New report offers insights into making all nurses’ experiences with CNO more equitable
The College of Nurses of Ontario (CNO) has released its first-ever Workforce Census: Experiences with CNO Report. This report explores how nurses from diverse communities experience CNO’s regulatory processes and equity initiatives.
This important work supports CNO’s public protection purpose and upholds our commitment to CNO’s multi-year Equity Strategy by implementing meaningful actions that will make engagement with CNO more equitable for all nurses.
“We are committed to learning about nurses’ diverse lived experiences, so that we can effectively continue supporting them in providing safe patient care. To deliver on this commitment, we conducted a groundbreaking census that sheds light on equity gaps that need our attention in nursing regulation,” said Silvie Crawford, CNO’s Registrar & CEO.
About the census and collecting the data
In 2024, CNO conducted our first-ever voluntary Workforce Census. CNO is grateful to everyone who contributed to putting together the census, including, the Indigenous Primary Health Care Council, Canadian Black Nurses Alliance, Pan-Canadian Association of Nurses of African Descent (Ontario Black Nurses’ Network and Canadian Black Nurses Network), and the Registered Nurses’ Association of Ontario’s (RNAO) Black Nurses Task Force.
We received over 31,000 survey responses. The feedback offers important perspectives that will help guide our future work.
“Thank you to everyone who participated in our census and contributed to these results. We appreciate your openness in sharing your personal experiences and value every perspective,” said Brent Knowles, Director, Analytics & Research.
As with all voluntary surveys, these results reflect the opinions of those who chose to participate and should not be generalized to the entire profession. The feedback, however, provides important insight into how some nurses perceive CNO’s regulatory and equity activities, and highlights opportunities.
Key findings
Overall, nurses expressed strong support for the importance of equity, alongside concerns about consistency and fairness across some regulatory processes.
- Nurses reported broad support for CNO’s diversity, equity and inclusion (DEI) initiatives, with 80% acknowledging the importance for CNO to understand diverse perspectives and experiences. Support was especially strong among internationally educated nurses (IENs) at 86%, women (80%) and those identifying outside the gender binary (91%).
- Survey results also showed 58% of respondents agreed CNO understands the importance of DEI. Also, about 67% felt CNO has explicitly condemned racism and discrimination. However, nurses under the age of 45, IENs, racialized groups, LGBQA+ individuals and nurses with one or more disabilities, were more likely to perceive gaps in CNO’s commitment to equity.
Please note that transgender is not included in the LGBQA+ acronym as gender was asked as a separate question from sexual orientation. The term Two-Spirit is also not included as Indigenous data will be released in a later publication. This work will be guided by Indigenous Peoples, Indigenous data experts and researchers to maintain cultural integrity and support respectful interpretation of the findings.
- The findings also indicated Black nurses, male nurses and nurses with one or more disabilities have self-reported disproportionate involvement in the professional conduct process compared with other groups. Some respondents in these groups said they felt frustrated with the process, expressing perceived bias and ableism as possible contributing factors. Respondents have expressed the need for greater transparency from CNO in professional conduct and fitness-to-practice decision making.
- Overall, about 72% of respondents felt CNO’s registration process is equitable. However, nurses who identified outside the gender binary, racialized individuals, LGBQA+ individuals and nurses with one or more disabilities reported lower levels of perceived equity.
- Nurses with one or more disabilities reported perceiving barriers to their registration and renewal processes, such as lack of support and resources.
Our next steps and actions
While collecting, analyzing and reporting on this data is an important first step, this work’s objective is to inform and guide sustainable change.
“We are dedicated to taking meaningful actions in response to these findings,” Crawford said. “We look forward to sharing these insights with our health system partners and exploring new ways CNO can integrate diverse perspectives of equity-deserving groups and Indigenous Peoples into our work.”
As we work toward strengthening our processes and improving inclusivity for all nurses, CNO will also introduce expanded gender identification options for applicants. We will implement a new policy to make it easier for nonbinary and gender non-conforming nurses to update their legal names on the public register, helping protect their gender identity and expression.
We will continue to encourage nurses to report any equity-related issues impacting their practice to CNO during investigations. In addition, we will explore adding data collection points to the complaints process to gain deeper insight into complainant demographics.
Going forward, we will also develop knowledge translation plans to integrate findings into CNO’s work and share these data-driven insights with our system partners to influence change in the broader health care system.