on Find a Nurse and www.cno.org.

Discipline Committee 2016 year-end report

Fitness to Practise Committee

The Fitness to Practise Committee determines if a nurse is suffering from a physical or mental condition or disorder that is affecting, or could affect, their practice. If so, the committee determines if that nurse’s practice should be subject to terms, conditions or limitations, or if the nurse should no longer be permitted to practise. The committee can accept agreements where the nurse acknowledges their incapacity and agrees to undergo treatment and monitoring, or it can hold a hearing.

In 2016, a total of 82 matters came before the committee. Of these, 62 were resolved through agreements; 15 were resolved through hearings; and the remainder were resolved through either a return-to-practice process, resignation or revocation.

Fitness to Practise Committee 2016 year-end report

Quality Assurance Committee

Nursing is a complex and ever-changing profession. Nurses have an obligation to keep their skills and knowledge up to date. Nurses in every setting demonstrate their commitment to continually improving their knowledge and skills by engaging in practice reflection, and by setting and achieving learning goals. They do this by participating in CNO’s Quality Assurance Program.

The Quality Assurance Committee encourages nurses to participate in the program and addresses those instances when nurses do not comply with it.

In 2016, 832 nurses had their participation in the Quality Assessment program reviewed. By the end of 2016, 716 nurses had satisfactorily completed the practice assessment, 19 nurses were continuing to complete activities as directed by the committee, 32 nurses were granted a deferral to 2017 for extenuating circumstances, and 34 indicated they were no longer practising, chose to resign their registration or had their practice revoked.

Quality Assurance Committee 2016 year-end report

Registration Committee

The Registration Committee determines if people who want to become nurses have the knowledge, skill, judgment and character to provide safe and ethical care. To register as a nurse in Ontario, people entering the profession must meet several requirements, such as education, language proficiency and evidence of practice.

If an applicant doesn’t meet a registration requirement, the application is referred to the Registration Committee. The committee carefully reviews evidence submitted by the applicant in support of their application. To ensure the review process is fair, applicants are invited to submit personal statements, documents from verified sources, and any other information that will help the committee make an informed decision.

In 2016, the committee reviewed the applications of 1,271 people who did not meet one or more of the registration requirements.

Registration Committee 2016 year-end report

Council

Nancy Sears, RN, President (January to June)
Megan Sloan, RPN, RN, President (June to December)
Pedro Andrade, RN (June to December)
Loy Asheri, RN (January to June)
Jim Attwood, RN (January to June)
Cheryl Barnet, NP
Cheryl Beemer, RN
Yvonne Blackwood, public member
Dalton Burger, public member
Sarah Corkey, RN (January to June)
Dawn Cutler, RN (June to December)
Renate Davidson, public member
Tanya Dion, RN (June to December)
Catherine Egerton, public member
Cheryl Evans, RN
Ashley Fox, RPN
Grace Fox, NP
Joanne Furletti, RN (March to December)
Deborah Graystone, NP
Michael Hogard, RPN
Terry Holland, RPN (June to December)
Joe Jamieson, public member
Andrea Jewell, RN

Rob MacKay, public member
Mary MacMillan-Gilkinson, public member
Connie Manning, RPN
Debra Mattina, public member
Susannah McGeachy, NP (January to June)
Ashleigh Molloy, public member
Nicole Osbourne James, public member
April Plumton, RPN (January to June)
Desiree Ann Prillo, RPN
Sandra Robinson, NP (June to December)
George Rudanycz, RN
Laura Sanderson, RPN
Maria Sheculski, public member (June to December)
Nancy Sears, RN (January to June)
Megan Sloan, RPN
Margaret Tuomi, public member
Devinder Walia, public member
Cathy Ward, public member
Heather Whittle, NP
Chuck Williams, public member
Ingrid Wiltshire-Stoby, RN (June to December)