I recently retired from my job as a community health RPN and started a voluntary position as a board member at my local hospital’s Quality and Risk committee. I’d love to maintain my RPN designation with CNO, which I’ve held for 35 years, but I’m not sure if I’m practicing nursing in this role. Should I renew my registration in the General Class or move to the Non-Practising Class?
Thank you for your question. Deciding whether to renew in the General Class or move to the Non-Practising Class is a very personal decision that requires careful consideration.
First, it’s important to understand CNO does not have a list of jobs, roles or activities considered to be nursing practice. Nursing practice is diverse and not defined by your role, title, practice setting or the activity you may be performing. Additionally, practicing nursing isn’t the same as being employed as a nurse in clinical, non-clinical or volunteer roles. This means if you volunteer as a nurse, then you are practicing nursing.
CNO can’t determine whether you’re practicing nursing in your role—this is something you must self-declare. As a reflective health professional, you’re in the best position to decide if you’re practicing nursing. To help you with this, we have developed an FAQ titled “Am I Practicing nursing in my new role?” Here are some questions to consider:
- Are you using your nursing knowledge, skill and judgment in your role?
- Do you have a direct or indirect effect on health care systems in your role?
- Are you conveying to the public or your colleagues that you are a nurse in this role?
- Based on your role, title and how you present yourself, would people expect you to use your nursing knowledge or skill in your interactions with them?
If, after answering these questions, you determine you are practicing nursing, you must remain registered in the General Class and use your protected title (e.g., nurse, RPN). You also will remain accountable to CNO and to the public as an RPN and are accountable to CNO’s Standards and Guidelines, including participation in the Quality Assurance Program.
If you determine you’re not practicing nursing in your role, you can move to the Non-Practising Class or resign from CNO. Moving to the Non-Practising Class allows you to maintain your RPN registration with CNO, but you cannot practice nursing or present yourself as qualified to practice nursing in Ontario. If you’ve resigned your membership or moved to the Non-Practicing Class, you can reinstate your membership in the General Class if certain requirements are met. You can read more about this process on our Reinstatement page.
I hope this helps you make a decision. All the best in your new volunteer role!
Dina Vaidyaraj RN, BScN, MN
Advanced Practice Consultant, Practice Quality
I was helping another nurse provide personal hygiene care to a newly admitted patient. The other nurse made a sexualized joke toward the patient about the size of their breasts. The patient did not say anything about it, so I am not sure they heard it. Do I need to report this to CNO?
Thank you for your question about this important topic—sexual abuse. Sexual abuse can be a difficult topic. This makes it even more important to ask questions and learn about it, including how sexual abuse can occur in the nursing profession. Increasing knowledge about sexual abuse helps us understand better what contributes to nurses sexually abusing patients and leads to developing strategies to prevent it happening.
All nurses, regardless of their role or practice setting, are accountable to nursing standards of practice. This includes the Code of Conduct, which states that nurses act with integrity in the patient’s best interest. Nurses do so in part by establishing and maintaining professional boundaries with patients. In the scenario you described, the nurse crossed a professional boundary when they made a sexualized joke toward the patient.
When a nurse engages professionally with a patient, they establish a therapeutic relationship (see Therapeutic Nurse-Client Relationship). This relationship exists regardless of the context or length of the interaction. In the scenario you described, the nurse is in a therapeutic relationship with the newly admitted patient and, importantly, an individual is considered to be a nurse’s “patient” for one year following the end of the therapeutic nurse-patient relationship.
The therapeutic nurse-patient relationship is based on trust, respect, empathy, professional intimacy and power. In this relationship, nurses hold a position of power by virtue of having authority and influence in the health care system, specialized knowledge and skills patients rely on, access to patients’ bodies and access to privileged information. Abuse occurs when a nurse misuses their position of power. There are multiple forms of abuse. Abuse may be verbal, emotional, physical, sexual, financial or take the form of neglect. Let’s focus here on sexual abuse.
Section 1(3) of the Health Professions Procedural Code, Schedule 2 of the Regulated Health Professions Act, 1991, defines sexual abuse of a patient by a member, meaning a nurse or other regulated health professional, as
(a) sexual intercourse or other forms of physical sexual relations between the member and the patient,
(b) touching, of a sexual nature, of the patient by the member, or
(c) behaviour or remarks of a sexual nature by the member toward the patient.
Preventing sexual abuse is everyone’s responsibility. In Ontario, there is zero-tolerance for patient sexual abuse by health care professionals. Sexual abuse of a patient is an act of professional misconduct and results in a reprimand and either a suspension or, for certain acts of sexual abuse, mandatory revocation of a nurse’s certificate of registration. Nurses are trusted members of the health care team and their first priority is to protect the patient from harm.
Nurses, other regulated health care professionals, nurse employers and individuals who operate a facility where nurses work have legal obligations to file a report with the CNO about any sexual abuse.
In this scenario, it does not matter that the patient did not respond to the nurse’s inappropriate joke or comment.
- Due to unequal power in the nurse-patient relationship, the patient may not feel comfortable voicing their discomfort about the nurse’s inappropriate joke or comment.
- As a nurse, you have a legal obligation to report your colleague to CNO because the sexualized joke or comment they made, as defined by law, is sexual abuse.
- Patients who have been named in a sexual abuse report can apply for funding for therapy from CNO.
- Community support services are also available for people who have experienced sexual abuse and those seeking information about sexual abuse.
If you have concerns about the practice or conduct of a nurse, you can file a report online or send the completed report form to our Professional Conduct department at Investigations-Intake@cnomail.org.
Emily Marcogliese, RN, PhD
Advanced Practice Consultant, Practice Quality