Tittle: College of Nurses of Ontario Professional Misconduct Disciplinary Hearing

Name: Sharon Taylor

Student #: 822-734-778
College: Humber College
Course: NURS 217
Professor: Janet Jeffrey
Date: November 3,2014

Increasing cases of misconduct behaviours are prevailing in all aspects of the nursing profession
field today. The College of Nurses of Ontario (CNO) sets and enforced standards of practice to which
nurses must adhere to in order to provide the public with safe, effective and ethical nursing care.
Professional misconduct is as an act or omission that is in breach of these accepted ethical and
professional standards of conduct CNO (2009) Practice Standard Professional Misconduct.
Retrieved from cno.org.
An example of a case of professional misconduct which was brought before the panel of
Discipline Committee on January 23 and 24 of 2010 to the College of Nurses of Ontario (CNO). The
allegations were that the Member committed an act of misconduct in that while engage in the practice
of nursing as a Registered Practical Nurse (RPN) abused a client physically, verbally and emotionally.
The Member was alleged to have failed to respond to the clients needs in a timely manner and also he
imposed and failed to remove an inappropriate restraint on the client. This act of conduct relevant to the
practice of that having regard to all circumstances be regarded as disgraceful, dishonourable and
unprofessional. At the time of this allegations, the client, an elderly man suffered from dementia,
cardiovascular disease, arthritis and had had a stroke. CNO Discipline Decision (2012). Retrieved
from http://www.cno.org/en/protect-public/discipline-decisions/. He also spoke Italian, therefore most
of the staff have difficulty understanding him. He was at risk for falls and had history of aggressive
behaviours.
On the evening in question, July 9,2010 the client wandered in the hall ways of the Facility
where he was receiving care, he was in a very agitated state. It was alleged that the client was taken
back to his room on several occasions by the Member who was providing care. The client however
wandered out again at approximately 12:45 am one morning. He was returned back to his room once
again by the Member only this time the client room door was closed. The Member remained outside the
door for at least six minutes while the client kicked and yelled at the door. After the noise subsided the
Member entered the client room, she found the client lying on the floor with blood oozing from a side

of his head and in a puddle of urine. The Member had the Personal Support Worker (PSW) on duty
called the Registered Nurse (RN) who instructed the Member to call 911. The client was transferred to
a hospital where it was determined that he had suffered from a fractured hip and intracranial
hemorrhage. The client died the following day as a result of the injuries he received in the incidence.
An investigation was conducted at which time the Members employment was terminated.. CNO
Discipline Decision (2012). Retrieved from http://www.cno.org/en/protect-public/discipline-decisions/
The Member was brought before the Disciplinary Committee who after hearing multiple
testimonies and watching a security video finds that the Member committed acts of Professional
Misconduct. The Committee suspended the Member's Certificate of Registration for two months, have
the Member attend sessions for Therapeutic Nurse-client relationship sessions with nursing expert at
her own expenses for four months, complete on line questionnaire on Professional Standards and
Restraints and monitoring for 12 months to ensure the protection of the public. The Member was
neither present nor represented at the hearing, she was deemed to have denied the allegations in the
Notice of Hearing. The Hearing proceeded on the basis that the College bore the onus of proving the
allegations in the Notice of Hearing against the Member. CNO Discipline Decisions (2012). Retrieved
from http://www.cno.org/en/protect-public/discipline-decisions/.
I believe that a case of this nature where there is a loss in a life there should be a much harder
punishment,. than in cases where no life was loss. The reason been, the Member was very much aware
of the clients situations and also aware of the Facilitys policies and Procedures as well as the
intervention set out in the plan of care. She failed to check and monitor the client in a professional
manner. She did not recognize the limitations of her practice, did not collaborate with her staff and did
not carry out proper evaluations for her client. The Member did not act in the clients best interest and
contradicts the standards and expectations that contribute to public protection as set in the CNO
Therapeutic Client Relationship.
There are ethical values set by the CNO Ethical Standards, which includes client well-being,

client choice, respect for life, and maintaining commitments to clients and all these values were
contravened by the Member.
Client well-being
Promoting client well-being means facilitating the clients health and welfare and preventing
and removing harm CNO Practice Standard- Ethics. Retrieved from www.cno.org. The Member must
carry out all interventions and plan of care, bearing in mind that the client well-being is the most
important priority (Dugas, Knor,1995,p.125). In the case discussed the client records showed that he
suffered from dementia, a disease that affects the mind, personality and physical functions and requires
competent and passionate care. Client centred care should focus on issues beyond the disease and task
that is to be performed to the client. Clients who suffer from dementia experiences behavioural
changes, for example, mood swing and thought disturbances which can lead to wandering.Wandering
is a complex behaviour which calls for observation, investigation and variety of individualized
approaches(Touchy et al., 2012, p.352). This will prevent falls and lost of clients who may try to leave
the Facility. The client also spoke Italian which made it difficult for the member to understand his
needs. It is required for the Member giving care to know their client and recognize their abilities to
relate effectively (Touchy, Jett, Boscart & Mcleary, 2012, P. 344). In the case, the Member was aware
of the difficulties in dealing with this clients situations, she even made notes of some interventions that
should have been done, however, none of the interventions was used in helping the client. The
Member's failure to check on the client in a timely manner compromised his safety.
Client Choice
All clients have the moral right to make decision about themselves and their own behaviour in
accordance with their values (Dugas, Knor,1995,p.125). Clients who are not competent in all areas,
for example the client in this case who suffered from dementia may still be able to make some decision
and should be given the opportunity. Subsequently a therapeutic relationship should be maintained
when a client is incompetent. In this case, the Member imposed a restraint on the client when he stood

by the door and prevent the client from getting out. Restraints are physical, chemical or environmental
measures used to control the physical or behavioural activity of a person or a portion of his body.
Physical restraint limited the client's movement CNO (2009). Practice Standard -Restraint. Retrieved
from www cno.org. The use of physical restraints can be included in nursing practice to aid in
situations where the client becomes a threat to self or others, however nurses need to be educated on
their uses. Nurses need to be aware of the benefits and the consequences that restraints can have on a
patient. They have to be properly educated in regards to using restraints, which will result in an
educated decision on whether the patient needs physical restraints or if alternative methods can be
implemented. The clients as well as family members should be included in the plan and made aware of
the type of interventions intended which should include the education on restraints and also obtaining
consent before implementation CNO (2009). Practice Standard -Restraint. Retrieved from
www.cno.org. Also, nurses should consider using the least method of restraint first, for example, using
a patient sitter for consistent observation of client. Some of the risk of physical restraint includes
bruises, increase agitation and increase risk for mortality as a result of injuries such as head trauma and
fracture. An older person who suffer from physical and mental disturbances are more at risk than a
healthy person to display dangerous effects resulting from physical restraint (Touchy et al., 2012,
p.352).
Respect for life
Respect for life means that human life is precious and need to be respected, protected and
treated with considerations CNO (2009). Practice Standards- Ethics. Retrieved from www cno.org. It
is very important for health care professionals to make every effort to preserve life. In this case the
Member when caring for the client did not attend to the client needs in a timely manner, the client was
left alone for too long without any interventions, this behaviour can be classified as abusive and
negligent. Older adults with mental disturbances and who are fully dependent are at a high risk for
abuse. Elder abuse can be defined as any action by someone in a relationship or trust that result in

harm or distress to an older person, while neglect is a lack of action by that person in a relationship of
trust with the same result (Touchy et al., 2012, p.378). Also elder abuse involves inadequate care and
nutrition, low standards of nursing care, inappropriate and aggressive staff-client interaction,
abandoning or leaving the client alone for too long and negligent health care (Touchy et al., 2012,
p.378). Neglect may occur if the care provider does not know how to provide care or does not realize
that what they are doing could be harmful. The Member, should seek further assistance for care when
she recognized that she cannot provide adequate care; or she should arrange for another care-giver to
perform care to the client. Nurses must be vigilant and sensitive to the potential for abuse, all safety
measures should be exercise and adhere to to prevent serious injuries or loss of life of the client.
Maintaining Commitment to client
Nurses have an obligation to maintain the commitments assured as regulated health
professionals. CNO (2009). Practice Standards Ethics. Retrieved from www.cno.org. It is the nurses
responsibility to provide safe, effective and ethical care that promotes health, restore health and to
alleviate suffering. Nursing are also obligated to avoid abandonment, abuse and neglect. In this case the
Member failed in maintaining commitment to the client which was left unattended behind closed door
which led to him been injured. The Member did not exercise knowledge and judgement in his care for
the client. A Member must bring respect and trust to the public and uphold the Standards of the nursing
profession.
Communication problems between client and health care providers are the root causes of
medical error, insufficient medical treatment, excess pain and even loss of life. One main reason for
communication problems is language barrier. Addressing communication barriers is a very important
component of a Facility. It affects the access to health care and services; the quality of care for those
clients who are not fluent in an official language is affected through interactions with health
professional who may because of a barrier, fail to meet ethical standards in providing heath care.
Health. Canada-Language barrier in access to heath care- Retrieve from

http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/2001-lang-acces/index-eng.php. Also poor

communication makes it less likely for client to receive care, to understand care, and to become
dissatisfied of care. I would suggest that the need for an interpreter and translator be brought into the
facility to mitigate language barriers. These interpreters should be well trained, convenient, trustworthy,
knowledgeable of patient and medical terminologies. The benefits of having interpreters or translator is
the improvement of communication which therefore increases access to health care, better quality care,
and more client satisfaction for clients who suffer from a language barrier and by extension the
enhancement of health and well-being of the client.
Another suggestion would be for Facilities to revisit their policies and procedures and include
the provision of patient sitters. A patient sitter is a member of hospital personnel that will essentially
monitor the behaviour and habits of a particular patient in a hospital setting or medical centre. He or
she will work under the direct supervision of nursing staff, and provide status updates and reports
regarding the patient. A sitter is usually recommended if the patient is a flight risk, or a danger to
himself or others in the hospital. Other situations may call for a sitter as well, especially if the patient
needs a significant amount of attention and care for a particular medical condition Guardian Geriatrics
Journal (n.d)-Retrieve from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578770/. The role of the
patient sitter would include the monitoring of client during the use of toilet and while showering, the
removal of any objects in the room that patients may use to harm themselves or others,
this may include knives, scissors, cord or plastic bags. To remove any clutters that may result in a fall,
to provide accompaniment while at dinning room and to reduce agitation by removing patients to a
calm environment expressing sympathy to patient and responding to them in a respectful manner.
Conclusion
The CNO sets and enforce standards of practice to which nurses must adhere to in order to
provide the public with safe effective and ethical nursing care. In the case discussed above the Member

mistreated the client, in imposing physical abuse and demonstrating negligent behaviours. She did not
attend to the clients needs on a timely manner neither did she make caring for the client her priority,
which should be most important. The client was forced to stay behind a close door which lead to a fall.
The client suffered injuries which led to his death.
Therefore I would propose the support of a role for a patient sitter as part of the management of
patients with metal disorders such as dementia. The use of a patient sitter may likely be the most costeffective way for protecting the client from any possible harm or elopement..The sitter should be able
to carefully document, monitor and reassess the clients conditions. If implemented, regulations or
guidelines set out would provide safeguards in the Facility and ensure safe and effective patient care.
Also I would put in place professional interpreters and translators to assist where they are
language barriers. to improve communications between clients and nurses which will automatically
improve health services in health care.

References

Dugas, Knor,1995,p.125
CNO (2009) Practice Standard Professional Misconduct. Retrieved from cno.org.
. CNO Discipline Decision (2012). Retrieved from
http://www.cno.org/en/protect-public/discipline-decisions
CNO Practice Standard (2009)- Ethics. Retrieved from www.cno.org.
CNO (2009). Practice Standard -Restraint. Retrieved from www cno.org.
Guardian Geriatrics Journal (n.d.)-Retrieve from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3578770/
Health. Canada-Language barrier in access to heath care- Retrieve from
http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/2001-lang-acces/index-eng.php
Touchy, Jett, Boscart & Mcleary, 2012, P. 344