Social Media - Ontario Nurses' Association

President’s MessagevisionLeading in regulatoryexcellencemissionRegulating nursing in thepublic interestTo tweet or not totweet: It is a matter ofprofessional judgmentThis is my first column as the new Council president. I’m excited about this new roleand the opportunities it gives me to use my experiences as a Council member, nurse andeducator to support the work of Council.Council members spend many meetings deciding on changes to regulations or settingstrategic priorities. They also take time to learn about issues currently affecting theprofession and the public.For example, recent College research found that 60 per cent of Ontario nursesuse social networking sites. To learn more about social networking in a regulatedenvironment, Council members participated in a workshop in September. Not only didthis education help me in my role on Council, it also led me to think about how I usemy professional judgment in both my work and personal life.Social networking technology gives us new possibilities for connecting with widegroups of people, but it also presents unprecedented risk to our clients, colleagues andthe public’s trust in us. It is easy to be fooled into thinking your Facebook or blogposting is secure or private, but with the push of a button a message intended for a selectgroup can reach many other people. It is important to think about what we post online:is it an opportunity to spread important information, or is the material personallyembarrassing? Does the message break a trusted relationship with a client?In my career—I am an ER nurse and an educator at two colleges—I have seen“new” technology come and go. Professionalism however, never changes. As regulatedhealth professionals, our first priority is to our clients and to protecting the therapeuticrelationship. We also have an obligation to our employer and to our profession.The College can provide you with information and guidance. The practice standardscover important topics such as the therapeutic nurse-client relationship and maintainingconfidentiality. And read the cover article in this issue (page 10). It features interviewswith three Ontario nurses who use social media in their practice, and looks at how theCollege’s practice standards offer relevant and practical guidance on the professional useof social media.Your employer can support you by providing guidelines, processes and rules that willhelp you use social networking to its full advantage.But these are only resources. In the end, how you behave on social networks is yourdecision. You have the education and the experience to be a member of a regulatedprofession with all the privileges and accountabilities that come with that role. By usingyour professional judgment, you can be sure you are making a decision that will protectyour clients and promote public confidence in the nursing profession.Kris Voycey, RNPresident6 College of Nurses of Ontario the standard Fall 2011

NEWSPhoto: CNONew College DirectorIn July, Janet Anderson, RN becamethe College’s Director of Practice andRegulatory Policy.In her new role, Anderson providesstrategic leadership to the College in theareas of Entry to Practice, RegulatoryPolicy, Practice Standards and QualityAssurance.Since joining the College in 2003,Anderson has managed, in succession,the Practice and the Quality Assuranceteams.A registered nurse, Anderson has 28years of experience in a variety ofleadership roles (such as clinical educator,manager, continuing education instructorand staff nurse), and settings includingacute, long-term, community care andacademia.She currently serves as co-chair of theQuality Assurance Working Group of theFederation of Health Regulatory Collegesof Ontario and member of the RegulatoryAdvisory Panel for Ontario’s eHealthInitiative.“Janet’s regulatory expertise, relationshipswith the College’s many stakeholdersand genuine enthusiasm for the College’srole in supporting nurses to meet theiraccountabilities to the public, position herwell to lead the Practice and RegulatoryPolicy Department,” says Anne Coghlan,RN, the College’s Executive Director andCEO. SNPs test new QAProgram toolOn June 1, the College completed thepilot testing of the new Practice SimulationAssessment. This is one of the tools forassessing Nurse Practitioners (NPs) whoare selected for Practice Assessment — acomponent of the College’s QualityAssurance (QA) Program.The pilot testing was for Primary HealthCare NPs. Forty-five NPs volunteered toparticipate in the assessment and 28 NPswere selected as examiners. During theassessment, which took about four hoursto complete, participants rotated througha series of stations using standardizedclients.The stations focused on the corecompetencies for Primary Health Care NPpractice. An examiner assessed the NPs’:■ ability to perform a physical examination■ history-taking skills■ communication skills■ ability to make a diagnosis■ ability to identify treatment and a planof care.“Overall, the participants found that theassessment evaluated essential NP corecompetencies,” says Janet Anderson,Director of Practice and RegulatoryPolicy at the College. “The pilot providedhelpful feedback regarding the ongoingdevelopment and implementation of theassessment.”Once the results of the pilot have beenfully analyzed, the Practice SimulationAssessment for Primary Health CareNPs will be fully integrated into the QAProgram for 2012. SWhat’s new atcno.orgNursing is a profession that constantlyevolves, and the College’s website isevolving along with it.The College is currently preparing www.cno.org for the 2012 renewal season.It is building upon the successes andlessons learned from last year’s renewalseason to create a faster and moreconvenient renewal experience for allCollege members.Creating a better user experience isalso why the College recently updatedits online application request formfor individuals educated outside ofOntario who wish to register withthe College. After submitting thecontinued on page 188 College of Nurses of Ontario the standard Fall 2011

FeatureNew NPpractice documentThe revised Nurse Practitioner practice standard isincluded with this issue of The Standard. It outlines thenursing practice expectations for all Nurse Practitioners(NPs). The document has been extensively updated toreflect changes to the regulations in the Nursing Act, 1991and to include feedback the College has received from NPssince it published the previous Nurse Practitioners practicestandard in 2008.The Ontario government passed Bill 179 (the RegulatedHealth Professions Statute Law Amendment Act) in 2009,amending 26 health-related statutes. Amendments to theNursing Act came into effect on October 1, 2011. Theseamendments bring substantive changes to nursing practiceand give NPs new authorities including setting or casting afracture of a bone or dislocation of a joint; and dispensing,selling, compounding and/or broadly prescribingmedication in keeping with the regulations.Medications NPs prescribe are no longer listed inregulation; therefore the College is discontinuing the“NP drug list.” This change is consistent with anotheramendment the Ontario government made on July 1,which eliminated the laboratory list. (The government hasnot yet revoked other lists for NPs, such as those related toultrasound and X-ray.)Registered Nurses and Registered Practical Nurses arenow able to implement client care orders made by NPs.Nurses can perform procedures, such as venipuncture orcatheterization, when NPs have ordered the procedures.“In view of all these changes, the entire Nurse Practitionerdocument has been re-written,” says Lori Adler, RN,Manager of Practice Standards. “The new documentreflects the amendments to the Nursing Act and providesthe expectations for NP practice with regard to the newcontrolled acts.” Included in the document is a decision treeto help NPs decide whether to perform a controlled act.What’s new?The document identifies NPs’ accountabilities in relationto the new controlled acts of dispensing, selling andcompounding medication, and setting or casting a fractureof a bone or dislocation of a joint. Also new are the NPs’accountabilities when providing client care orders that areimplemented by other health care professionals, includingother nurses.The College has added an appendix to clarify theaccountabilities of NPs in independent practice whoobtain and maintain a stock of medication for use in clientcare (for example, to dispense or administer to clients).Most NPs work in settings where the employer procuresmedication, and where there are established policies forthe safe storage, use and disposal of medication. Theregulation requires NPs in independent practice who usemedication in client care to work with pharmacists toestablish their own procedures.“The revisions to the document go beyond the changesto the controlled acts,” says Adler. “The new practicestandard also incorporates content based on feedbackreceived from NPs, and practice trends identified by theCollege’s Practice and Regulatory Policy department overseveral years.”Two examples of concepts NPs have raised are theaccountabilities of NPs when following up on orderedtests, and an ethical framework to guide NPs whomight need to discontinue the therapeutic nurse-clientrelationship.“Feedback from NPs has been valuable for creating adocument that promotes safe and ethical nursing practice,and focuses on the client’s interests and safety,” says Adler.For more Nurse Practitioner resources, go towww.cno.org/np. SCollege of Nurses of Ontario the standard Fall 20119

Nursing 2.0Many of our nursing colleaguesare networking, sharing information and developing themselvesprofessionally by using social media. How are they doing it without riskingtheir professional and personal reputations?10 College of Nurses of Ontario the standard Fall 2011

Robert Fraser, RN, and Kamini Kalia, RN (inset)believe nurses have a professional responsibility tounderstand the impact of social media on health care.FeatureNurse’s Social Media Advantage. “Quite simply, this is howcommunication is evolving,” he says. “Nurses must payattention to these changes if we are to continue to buildour professional image and be included in shaping thefuture of the health care system.”“Engage, exchange and enrich,” saysKamini Kalia, RN, as she explains herphilosophy of social media. “By ‘engage,’I’m referring to how users of social mediatools — such as Facebook, Google+, Twitteror a blog — play active, participatory rolesin building communities. ‘Exchange’ refersto the information-sharing that occurs ina variety of formats such as videos, textand photos, while ‘enrich’ refers to themany opportunities social media presentsfor learning and forming professionalrelationships.”Kalia, who works as a clinical nurse specialistat St. Joseph’s Health Care London andmakes presentations to nurses about socialmedia, feels that nurses have a professionalresponsibility to understand the impactof social media on health care. “We needto not only understand how social mediacan advance our nursing work, but alsoto recognize how social media is affectingpeople’s experience of their health andillness,” she says. “Patients have access to a lot of healthinformation online — some reliable, some not. Socialmedia allows nurses to use their knowledge, judgment andcritical thinking abilities to create and share reliable onlinehealth resources.”Photo: Melanie GordonPhoto: SwavekAnother reason why nurses should care about social mediacomes from Robert Fraser, RN, a junior fellow at MasseyCollege in Toronto and the author of the book TheThis does not mean that traditional media for sharinginformation, such as print publications or conferences, aregoing to be replaced by Twitter posts and blogs overnight.However, according to Fraser, nurses need to stop thinkingof social media tools as “distractions” from the traditionalforms of communication.“There is nothing wrong with using traditional vehiclesfor knowledge-sharing, collaborating or networking, butdoing so sometimes means we aren’t leveraging the potentialof newer approaches,” Fraser says. “Take a conference, forexample. If I attend two conferences a year, I will meet ahandful of nurses, and I probably can’t attend every session.But, by using professional networking sites like LinkedIn,I can connect with more of my colleagues more frequently.By having a website or a blog, I can post and share contentyear round. Websites and blogs also allow me to accessinformation or watch a video when I have time.”Picking the right toolIn the past, the Simcoe Muskoka District Health Unit,where Joyce Fox, RN works, used print materials, mediaadvertisements, the unit’s website, displays at communityevents, word-of-mouth and other traditional publicrelations tools to inform people about the unit’s initiatives.Recently, the health unit used social media for the firsttime to launch a campaign to raise awareness of the linksbetween alcohol use and chronic disease.“Prior to launching the campaign, we realized that wehad to develop a social media strategy as part of ourcommunications approach,” says Fox. “We still usedposters and press releases, but without targeted Twitterand blog activity and Facebook, it would have been a morestatic campaign. The target audience for the campaignwas adults aged 30 to 44 — a group who is active on theweb and uses it to find health information. Social mediaallowed us to reach these people where they spend manyhours a day — on the web or their cell phones.”College of Nurses of Ontario the standard Fall 201111

FeatureWhat the standards sayWhen making decisions about using social media, nursescan turn to College’s practice standards. The followingstatements from College standards are paired withquestions nurses should consider when posting commentsor photos, or sharing information, on social media outlets.Ethics“Nurses have a duty to conduct themselves in a mannerthat reflects well on the profession.”■ What is the purpose of the post?■ Is there anything in what I’m about to post that reflectsnegatively on the profession or on me as a health careprofessional?“Nurses demonstrate regard for colleagues byconducting themselves in a way that promotes respectfor team members.”■ Is there a more productive way to address issues thandiscussing them online?■ Might posting this information undermine my colleaguesor portray my workplace in a negative light?Therapeutic Nurse-Client Relationship“The nurse meets the standard by setting andmaintaining the appropriate boundaries within therelationship, and helping clients understand whentheir requests are beyond the limits of the therapeuticrelationship.”■ Is the person contacting me online still a client?■ What is/was the nature of our nurse-client relationship?■ What are my intentions in communicating with thisperson outside of the practice setting?■ What would the client expect from me, as a nurse, in thissituation?Confidentiality and Privacy“One way nurses maintain boundaries and build nurseclientrelationships based on trust is by respectingclients’ rights around confidentiality and privacy.”■ Could the information I’m sharing be used to identify acurrent or former client?■ Was any of the information I’m sharing collected duringthe course of a therapeutic nurse-client relationship?■ What could be the repercussions for the client and myselfif I reveal his or her personal health information?■ What does it really mean to have “privacy settings” onmy social media outlets?■ Who can view my posts?One of the challenges Fox and her team faced was figuringout the differences between the social media tools theyused. “Each social media tool has its own culture, rules ofoperating and etiquette to be followed,” says Fox. “And,although we are accustomed to writing material for thepublic, the nurses overseeing the blog needed to learnhow to provide ‘professional service’ in the more casual,conversational style of social media.”Indeed, as social media etiquette and culture continue toevolve, some sites will become more appropriate or lessappropriate than others for professional use.A matter of judgmentThe casual and conversational style of social mediacan make it easy to unintentionally cross professionalboundaries. Fraser has words of advice for nurses who areconcerned about the blurring of boundaries that can occurbetween one’s personal and professional lives when usingFacebook or Twitter.“Always err on the side of caution,” advises Fraser. “I onlypost pictures or thoughts that I do not mind makingpublic. A lot of people still think that what they do andsay online shouldn’t matter, but it can. If you are notcareful, what you make public about yourself online canbecome the equivalent of wearing a dirty shirt to a jobinterview. It’s all about how you are perceived by others.”According to Fraser, one of the biggest traps nurses fall intois forgetting about what he calls their “professional filters.”These filters, which help determine what is appropriate tosay and do online, include government laws (such as thePersonal Health Information Protection Act), and standardsor policies about social media developed by professionalassociations, regulatory bodies and employers.It is important to use your personal and professionaljudgment to determine what you would want to broadcastto the world. “Before you press the save, send or postbutton, you should consider one thing — would I want whatI’m about to say to be printed in a newspaper or displayedon a billboard with my name and image next to it,” Frasersays. “If not, consider rewording it or if it should be sharedat all.”Consider the impactThe College’s practice standards are an important “filter”that nurses should consult when making decisions abouttheir use of social media (see sidebar). For example, nurses12 College of Nurses of Ontario the standard Fall 2011

Featurehave professional and legal accountabilities to considerin relation to client privacy.“The College’s standards of practice that deal withmaintaining client privacy, as well as governmentprivacy laws, are relevant online just as they areanywhere else,” says Kalia. “Unfortunately, I haveseen health care professionals describing their practicesettings, colleagues and patients online. A strangermay not be able to identify the place or person,but it’s not as anonymous within your professionalcommunity. When nurses make negative commentsonline about their workplace or peers, or write detailsabout a patient, it is not only distasteful, it alsobreaches these standards and laws.”In addition, nurses are responsible for maintainingthe boundaries within the therapeutic nurse-clientrelationship, which is something that nurses shouldconsider before accepting a “friend” request from aclient on Facebook or making a comment on aclient’s blog.During her facility’s campaign, Fox discovered thatnurses might need to consider other factors beyondmaintaining privacy and appropriate boundaries. Asactivity on the campaign blog increased, Fox and thenurses overseeing it found that it became challenging todocument the information they were sharing. “We hadto sort out how to document the nursing services beingprovided to meet the College’s Documentation practicestandard.”Fox says that her organization is building on what theylearned as a result of this campaign. They are developingpolicies about the use of social media at the health unit.Having such policies in place supports nurses in makingappropriate use of social media inside and outside theworkplace.One of the objectives in the College’s new strategic planis to lead in regulatory innovation by supporting theintegration of technology into nursing practice. TheCollege’s Quality Assurance Program already requiresnurses to demonstrate how they apply technology inpractice. The College is also looking at ways to providenurses with guidance and resources to help them makesuitable decisions about social media.Strengthen nursingOne of the strengths of social media is its ability toPhoto: Simcoe Muskoka District Health UnitJoyce Fox, RN, at the Simcoe Muskoka District Health Unit, which recentlyused social media for the first time to launch an information campaign.bring like-minded individuals together to share ideasand information. Fraser and Kalia see potential in socialmedia to strengthen the nursing profession and nurses asindividuals.“If we can start connecting more often with others,we have the opportunity to increase the amount ofresearch, knowledge building, discovery and innovationin nursing,” says Fraser. “Social media can be used toincrease the dissemination of ideas and foster nursingknowledge, which ultimately help nurses provide bettercare to patients.”Fraser, who also operates a blog, Nursing Ideas, says thatengaging with social media has developed him as a nurse.“Running the blog pushes me to consider how I can havean impact beyond where I live and work,” he says. “It hasexpanded my opportunities to contribute to the health,learning and development of others. Also, knowingothers are following my blog forces me to continue togrow and develop; it makes me want to improve onwhat I’m doing, which plays into the cycle of continuallearning that nurses should engage in.”“Right now, thousands of our nursing colleagues areblogging and tweeting insights, or posting the latestinformation from workshops or conferences they’veattended,” says Kalia. “All of this information-sharingmakes for more-informed nurses, and what could bebetter than that?” SCollege of Nurses of Ontario the standard Fall 201113

FeatureTeamwork paysoffOnce a year, the nurses at McCormick Home — a 160-bed longtermcare facility in London — meet to enjoy a pizza dinner andreview the requirements of the College’s Quality Assurance (QA)Program. As a group,they read the selectedpractice documents, giveand receive peer input,and help each other when“The nurses thatparticipate in this they need clarification onevent successfullycomplete the QA the process.requirements eachyear,” explains SusanRumble, RN, education coordinator at McCormickHome. “And the nurses’ continuous learning andachievement of their goals contribute to quality clientcare at our facility.”Rumble starts the dinner discussion by asking, “Whatwould you like to improve on this year?” Then, thenurses are paired up and help each other with peer input.“This forum gives them a starting point,” says Rumble.“When they leave, they are equipped to continue theirpractice reflection and use that and the peer input tocreate learning goals and activities.”The nurses suggest topics for discussion and seeklearning opportunities throughout the year to achievetheir learning activities and goals. To complement theQA tools and resources that the nurses use online atwww.cno.org/qa, Rumble keeps a binder in her officewith all of the College’s QA resources. “Having extrablank forms, samples and practice standards helps thosewho prefer to see their work in hard copy,” she says.Susan Rumble, RN, gives nurses a starting point for QA.When the nurses meet at the next pizza session,Rumble asks if they have achieved their goals or if thereare still knowledge gaps they can address in the newLearning Plan.Another benefit of the event has been the team building.“This common goal of ‘tackling’ QA while meetingover pizza has been great for camaraderie,” says Rumble.“Staff from different shifts sometimes don’t cross paths,but this dinner brings them together and gives them anopportunity to share experiences and information.”Photo: SwavekThe feedback from the nurses who attend the session hasbeen overwhelmingly positive. “They tell me ‘QA isn’t ashard as I thought it would be,’ or ‘This has helped clarifywhat the College is looking for in a Learning Plan,” saysRumble. “But mostly they say ‘Thanks for giving me agood start.’” S14 College of Nurses of Ontario the standard Fall 2011

The practicedocumentsselected forthe2012QAProgram■ Documentation, Revised 2008■ Therapeutic Nurse-Client Relationship, Revised 2006■ Nurse PractitionersCreate your learning goals using the online QA Programat www.cno.org/qaResources for the 2012 program year will be availableonline in DecemberOnline RenewalIt’s so easyto use!Starting Oct. 20, 2011www.cno.org/mym

QuizQuiz questions arebased on queriesto the College; realnames have notbeen used.Take the Quiz:NP scope of practiceNurse Practitionersare accountablefor workingwithin their legalscope of practice,and for knowingand complyingwith legislationthat applies toindividual practicesettings andsectors.1André is an RPN on a medical in-patientunit. One of his clients has developed afever. The Nurse Practitioner (NP) on the unitorders various tests to rule out infection. TheNP writes a client order that will require Andréto perform catheterization to obtain a urinespecimen to send to the lab for analysis. Andréis familiar with receiving client orders from aphysician to perform this controlled act, but hequestions whether he is allowed to implementan order from an NP.Can André accept a client order from an NP toperform this procedure?Yes André can accept a client order from anNP to perform a controlled act procedure.No RNs and RPNs cannot accept a clientorder from an NP to perform a controlled actprocedure.2Charlotte is an NP in an emergencydepartment. Mario, a client knownto have a seizure disorder, presents withseizure activity. After assessing the client,Charlotte determines that diazepam shouldbe administered. She has the knowledge, skilland judgment to prescribe and administerdiazepam but does not know if she isauthorized to do so.Should Charlotte administer diazepam to thisclient?Yes As an NP, Charlotte has the authority toprescribe and administer this medication.No Although Charlotte has the knowledge,skill and judgment to prescribe this medication,she must obtain an order from a physician toadminister it.3Jonah is an NP in a community healthcentre that provides care to a largepopulation of seniors. He wants to organizean osteoporosis prevention and screeningclinic, which means his clients will requirebone mineral density (BMD) tests. Jonah hasexpertise in this area of care, but he is not sureif he has the authority to order BMD tests as apart of the screening process.Can Jonah order a BMD test?Yes Jonah is an NP and has the authority toorder this diagnostic test.No Current regulation does not authorizeNPs to order this particular test.4Gary is an NP who provides outreachservices to a long-term care home. Hisservices include providing episodic care toresidents to help prevent emergency departmentadmissions. Because he only provides outreachservices, Gary is not sure who would beresponsible for following up with results oflaboratory tests he orders for clients.Is Gary accountable for following up on thetests that he orders?Yes If Gary orders the tests, he isaccountable for following up on them.No Gary is only providing episodic care, so hedoes not need to follow up.Answers on page 2116 College of Nurses of Ontario the standard Fall 2011

CouncilCouncilmeetingsThe draft minutes of theSeptember Council meeting willbe posted on the website atwww.cno.org/agendas in lateSeptember.Council memberupdateCouncil meetings are open tothe public.Upcoming meetings:Dec. 8, 2011In June, Lyn Harrington, Public Member,and Jason Powell, RN, resigned fromCouncil.March 7, 2012June 7, 2012Sept. 12, 2012Photos and short biographies of Councilmembers appear in Special Supplement:Council, Committees and Executive for2011-2012 in this issue of The Standard.Lyn HarringtonJason Powell, RNCouncil meetings begin at0900 hrs in the College’s CouncilChambers at 101 Davenport Rd.in Toronto. The Council agenda,as well as any changes to datesand times, are posted atwww.cno.org/agendas at leasttwo weeks before the meeting.Space is limited. To attend,contact Jenna Hofbauer,Council Affairs Coordinator, at416 928-0900, ext. 7566;1 800 387-5526, ext. 7566 (tollfreein Ontario); orjhofbauer@cnomail.org.New at cno.orgcontinued from page 8Application Package Request form atwww.cno.org/apply, the Collegewill mail applicants information aboutthe registration process and therequirements for becoming a nurse inOntario.Also of interest are important changesto the Nurse Practitioner (NP) scope ofpractice. Among other changes, the NPlaboratory and medication lists are nowrevoked and have been removed fromthe website. NPs now have the authorityto order lab tests as appropriate for clientcare.The government has approved amendedregulations affected by the passage ofBill 179, the Regulated Health ProfessionsStatute Law Amendment Act, 2009. Asa result, NPs have the authority to set orcast a fracture of a bone or dislocation ofa joint, and dispense, sell, compound orprescribe medication in keeping with theregulations. As well, Registered Nursesand Registered Practical Nurses will beable to accept client care orders from NPsfor procedures that they previously couldnot, such as venipuncture to obtain bloodsamples.Visit www.cno.org/np to learn moreabout how these changes may affectyour practice. S18 College of Nurses of Ontario the standard FALL 2011

2012 Renewalstarts soon!Membership renewal for 2012 opens on Thursday, Oct. 20.The 2012 membership fee has increased to $175.15 ($155 +13% HST). More information about the fees can be foundon the College’s website at www.cno.org/fees.Renewal supportMembers who completed renewal online last yearwill find it even simpler this year as there are fewerquestions to answer. To renew, access the MaintainYour Membership section of the College’s website(www.cno.org/mym). You will need the username andpassword you created last year to access your MaintainYour Membership account. Instructions for retrievingforgotten usernames and passwords are available in theMaintain Your Membership section.In early October, you will receive by mail a brochurethat contains all the information you will need to preparefor 2012 renewal. If you need help, Customer ServiceRepresentatives will be available (see sidebar).Your accountabilityAs a regulated health professional, you are accountablefor paying the renewal fee and completing the renewalform. The fee must be paid by the Dec. 31, 2011deadline; otherwise, you will be required to pay a latefee of $113 ($100 + 13% HST). The online renewalform must be completed by Jan. 31, 2012. Failure tocomplete the form puts you at risk of an additional feeregardless of whether you paid your renewal fee beforeDec. 31. Nonpayment of any outstanding fee will resultin suspension.Don’t wait until the last minute to renew! There is asignificant increase in the number of calls for renewalassistance after Dec. 20. If you think you’ll need helpfrom a Renewal Customer Service Representative, renewearly to avoid long waits on the phone caused by thelast-minute rush. Another tip: if you have to speak to arepresentative, call after 1700 hrs when the phone linesare often less busy. SRenewal Customer AssistanceStarting Oct. 20■ Monday to Friday, 0830 hrs to 1900 hrs(including holidays)■ Saturday, Dec. 31, 0830 hrs to 1700 hrsPhone1 866 573-5405 (toll-free in North America)416 849-6135 (If you are calling from outsideNorth America)Emailrenewal@cnomail.orgNote: The College’s office will be closed fromSaturday, Dec. 24, 2011 through Monday, Jan. 2,2012 (inclusive); however, customer assistance withrenewal remain available at the above numbers.College of Nurses of Ontario the standard Fall 2011 19

SpecialCouncil, Committees and Executive for2011–2012Supplement

CNO Council Members 2011–2012Meet your CouncilmembersCouncil establishes the goals, objectives andpolicies of the College according to the governinglegislation. It is composed of 39 members: 18 publicmembers, 14 Registered Nurses (RNs) and sevenRegistered Practical Nurses (RPNs) from across theprovince. Nurses are elected by their peers, whilepublic members are appointed by the provincialgovernment.Council makes decisions that have a direct impacton nursing regulation in Ontario. Each decision isbased on one question: does this decision protectthe public?Central/TorontoYvonne Ramlall, RPNYvonne is a staff nurse on an acute surgicalfloor at the Holland Orthopaedic and ArthriticCentre/Sunnybrook Health Sciences Centre.Contact[w] Email: yvonne.ramlall@sunnybrook.caCentral EasternApril Leslie Cheese, RPNApril has worked over 20 years in nursing. Sheis currently working in primary care.Contact[h] Email: apeplum@xplorenet.comNicole P. Florent, RNNicole is a part-time nurse at the BellevilleDialysis Clinic, and a part-time research nurseat Queen’s University.Contact[h] Email: florent_nicole@hotmail.com[w] Email: florenn2@kgh.kari.netNancy Sears, RNNancy is a professor of health sciences atSt. Lawrence College in Kingston, teachingwithin the Laurentian University/St. LawrenceCollege collaborative nursing program.She is also a health care management andpolicy consultant with special interest inpatient safety, health care service and systemorganization, design and management.Contact[h] Email: nsears@sl.on.caCentralDennis Curry, RNDennis is a staff nurse on the mental healthunit at the Royal Victoria Hospital in Barrie.Contact[h] Email: dennishcurry@hotmail.comCentral WesternJudie Coutts, RNJudie is an educator at Conestoga College.Contact[h] Email: jhcoutts@gmail.comMarianne Fletcher, RNMarianne is a clinical care leader in theemergency department at Joseph BrantMemorial Hospital in Burlington.Contact[h] Email: mdfletcher@cogeco.caAngela Verrier, RPNAngela is an RPN who works at a doctor’soffice in Vineland.Contact[h] Email: angela.verrier@cogeco.ca*1 RN Council member vacancyii College of Nurses of Ontario Council 2011–2012

CouncilCatherine EgertonCatherine is a retired banker having workedfor 31 years at CIBC. She recently obtained heralternative dispute resolution certificate fromthe University of Western Ontario.Contact[h] Email: cecegerton@hotmail.comMonina Lim-SerranoMonina has worked as a special andconstituency assistant to several members ofparliament. She is a retired member of theToronto police chief’s advisory council.Contact[h] Email: moninalimserrano@aol.comOmar FaroukOmar previously served as the chairman forthe Employment Insurance Board of Referees.He oversees a food bank. Omar is a marriageofficer and community counsellor, and holdsa certificate in conflict resolution from YorkUniversity.Debra MattinaDebra is a former Registered MedicalRadiation Technologist and is now a semiretiredpolicy advisor and adjudicator.Contact[h] Email: debmat1@sympatico.caContact[h] Email: omarfarouk52@yahoo.caDianne KimberleyDianne is a retired human resources specialistwho worked in corporate recruiting/selectionand also worked as a vocational consultant injob search and placement.Contactc/o Jenna Hofbauer, Council AffairsCoordinator[w] Email: jhofbauer@cnomail.orgJoan KingJoan is a retired politician, having spent 15years as a municipal councillor and five yearsas a school trustee in Toronto.Contact[h] Email: joan_king@rogers.comAbdul Hai PatelAbdul is a retired systems analyst currentlyconsulting in the areas of human rights,mediation and conflict resolution. He wasextensively involved in the community andserved as a commissioner for the OntarioHuman Rights Commission from 1999 to 2005.Contact[h] Email: afsaz@rogers.comMargaret TuomiMargaret is a self-employed accountant andincome tax preparer in Kagawong.Contact[h] Email: margtuomi@gmail.comJudith LeznoffJudy is a retired teacher who specializedin teaching Spanish, English as a secondlanguage and music.Contact[h] Email: leznoff@rogers.comAlaine WillsAlaine is currently working as an employeroutreach and marketing consultant (jobdeveloper). Her background is in humanresources and project coordination.Contact[w] Email: alainewills@yahoo.com*1 public member vacancyCollege of Nurses of Ontario Council 2011–2012v

Guiding CouncildecisionsThe College’s Council receives leadership and guidance from its ExecutiveCommittee. The committee, which is made up of the Council President,two Vice-Presidents (one RN and one RPN) and two public members*,provides direction during Council meetings and ensures that the statutorycommittees are working effectively.Between Council meetings, the Executive Committee has the ability tomake decisions on matters that need to be addressed before the nextCouncil meeting. The Committee serves as the College’s Patient RelationsCommittee, and advises Council about the Patient Relations Program.Meet your Executive Committee for 2011–2012Kris Voycey, RNPresidentKris Voycey is an emergency room nurse at Hôtel-Dieu Grace Hospital inWindsor. Kris is also a member of the nursing faculty at St. Clair College inWindsor and Conestoga College in Kitchener.“It has been a real honour to be elected as Council President. The Collegeensures that the public is protected, and as a nurse I truly understand theimportance of this commitment. I am fortunate to be involved in decisionmakingthat has a direct impact on nursing regulation and helps maintainthe standard of care.“I draw from my professional background when engaging in discussionsat Council, but I believe that the combination of the public and nursingperspectives is essential to making decisions that protect the public.”Evelyn Kerr, RNVice-PresidentEvelyn Kerr is the director of nursing clinical practice at The OttawaHospital.“I feel very fortunate to have been elected to the leadership role of Vice-President, RN, on the Executive Committee. It is important to me, as anurse, to be involved in the College’s Council because self-regulation isa privilege. The Ontario government and the public continue to haveconfidence in the College to regulate the nursing profession.“In my current position in the nursing professional practice departmentat The Ottawa Hospital, I am called upon almost daily to reflect on ourpractice standards and guidelines while counselling nurses about issues ofconcern.vi College of Nurses of Ontario Council 2011–2012

Council“At Council, I am able to use my knowledge and skills to help in decisionmakingand, in some small way, to contribute to my regulatory body’s rolein public safety and protection.”Monica Seawright, RPNVice-PresidentMonica Seawright is employed full-time at Bayshore Home Health in asupervisory role, and maintains a casual part-time position as a bedsidenurse at Chatham-Kent Health Alliance.“By being on Council, I feel I have gained knowledge and a broaderunderstanding of how the College works and how one area of regulationimpacts another. I have learned more about the role of standards andguidelines, and this knowledge has shaped and guided my practice andthe care that I provide.“I find that participating on Council and engaging in discussion serve asa good reminder of the College’s role in nursing regulation and that it ishere to protect the public. I think that the College does an amazing job ofworking with other regulatory bodies in Canada and internationally.”Yvonne BlackwoodPublic MemberYvonne Blackwood is a retired career banker who worked 38 years withRBC Royal Bank. During her career she held many management positions.Yvonne is an active volunteer and was a board member of numerousorganizations, including the Children’s Aid Society of Toronto and theOntario Trillium Foundation. She is also an author and speaker.“It is extremely important to be involved with an organization that hassuch a tremendous impact on the health and well-being of Ontarians.During my three years on Council, I have learned a lot about nursingregulation, the policies in place to protect the public and the College’smany resources for nurses.“As a public member, I try to look at the broader picture when makingdecisions at Council because I know that all of our decisions are made toprotect the public interest.”* There is currently one public member vacancy.College of Nurses of Ontario Council 2011–2012vii

Council members apply those same skillsto ensure that the public of Ontarioreceives quality nursing care.”Professional experience matters“When making decisions at the Counciltable, I remember the patients andfamilies for whom I’ve provided care, aswell as the discussions and interactionsI’ve had with other nurses,” says Bianchi.“These experiences have helped defineme as a nurse and given me insight intothe client-nurse experience.“Since joining Council, I’ve learnedthat nursing regulation is a greatresponsibility and privilege,” she adds.“It means putting the interest of thepublic before that of one’s profession.This experience has taught me thatregardless of where a nurse is—bedsideor boardroom or Council—we can eachadvance and promote excellence in clientcare and nursing practice.”Growing personally and professionallyYvonne Ramlall, RPN, who joinedCouncil in 2009, works as a staff nurseon an acute surgical floor at the HollandOrthopaedic and Arthritic Centre campusof Sunnybrook Health Sciences Centre.“My experience as a nurse helps me tomake sound decisions that protect thepublic,” says Ramlall. “I have knowledgeof the public’s expectations because Ilisten to my patients. This allows meto share a wealth of experience andunderstanding from my practice setting.“I have learned a great deal from beingon Council,” Ramlall continues. “It hasprovided a tremendous opportunity forpersonal growth and development interms of leadership skills. I am able tobring new information and insights to mycolleagues in the workplace.”Public members balance professionalperspectives“I find being a member of Council is oneof the most rewarding experiences of mylife,” says David Bockman, one of Council’s18 public members. Bockman workedin banking and business developmentfor more than 40 years before beingappointed to Council in 2006.By working together, Council membersmake decisions that affect nurses inevery practice setting. “Being a publicmember enables me to bring an ‘outside’perspective to the Council table,” hesays. “It is particularly important to meto know that our opinions are listenedto, and that we are not just ‘rubberstamping’ the decisions,” says Bockman.Are you our next Councilmember?Are you willing to share your perspective and relevant ideas duringdiscussions?Do you have a good understanding of nursing practice?Can you commit to completing the preparatory work before attendingmeetings?Are you willing to demonstrate your accountability to the public bymaking decisions that are in the public interest?If so, then consider running for Council. Elections are held in each of theeight districts every three years. The 2012 election will be held for:■RNs and RPNs in the Central Western and Southwestern districts■RPNs from the Central/Toronto districtVisit www.cno.org to determine your electoral district, read theeligibility criteria and find instructions for submitting your name forelection. Or, contact Jenna Hofbauer, Council Affairs Coordinator, atjhofbauer@cnomail.org, 416 963-7566, or toll-free in Ontario at 1 800387-5526, ext. 7566.College of Nurses of Ontario Council 2011–2012ix

Fitness to PractiseCommitteeThe Fitness to Practise (FTP)Committee determineswhether a nurse is sufferingfrom a physical or mentalcondition or disorder that isaffecting, or could affect,her or his practice. If a nurseis found to be incapacitated,the nurse’s certificate maybe revoked or suspended,or have specific terms,conditions and limitationsattached to it for a givenlength of time.Photo: CNOStanding (from left to right): Angela Verrier, RPN–Chair; Sylvain Leduc, NP; Sheelagh Rutherford,RN; Christine Davis, RN; Christine Noels, RN; Megan Sloan, RPN; Lori MacCullouch, RN; and RosemaryHardwick, RPN. Sitting (from left to right): Beverly Spencer, RPN; Joan King, Public Member; VivianSiciliano, NP; Catherine Egerton, Public Member; Margaret Tuomi, Public Member; and Marilyn Ott, RN.Absent: Charyce Adams, RPN; John Bald, Public Member; and Gino Cucchi, Public Member.Inquiries,Complaintsand ReportsCommitteeThe Inquiries, Complaintsand Reports Committee(ICRC) screens mattersrelated to public complaintsor information the Collegereceives through reports.The Committee reviewswritten materials anddetermines whether aPhoto: CNOStanding (from left to right): Monica Seawright, RPN; Yvonne Blackwood, Public Member; Joel Kuper,RN; Omar Farouk, Public Member; Gretchen Grenke, RPN; Dianne Kimberley, Public Member; and AlaineWills, Public Member. Sitting (from left to right): Evelyn Kerr, RN; Nicole Florent, RN; Kris Voycey,RN-Chair; Shannon Wright, RN; and Joanne Nault RPN. Absent: David Bockman, Public Member; andGabriella Golea, RN.hearing is required or ifsome other action wouldaddress the public interest.x College of Nurses of Ontario Council 2011–2012

Committee Membership 2011–2012Executive CommitteeKris Voycey, RN, President — ChairYvonne Blackwood, Public MemberEvelyn Kerr, RN, Vice-PresidentMonica Seawright, RPN, Vice-PresidentVacancy — Public MemberInQuiries, Complaints andReports CommitteeKris Voycey, RN — ChairYvonne Blackwood, Public MemberDavid Bockman, Public MemberOmar Farouk, Public MemberNicole Florent, RNGabriella Golea, RN*Gretchen Grenke, RPN*Evelyn Kerr, RNDianne Kimberley, Public MemberJoel Kuper, RN*Joanne Nault, RPN*Monica Seawright, RPNAlaine Wills, Public MemberShannon Wright, RN*Vacancy — Public MemberDiscipline CommitteeAgnese Bianchi, RN — ChairCarl Balcom, RN*John Bald, Public MemberLinda Bracken, Public MemberApril Cheese, RPNGino Cucchi, Public MemberDennis Curry, RNSamantha Diceman, RPN*Spencer Dickson, RN*Bill Dowson, Public MemberAlice Edwardson, RNJoseph Gajasan, RNTammy Hedge, RPN*Zahir Hirji, RN*Michael Hogard, RPNMiranda Huang, RN*Lindsay Hyslop, NP*Kim Jinkerson, RPN*Joan King, Public MemberDebra Mattina, Public MemberAbdul Hai Patel, Public MemberTracy Richardson, RN*Anastazia Rybak, RN*Nancy Sears, RNKarl Sweet, NP*Barbara Titley, RPN*Margaret Tuomi, Public MemberAngela Verrier, RPNVacancy — Council, RNFitness to Practise CommitteeAngela Verrier, RPN — ChairCharyce Adams, RPN*John Bald, Public MemberGino Cucchi, Public MemberChristine Davis, RN*Catherine Egerton, Public MemberRosemary Hardwick, RPN*Joan King, Public MemberSylvain Leduc, NPLori MacCullouch, RN*Christine Noels, RN*Marilyn Ott, RN*Sheelagh Rutherford, RN*Vivian Siciliano, NP*Megan Sloan, RPNBeverly Spencer, RPN*Margaret Tuomi, Public MemberQuality Assurance CommitteeJudie Coutts, RN — ChairDarlene Daly, RPN*Bill Dowson, Public MemberSam Ibrahim, NP*Dianne Kimberley, Public MemberJudith Leznoff, Public MemberMarie Marques, RNJanice McCallum, RN*Yvonne Ramlall, RPNJoyce Tsui, RPN*Alaine Wills, Public MemberRegistration CommitteeLaura Duffield, RN — ChairFaira Bari, Public MemberNancy Bikaunieks, NP*David Bockman, Public MemberLinda Bracken, Public MemberSabrina Cestola, RPN*Edward Cruz, RN*Marianne Fletcher, RNMonina Lim-Serrano, Public MemberJacquelyn Macknight, RPN* Appointed Committee membersCollege of Nurses of Ontario Council 2011–2012xi

GETInvolvedBe part of Council■ Shape the future of nursing practice■ Support nurses in providingquality care to clients■ Participate in decision-making aboutCollege policies and programsto facilitate quality nursing carefor the publicThis is Your Chanceto put yourselfin nursing regulationSubmit your name to stand for election ornominate a colleague.Nomination packages for the election ofCouncil members are included with thisissue of The Standard and are available atwww.cno.org/elections.Nominations are due by Jan. 16, 2012.Have a question or want to learn more aboutour elections?Visit: www.cno.org/electionsE-mail: jhofbauer@cnomail.orgContact: Jenna Hofbauer, Council Affairs CoordinatorTel.: 416 928-0900, ext. 7566Toll-free in Ontario: 1 800 387-5526, ext. 7566RNs and RPNs from theCentral WesternSouthwesternelectoral districts.RPNs from theCentral/Torontoelectoral district.

QuizQuiz answers from page 161Yes Recent amendments to the Nursing Act, 1991and its regulations allow RNs and RPNs to carryout controlled act procedures that they are authorizedto perform when an NP has ordered the procedures.In addition, amendments to regulations under thePublic Hospitals Act allow NPs to order diagnostics andtreatments for hospitalized in-patients.André should consider the same standards as when heaccepts a client order from another prescriber, such as aphysician — including assessing the appropriateness of theorder for the specific client and discussing any questions orconcerns with the NP.RNs and RPNs are accountable for implementingorders safely and appropriately. NPs who provide ordersare accountable for determining that the procedure iswarranted for the client, documenting the order clearlyand completely, and being available to other health careprofessionals to respond to questions and clarify orders.2No Diazepam is a controlled substance under theControlled Drugs and Substances Act, and NPs are notauthorized to prescribe controlled substances. According tothis federal legislation, the only practitioners authorized toprescribe controlled substances are physicians, dentists andveterinarians.In addition to having the competencies to performa procedure, nurses must also ensure that they havethe appropriate authority. As an NP, Charlotte isauthorized to prescribe medication in accordance withher knowledge, skill and judgment, but current legislationdoes not give her the authority to prescribe controlledsubstances such as diazepam. For this reason, she mustconsult a physician to obtain a client-specific order toadminister diazepam to Mario.3No Jonah is not authorized to order a BMD test. TheMinistry of Health and Long-Term Care has passedregulatory amendments that reduce the restrictions on NPsordering laboratory tests and medications and so, thosespecific lists have been removed. However, there are stillrestrictions on the diagnostic tests that NPs can order, suchas X-rays.The BMD test is an X-ray test that falls underthe Healing Arts Radiation and Protection Act, 1990.According to this act, an NP can order X-rays of thechest, ribs, arms, wrist, hand, leg, ankle and foot, aswell as mammography, but a BMD test usually involvesan X-ray of the spine, which is not included on this list.Therefore, NPs cannot order a BMD test.Jonah could obtain BMD tests for the client populationthrough a medical directive from a physician associatedwith the clinic. For more information about directives,please see the Directives practice document.4Yes When ordering tests, NPs are accountable forreviewing the results of the tests ordered, providingtimely follow-up when required, and making themselvesavailable to receive critical test results from laboratoriesand diagnostic facilities. If an NP cannot be physicallypresent to provide a follow-up, then the NP is accountablefor ensuring that a reliable system for follow-up is inplace. For example, NPs who work in consulting oroutreach roles who may be intermittently involved inclient care must ensure the organization has a processin place forresults to bereviewed andacted on. If nosuch proceduresexist, thenthe NP mustwork withthe employerto establish areliable systemto ensure thatfollow-upwill occur.In Gary’ssituation,he mayassume totalresponsibilityfor follow-upor work withthe long-termcare hometo develop areliable systemfor follow-up.College of Nurses of Ontario the standard Fall 201121

you asked usform and paying the fee. You willreceive a letter confirming that youare registered in the Extended Classand outlining the protected titles thatyou are required to use when signingyour name: RN(EC) or NP.You may choose to add yourspecialty certification to your title aswell. The College currently registersNPs in one or more of the followingspecialty certificates: PrimaryHealth Care (NP-PHC), Paediatrics(NP-Paediatrics) and/or Adult(NP-Adult).While you wait to completethe registration process, you mustcontinue to use the RN title whensigning your name.For more information on theNP registration process, refer tothe College’s Registering as a NursePractitioner in Ontario guide.QI am a nurse working in asexual health clinic. I have anadolescent client who is competentto make decisions about his care. If Icall his home with test results and hisparent answers and demands to knowwhy I am calling, can I disclose thisinformation to the parent?AYou must have the consentof the client to disclose thisinformation to his parents.According to the Personal HealthInformation Protection Act, 2004,information privacy is defined as theclient’s right to control how his orher personal health information iscollected, used and disclosed.While this client is competentto make decisions about his care,consent to treatment does not includeconsent to disclose personal healthinformation. Therefore, you shouldask him at his initial assessment ifyou can provide information to hisparents or other family memberswhen calling his home.If he is not comfortable with givinghis consent, you should considerother strategies for responding to aparent who wants to know why youare phoning.Even better, during the initialappointment, you can schedule afollow-up appointment for the testresults. Or, if he has a private cellphone, ask for his consent to call thecell phone and leave a message withthe results if necessary.QI am a nurse manager at along-term care facility, and I’mconsidering hiring a new graduatewho will be working with a TemporaryClass registration. Are there anypractice conditions I need to considerif I hire him?AYes, there are certainconditions for TemporaryClass registrants. Registration in theTemporary Class allows individualswho have met all of the requirementsfor registration except for thesuccessful completion of the nationalexam — the Canadian RegisteredNurse Examination or the CanadianPractical Nurse RegistrationExamination — to practise nursingin Ontario while they wait to writethe exam or wait for their examresults. Temporary Class registrationis granted for a six-month period,and the registrant can only practisenursing within the facilities identifiedon their Temporary Class registrationform.When hiring Temporary Classregistrants, you will need to ensurethat they are supervised by an RN,RPN and/or NP. The supervisionmay be direct or indirect dependingon their needs, competence andexpertise, and familiarity with thepractice setting in relation to thedemands of the client populationand the nature of care clientsrequire. Employers are responsiblefor having sufficient resourcesavailable for this supervision.Temporary Class registrants willnot be able to perform a controlledact unless it is ordered, and cannotinitiate or delegate a controlled act.They are not allowed to supervise,monitor or direct the practice ofanother nurse, but can still learnabout “in-charge” roles under thesupervision of a mentor, preceptor oranother designated resource nurse.They are also able to supervise thecare provided by unregulated careproviders as part of a collaborativepractice model.The member must use thedesignation “Temporary” or“Temp” after her or his name. TheTemporary Class registration isrevoked if the member successfullyenters into the General Class, failsthe exam or six months have passed,whichever comes first.You can confirm an individual’sregistration status through theCollege’s Find a Nurse tool at www.cno.org. For more information onthe Temporary Class, refer to theCollege’s Temporary Class fact sheetat www.cno.org/docs. SAll College documents can be found atwww.cno.org/pubs.Have a question about applying theCollege’s practice standards? E-mailthe Practice Support Line at ppd@cnomail.org. Or, call 416 928-0900,ext. 6397; or toll-free in Ontario at1 800 387-5526, ext. 6397.College of Nurses of Ontario the standard FALL 2011 23

Reflect on Professional conductThe College responds to concerns received from the public,employers and other sources through its complaints andreports processes. The goal is to enhance the quality ofnursing care and ensure public protection by reinforcing theCollege’s standards of practice, and by providing nurses withopportunities to reflect on and improve their practice.This column is intended to help nurses understand and reflecton commonly raised concerns, as well as the College’s overallapproach to resolving those concerns.The scenarios are examples based on actual complaints orreports. All names, locations and identifying characteristicshave been changed to protect confidentiality.Reporting criminaloffencesAs members of a self-regulated profession, nurses areaccountable for reporting if they have been found guilty ofa criminal offence. Since criminal activity by a nurse couldundermine the public’s safety or trust in the profession,not reporting a guilty finding to the College is takenvery seriously. Applicants for membership also have anobligation to provide criminal reference information tothe College when they apply for registration. While theexpectation is on the member or applicant to report, thereare also times when the College receives this informationfrom other sources such as an employer, the media or thepublic.However, criminal convictions do not automaticallydisqualify an individual from nursing. Applicantswith criminal findings are referred to the RegistrationCommittee, which considers the relevance of the findingto the application for registration. For current members ofthe College, the Executive Director determines whetherto investigate the finding’s relevance to the member’ssuitability to practise nursing.Criminal offences can occur in or outside of theworkplace. The College is only concerned with a nurse’sactivities outside of the workplace when they reflect onthe nurse’s integrity or that of the nursing profession, orif they pose a potential or actual risk to the public. Whendetermining the extent to which a criminal offence isrelevant to the member’s nursing practice, the Collegeconsiders the profession’s values such as trust, respect forlife, client choice and well-being, and truthfulness. TheCollege also considers factors such as how recently theoffence occurred, the nature of the offence, the member’sefforts at rehabilitation and the member’s current situation.Convictions that are considered to be very relevant to amember’s suitability to practise nursing, such as offencesinvolving a breach of trust or an act of violence, wouldmost likely result in an investigation and formal hearingbefore the Discipline Committee. The outcome of such ahearing could be a suspension of the nurse’s registration,terms and conditions on the nurse’s ability to practise inthe future, or a revocation. Criminal findings of guilt that24 College of Nurses of Ontario the standard Fall 2011

Reflect on Professional conductQuestions to consider1. What criminal offences would you consider to be relevant to anindividual’s suitability to practise nursing? Why?2. What action, other than an investigation and disciplinary hearing,can the College take to address a member’s criminal conduct?result in a committee finding of professional misconductare made public on the College’s Register and publishedin The Standard. However, as with all other kinds ofreports it receives, the College can also address criminalinformation about members through other remedialapproaches when appropriate.ScenariosThe following scenarios are based on actual reports. Theoutcomes may not reflect the findings in other similarsituations. Outcomes of matters reported to the College aredetermined on a case-by-case basis.Scenario 1: At the time of his application forregistration, Paul reported a 10-year-old conviction formarijuana possession. After Paul became a member, theCollege learned that, at the same time as the possessionconviction, he had been found guilty of trespassing. Amore recent finding for mischief also came to light. Pauldid not report these additional offences to the Collegedespite being reminded during annual membershiprenewal that nurses must report findings of guilt within30 days of the finding being made.Outcome: The Executive Director reviewed theinformation and asked Paul to meet with her. Heexplained that he thought he only had to report theoffence involving marijuana because of the reference tothe Controlled Drugs and Substances Act, and that themischief finding did not need to be reported becausehe had received an absolute discharge. He did, however,Members are required to report “findings of guilt foran offence,” which can include offences under theCriminal Code of Canada, as well as other offences.Not all findings result in a conviction. For example, ifthe member receives an absolute discharge or pardon,then there is a finding of guilt, but no conviction. Thefinding of guilt must be reported to the College. Thefact that a conviction did not result from the findingmay affect the College’s assessment of the criminalconduct, but does not affect the obligation to report.For more information on self-reporting criminalfindings, as well as other proceedings and findings,see the Mandatory Reporting process guide atwww.cno.org/docs.express remorse for the offences and for failing to reportthem as required. After reviewing details related to theoffence and meeting with Paul, the Executive Directordecided that an investigation was not necessary in thisinstance. The original offences took place 10 years agowhen Paul was a young adult and, although he did notreport the mischief finding, he had received a dischargegiven the relatively minor nature of the offence.Scenario 2: Yolande reported a finding of guilty fordrunk driving. She had driven home after drinking at afriend’s birthday party. She pleaded guilty to the offenceand received a one-year driving suspension. At the timeof the offence, she was employed full-time as a nurse. Heremployer was aware of the finding, and attested to hergood character and competence.continued on page 32College of Nurses of Ontario the standard Fall 2011 25

The followingdecisions and reasonsof the DisciplineCommittee formpart of the College’sSummarizedDiscipline DecisionsAnnual Report and arepublished as a requirement ofthe Regulated Health ProfessionsAct, 1991. By publishing thesedecisions, the College educatesnurses and informs the publicabout what does and doesnot constitute professionalmisconduct and incompetence.These decisions also providedirection to RNs, RPNs andNPs on practice standardsand professional behaviour, ifthey find themselves in similarsituations.The name of the Member whois the subject of the hearingmay or may not be included,as required by law. Informationrevealing the names of witnessesand clients has been removed.For copies of full decisions,visit the website atwww.cno.org/decisions, orcontact Bill Clarke at416 928-0900, ext. 7590 or1 800 387-5526, ext. 7590 (tollfreein Ontario).Kim Ettinger9715061Allegations and PleaThe College alleged that the Memberdressed and behaved inappropriatelywhile interacting with a client, andvisited another client after dischargefrom nursing services, obtained mealsfrom that client, brought flowers tothe client and exchanged books withthe client. It was also alleged that theMember misappropriated narcoticsfrom two clients.The Member was neither presentnor represented by counsel at thehearing. The hearing proceeded onthe basis that the Member denied theallegations.EvidenceTen witnesses testified at the hearing.The Member worked as a chargenurse at a long-term care and assistedlivingresidence. During a “pyjamaday” at the facility, the Memberchanged into lingerie and invitedpersonal support workers into ClientA’s room, where she leaned towardClient A while a photo was taken.Client B and her spouse testifiedthat the Member dropped in to visitthem at least three times beyond thetwo scheduled nursing visits. Theydid not know why the Membervisited. She brought flowers andbooks, and stayed for meals.Using hypothetical situations, anexpert witness gave her opinion as towhy these two instances representedbreaches of the standards of practice.Client B and her spouse noticedthat 100 Percocet pills were missingafter one of the Member’s visits. Theycounted out 40 pills of Oxycodonein a bottle, which they left on thecounter for the next visit. After theMember left, 20 pills were discoveredto be missing.Client C and his spouse testifiedthat during a visit to their home toremove staples from an incision, theMember spent considerable time inthe bathroom. Later that evening, thecouple realized that a full bottle ofPercocet was missing. They had hadno other visitors that day.FindingThe Panel found that the factssupported a finding of professionalmisconduct as alleged. The Member’ssexually explicit actions in relationto Client A were shameful to theMember and to the profession as awhole. The Member crossed clinicalboundaries, which shifted the nurseclientrelationship and could havebeen very detrimental to Client B.The Member’s theft of narcoticsfrom Client B and Client C involveddishonesty and casts doubt on her28 College of Nurses of Ontario the standard Fall 2011

Discipline decisionsmoral fitness. The Member oughtto have known that her conduct wasunacceptable.Submissions on OrderThe College sought an oralreprimand and a four-monthsuspension. The Member wouldbe required to complete specifiedremediation activities in preparationfor a series of meetings with anexpert in the therapeutic nurse-clientrelationship. For 12 months afterreturning to practice, the Memberwould be required to advise theCollege of her employers, provideemployers with a copy of the Panel’sdecision and reasons, and onlypractise for an employer who agreedto advise the College if the Memberbreached the standards of practice ofthe profession.Aggravating factors included theMember’s sexually suggestive conductwith Client A, that she breachedprofessional boundaries withClient B over a lengthy period oftime, and that her misappropriationof narcotics involved a breach oftrust and dishonesty. Although notan aggravating factor, there is noevidence of remorse or an admission,which might otherwise be considereda mitigating factor.Panel OrderThe Panel was concerned that theCollege’s proposed penalty did notadequately protect the public. Asa result, the Panel added a furtherlimitation to the proposed order,that the Member cannot practiseindependently in the communityfor a period of 12 months after herreturn to nursing. The purpose ofthis limitation is to prevent her fromhaving unsupervised access to clients’homes.Kirk Hewitt0109835Allegations and PleaThe College alleged that theMember had a verbal and physicalconfrontation with a client, madefalse and disparaging entries inanother client’s records, and madedisparaging or threatening commentsto various clients and co-workers.The Member admitted to theallegations, and the College andthe Member submitted a writtenstatement to the Panel in which theyagreed to the following facts.Agreed FactsThe Member worked at a specializedmental health centre that providedservices to clients with severe andpersistent mental health disorders,and was providing care to the sevenclients involved in this matter. WhenClient A approached the nursingstation and demanded to be released,the Member told him to step away.When Client A did not move, theMember said, “Is this going to bea problem?” and put his hands onClient A’s chest and pushed himbackwards.As a joke, the Member made falseentries in Client B’s worksheet, notingthat Client B had “… designed a timemachine, got wasted on mushrooms,beat up [a male co-worker]!” and“got stoned with [a female co-worker]on pot! and had sex with [a maleco-worker]...” The worksheet is usedto document client behaviour andincidents, but it is not kept as part ofthe client’s permanent health record.The Member said that he planned todelete the information after the chargenurse read it, but acknowledged thathe exercised poor judgment.The Member told Client C, animmigrant with no English andlimited French skills, that if she couldnot pick one of Canada’s officiallanguages, she should go back to herown country. He added that if shethought she might get killed, sheshould pick up a weapon along theway. The Member acknowledged thatthe comments were offensive andinappropriate.On 10 other occasions, whileinteracting with clients andcolleagues, the Member swore,raised his voice, used an angry tone,made inappropriate comments andresponded abruptly to requests forassistance.FindingThe Panel found that the factssupported a finding of professionalmisconduct as alleged. TheMember’s conduct included anextensive pattern of inappropriate,confrontational, demeaning, andangry comments and actions towardclients and co-workers. The Panelfound the Member’s behaviour to bedishonourable and unprofessional.Submissions on OrderThe College and the Member soughtan oral reprimand and a three-monthsuspension. The Member wouldbe required to complete specifiedremediation activities in preparationfor a series of meetings with aregulatory expert. For 24 monthsafter returning to practice, theMember would be required to advisethe College of his employers, provideemployers with a copy of the Panel’sdecision and reasons, and onlypractise for an employer who agreedto advise the College if the Memberbreached the standards of practice ofthe profession.Mitigating factors included thefact that the Member acceptedresponsibility and showed some insightinto his conduct and possible causes.Aggravating factors included theCollege of Nurses of Ontario the standard Fall 201129

vulnerability of the clients and therepeated pattern of behaviour over aperiod of approximately two years.Panel OrderThe Panel accepted the jointsubmission as reasonable and inthe public interest. The Memberaccepted responsibility for his actionsand cooperated with the College byagreeing to the facts and admitting toprofessional misconduct.Irek Iwanowski9820127Allegations and PleaThe College alleged that the Memberwas found guilty of a criminaloffence relevant to his suitability topractise, namely unlawful possessionof child pornography.The Member admitted theallegations, and the College andthe Member submitted a writtenstatement to the Panel in which theyagreed to the following facts.Agreed FactsThe Member came to the attentionof police during an investigationbeing conducted on the Internet.Police observed that the Member’sInternet-sharing files contained childpornography videos. After a warrantwas executed at the Member’s home, acomputer was seized and it was foundto have fragments of six video filescontaining child pornography. TheMember was charged and ultimatelypleaded guilty to unlawful possessionof child pornography. He self-reportedthis information to the College.FindingThe Panel found that the factssupported a finding of professionalmisconduct as alleged. The criminalconviction for possession of childpornography is of a serious nature,reflects greatly on the Member’ssuitability to practise and is regardedas disgraceful, dishonourable andunprofessional.Submissions on OrderThe College and the Member soughtan oral reprimand and a six-monthsuspension. The Member wouldbe required to complete specifiedremediation activities in preparationfor meetings with a regulatory expert.For 24 months after returning topractice, the Member would berestricted from providing nursingcare directly to any client under theage of 14. He would be required toadvise the College of his employers,provide his employers with a copy ofthe Panel’s decision and reasons, aswell as his criminal record and otherdocuments relating to his criminalconviction. He would only practisefor an employer who agreed to advisethe College if the Member breachedthe standards of practice of theprofession.College Counsel noted thatrevocation was not warranted inthis case as the Member readilyadmitted his conviction to theCollege and underwent courtappointedcounselling and therapy.An expert assessment indicated thatthe risk of repeating the offence wassignificantly reduced.Panel OrderThe Panel accepted the jointsubmission as reasonable and inthe public interest. The Memberaccepted responsibility for his actionsand cooperated with the College byagreeing to the facts and admitting toprofessional misconduct.The Panel takes the conviction ofpossession of child pornography veryseriously.Anthony MorrisIB12606Allegations and PleaThe College alleged that the Memberwas found guilty of seven criminaloffences relevant to his suitabilityto practise, namely theft, mischief,assault causing bodily harm, assault,spousal assault and failure to complywith recognizance, and that he failedto disclose the criminal convictions tothe College.The Member admitted theallegations, and the College andthe Member submitted a writtenstatement to the Panel in which theyagreed to the following facts.Agreed FactsThe Member’s registration wassuspended for nonpayment of feesfrom 1995 to 1999, from April toJune 2003 and from 2004 to 2008.In August 2008, the Memberapplied for reinstatement of hisCertificate of Registration and wasrequired to provide a police recordcheck. The criminal record checkindicated that he had been foundguilty of seven criminal offences inrelation to five separate incidents. In1993, he was found guilty of theftunder $1,000 and mischief; in 1996,he was found guilty of assault causingbodily harm; in 1997, he was foundguilty of assault; in 1998, he pleadedguilty to stealing merchandise; in2001, he pleaded guilty to spousalassault and failing to comply with arecognizance.The Member failed to disclosethese findings of guilt on his 2002and 2003 Annual MembershipRenewal Form.FindingThe Panel found that the factssupported a finding of professionalmisconduct as alleged. The Member’s30 College of Nurses of Ontario the standard Fall 2011

Discipline decisionsconduct compromised the integrityof the nursing profession, going tothe heart of the College’s abilityto regulate its members and theprofession. The conduct is beyondunprofessional and dishonourable,and reaches the level of disgraceful.Submissions on OrderThe College and the Member soughtan oral reprimand and a six-monthsuspension. The Member wouldbe required to complete specifiedremediation activities in preparationfor meetings with a nursing expert.For 24 months after returning topractice, the Member would berequired to advise the College of hisemployers, provide his employerswith a copy of the Panel’s decisionand reasons, and only practise for anemployer who agreed to advise theCollege if the Member breached thestandards of practice of the profession.College Counsel noted that theMember was remorseful, cooperatedwith the disciplinary process and waswilling to be rehabilitated.Panel OrderThe Panel accepted the jointsubmission as reasonable and inthe public interest. The Memberaccepted responsibility for his actionsand cooperated with the College byagreeing to the facts and admitting toprofessional misconduct.The order allows for specific andgeneral deterrence, and protectsthe public by providing for bothremediation and monitoring.Am Phatam0409391Allegations and PleaThe College alleged that the Memberwas found guilty of criminal offencesrelevant to her suitability to practise,namely possession of cannabis forthe purpose of trafficking, failure toabstain from communicating with anindividual, and failure to refrain frompossessing, ingesting or injecting anydrug or controlled substance withouta medical prescription.The Member admitted theallegations, and the College andthe Member submitted a writtenstatement to the Panel in which theyagreed to the following facts.Agreed FactsDuring an investigation in March2007, police discovered a marijuanagrow-operation in the Member’sresidence. Police also found anotherindividual present with the Memberat her residence.In April 2007, the Member pleadedguilty to the three offences. Sheserved 58 days of pre-trial custodyand 18 months of probation. She wasalso fined $1,000, which had notbeen paid at the time of the hearing.The Member self-reported theoffences to the College in May 2007.If she were to testify, she wouldsay that the offences occurred as aresult of her relationship with theindividual found at her home, duringwhich time she was scared, naïveand immature, and that she did notparticipate in the mechanics of thegrow-operation but did allow it tooccur in her home.FindingThe Panel found that the factssupported a finding of professionalmisconduct as alleged.Submissions on OrderThe College and the Member soughtan oral reprimand and a two-monthsuspension. The Member wouldbe required to complete specifiedremediation activities in preparationfor meetings with a nursing expert.For 12 months after returning topractice, the Member would berequired to advise the College of heremployers, provide her employerswith a copy of the Panel’s decisionand reasons, and only practise for anemployer who agreed to advise theCollege if the Member breached thestandards of practice of the profession.Panel OrderThe Panel accepted the jointsubmission as reasonable and inthe public interest. The Memberaccepted responsibility for her actionsand cooperated with the College byagreeing to the facts and admitting toprofessional misconduct.The order allows for specific andgeneral deterrence, and protectsthe public by providing for bothremediation and monitoring.Sary Som07332585Allegations and PleaThe College alleged that the Memberwas found guilty of a criminaloffence relevant to her suitability topractise, namely stealing a sum ofmoney exceeding $5,000.The Member admitted to theallegation, and the College andthe Member submitted a writtenstatement to the Panel in which theyagreed to the following facts.Agreed FactsThe Member started workingin a retail position during hernursing studies, and continuedto work weekends after obtainingher Certificate of Registration. InNovember 2008, she pleaded guiltyto stealing approximately $21,000from her employer between JanuaryCollege of Nurses of Ontario the standard Fall 201131

Online Renewal1. Easy!2. Fast!3. Convenient!4. Secure!OpensOct. 20, 2011Renew by Saturday, Dec. 31, 2011 toavoid extra fees.Visit the Maintain Your Membershipsection at www.cno.org/mym.

The College welcomes letters commending outstandingnursing care. The College accepts original signed lettersfrom clients or family members, or original signed lettersfrom facilities or agencies with a copy of the author’s letterIn Praiseof Nursesand the author’s permission to publish it. Letters may beedited for publication.Treated with respect and dignityI am writing this letter in praise ofthe excellent care my mother, Mrs.Jean Thompson, received while apatient at the Listowel MemorialHospital. She was admitted to thesecond floor in January and latertransferred to the first floor where shespent her remaining days receivingpalliative care until she passed away.My family and I were veryimpressed with the care that ourmother received from the staff onboth the first and second floors.Everyone treated my mother withrespect and dignity. The care thatshe received from all the staff wasexcellent.Please convey our praise andgratitude to the wonderful staff at thehospital.Yours sincerely,Jane EdenCaring, understanding andprofessionalI am writing this letter to expressmy sincere appreciation to afew wonderful nurses who havedemonstrated the highest levelof caring, understanding andprofessionalism. I would like tothank Nicole Cusson, RN; AmandaKosmerly, RN; and student nurseNicole Stewart on the 6th floor,south tower of the Sudbury RegionalHospital.My mother, Helen Sullivan,was admitted to the hospital inSeptember. She was being treated fora blood clot in her right leg. Furthertesting revealed that she had a masssomewhere between her lungs andthere was fluid around them, makingit necessary to insert a drainage tube.During the week of Oct. 11, mymother’s condition deteriorated andshe was not able to eat meals on herown. The next week proved to beextremely difficult for my mother asher health was not improving. OnOct. 18, my mother unfortunatelypassed away.During her stay at the hospital, weencountered several wonderful andcaring nurses. We were fortunate tohave nurses who went beyond theircall of duty to assist my mother andour family, especially during her lastthree days. We are thankful that wehad the assistance of nurses Nicoleand Amanda, and student nurseNicole. They offered and providedcare and assistance to our entirefamily during this most difficulttime.All three nurses demonstratedsincere caring, completeunderstanding and an extremelyhigh level of professionalism formy mother and our family. Theymade this most difficult situationas comforting as was possible, andfor this my family and I are trulygrateful.Sincerely,Deb SullivanSend your letters to:InPraiseOfNurses@cnomail.org orCollege of Nurses of Ontario101 Davenport Rd.Toronto, ON M5R 3P134 College of Nurses of Ontario the standard FALL 2011

Careers Careers Careers Careers Careers Careers Careers CareersCollege of Nurses of Ontario the standard Fall 2011 35

Careers Careers Careers Careers Careers Careers Careers Careers36 College of Nurses of Ontario the standard Fall 2011

Careers Careers Careers Careers Careers Careers Careers CareersPursueAre you looking for aworkplace that valuesintegrity, leadership andcollaboration? Do youappreciate working withprofessional and talentedcolleagues? If so, the Collegeof Nurses of Ontario mayhave the career you’ve beenlooking for.a Career at Your CollegeCareer opportunities in practice consulting, policydevelopment, investigations and other fields are posted onthe College’s website as they become available.Visit www.cno.org/hr for more information about growingyour career at the College.College of Nurses of Ontario the standard Fall 201137

A nurse demonstrates the standardsby developing innovative solutionsto practice issues.– from Professional StandardsThe Standard of Care.Photo: Melanie GordonWhen it comes to health care, “theonly thing worse than no information is inaccurateinformation,” says Andrea Norgate, RN.As kidney-pancreas transplant coordinator at theToronto General Hospital, University Health Network(UHN), Andrea is keenly aware of the long-termcomplications related to type 1 diabetes and howtransplants can lead to better health and a longer life.To provide accurate information about the scope andeffectiveness of the Toronto Pancreas Transplant Program,and increase potential transplants, Andrea embarked on amultifaceted information campaign in 2010.The program supports three types of transplantation:simultaneous pancreas-kidney transplantation; pancreasafter-kidneytransplantation; and pancreas transplantationalone. To raise awareness and improve understanding ofthese options, Andrea organized lunch-and-learn sessionsfor dialysis nursing staff at dialysis centres across Ontario.But she knew that to reach as many people as possible,she would have to be innovative and go beyond thetraditional educational approach — her solution was to useFacebook and Twitter to promote the transplant program.“I knew that a high percentage of people use socialmedia to search for health information, making it anexcellent tool for providing accurate, ongoing and up-todateinformation about the program,” says Andrea.“The Facebook page gave people who were interestedin transplants, or who had undergone one, a forum toexchange information, ideas and experiences,” she adds.Andrea notes that when she began the campaign UHNwas just developing its own social media policies, and mostsocial media sites were blocked. That posed a challenge ingetting the campaign running.“I needed to work from my home computer to set upthe social media pages,” she says. “To ensure the contentof the pages was appropriate, I relied on the College’spractice documents, particularly Confidentiality andPrivacy — Personal Health Information and Ethics.”Since the campaign was launched, UHN has openedcorporate Twitter and Facebook accounts, and finalizeda policy on using social media, which Andrea says makesthe process that much “clearer and explicit.”“My job — any nurse’s job — is to advocate for ourclients,” says Andrea. “Part of advocating is finding thebest ways to support clients’ needs. In this case, the answerwas combining traditional methods with social media, andthe result was a 400 per cent increase in referrals to thetransplant program.” SAt the College, the phrase “the standard of care” is more than atag line for the logo; it’s about setting the bar for safe, effectiveand ethical nursing care through the practice standards andguidelines. This page features nurses who have raised the baron the standard of care they provide their clients.38 College of Nurses of Ontario the standard Fall 2011