DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

Transcription

1 DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: Tammy Hedge, RPN Chairperson Miranda Huang, RN Member Sandra Steele, RPN Member Debra Mattina Public Member Margaret Tuomi Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) NICK COLEMAN for ) College of Nurses of Ontario - and - ) ) DALJIT MANN ) NO REPRESENTATION for Registration No. JF ) Daljit Mann ) ) ) LUISA RITACCA ) Independent Legal Counsel ) ) Heard: October 30, 2012 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on October 30, 2012 at the College of Nurses of Ontario ( the College ) at Toronto. The Member attended by teleconference at her request with prior approval by the Discipline Committee Chair. The Allegations Counsel for the College advised the panel that the College was requesting leave to withdraw the allegations set out in paragraphs 1 (c) ii, iii, 3 (a), (b), 4 (c) ii, iii, and 5 of the Notice of Hearing dated September 26, 2012 [ ]. In addition, College Counsel sought leave to withdraw allegations set out at paragraph 4, with respect to the conduct being characterised as disgraceful or dishonourable. The panel agreed to this request. The remaining allegations as set out in the Notice of Hearing are as follows:

2 IT IS ALLEGED THAT: 1. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93, in that, while engaged in the practi[c]e of nursing as a Registered Practical Nurse, you contravened a standard of practice of the profession or failed to meet the standard of practice of the profession with respect to the following incidents: a. while employed at [Facility A] in [ ] Ontario: i. you administered the incorrect amount of NovoRapid insulin to [Client A] on or about November 17, 2010; ii. you attempted to administer to [Client A] oral medication that had already been handled and/or mouthed by another client, on or about November 17, 2010; b. while employed at [Facility B] in [ ] Ontario: i. you failed to document any observations in the progress notes for [Client B], particularly with respect to her poor dietary intake and/or Head Injury Routine, on or about December 6, 2010; ii. iii. you failed to document any observations in the progress notes regarding [Client C] particularly with respect to the condition for which the client was in isolation, on or about December 22, 2010; you failed to document any observations in the progress notes for [Client D], particularly with respect to the condition for which it was suggested the client should be in isolation, on or about December 31, 2010; iv. you failed to document any observations in the progress notes for [Client E] particularly with respect to Head Injury Routine, on or about January 6, 2011; v. you administered Novomix 30 insulin to [Client F] contrary to the physician s order, and/or failed to take or document appropriate action when you learned of the overdose, on or about February 3, 2011; vi. you inappropriately challenged the son of [Client G] when he inquired about adequate pain management for [Client G], to the effect that it could not be known what pain the client was feeling because she could not communicate, on or about December 19, 2010; c. while employed at [Facility C] in [ ] Ontario: i. you administered Lipitor at 1800 hours to [Client H] when the order was for the medication to be administered at 2100 hours, on or about October 2, 2010; ii. iii. [Withdrawn]; [Withdrawn];

3 iv. you failed to administer nutrition through a feeding tube to [Client I] but documented as though you had done so as scheduled at 1630 hours on or about January 11, 2011; d. while employed at [Facility D in] Ontario: i. you made inappropriate comments and demonstrations of negative startle reactions you could elicit from various clients to [the] daughter of [Client J] on or about November 2, 2010; ii. iii. you made inappropriate comments to [the] daughter of [Client J] regarding the conduct of [Client J] and/or other clients, on or about November 2, 2010; and/or you failed to complete your scheduled shift and/or abandoned your clients by preparing to leave and sitting in the lobby of the facility at least 15 minutes before the end of you shift, on or about October 24, You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(13) of Ontario Regulation 799/93, in that, while employed as a Registered Practical Nurse at [Facility B] in [ ] Ontario, you failed to keep records as required with respect to the following incidents: a. you failed to document any observations in the progress notes for [Client B], particularly with respect to her poor dietary intake and/or Head Injury Routine, on or about December 6, 2010; b. you failed to document any observations in the progress notes regarding [Client C] particularly with respect to the condition for which the client was in isolation, on or about December 22, 2010; c. you failed to document any observations in the progress notes for the client, [Client D], particularly with respect to the condition for which it was suggested the client should be in isolation, on or about December 31, 2010; and/or d. you failed to document any observations in the progress notes for [Client E] particularly with respect to Head Injury Routine, on or about January 6, [Withdrawn] 4. You have committed an act of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, 1991, S.O. 1991, c. 32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93, in that, while engaged in the practi[c]e of nursing as a Registered Practical Nurse, you engaged in conduct or performed an act, relevant to the practice of nursing, that, having regard to all the circumstances, would reasonably be regarded by members of the profession as [Withdrawn], [Withdrawn] unprofessional with respect to the following incidents: a. while employed at [Facility A] in [ ] Ontario:

4 i. you administered the incorrect amount of NovoRapid insulin to [Client A] on or about November 17, 2010; ii. you attempted to administer to [Client A] oral medication that had already been handled and/or mouthed by another client, on or about November 17, 2010; b. while employed at [Facility B] in [ ] Ontario: i. you failed to document any observations in the progress notes for [Client B], particularly with respect to her poor dietary intake and/or Head Injury Routine, on or about December 6, 2010; ii. iii. you failed to document any observations in the progress notes regarding [Client C] particularly with respect to the condition for which the client was in isolation, on or about December 22, 2010; you failed to document any observations in the progress notes for [Client D], particularly with respect to the condition for which it was suggested the client should be in isolation, on or about December 31, 2010; iv. you failed to document any observations in the progress notes for [Client E] particularly with respect to Head Injury Routine, on or about January 6, 2011; v. you administered Novomix 30 insulin to [Client F] contrary to the physician s order, and/or failed to take or document appropriate action when you learned of the overdose, on or about February 3, 2011; vi. you inappropriately challenged the son of [Client G] when he inquired about adequate pain management for [Client G], to the effect that it could not be known what pain the client was feeling because she could not communicate, on or about December 19, 2010; c. while employed at [Facility C] in [ ] Ontario: i. you administered Lipitor at 1800 hours to [Client H] when the order was for the medication to be administered at 2100 hours, on or about October 2, 2010; ii. iii. iv. [Withdrawn]; [Withdrawn]; you failed to administer nutrition through a feeding tube to [Client I] but documented as though you had done so as scheduled at 1630 hours on or about January 11, 2011; d. while employed at [Facility D in] Ontario: i. you made inappropriate comments and demonstrations of negative startle reactions you could elicit from various clients to [the] daughter of [Client J] on or about November 2, 2010; ii. you made inappropriate comments to [the] daughter of [Client J] regarding the conduct of [Client J] and/or other clients, on or about November 2, 2010; and/or

5 iii. you failed to complete your scheduled shift and/or abandoned your clients by preparing to leave and sitting in the lobby of the facility at least 15 minutes before the end of you shift, on or about October 24, [Withdrawn] Member s Plea In taking the Member s plea, it became clear to the panel that the Member sought to resile from her original plea, as set out in the Agreed Statement of Facts (described below). Ultimately, the Member admitted to the allegations set out in paragraphs 1 (a) i, ii, 1 (b) i, ii, iii, iv, and v, 1 (c) i and iv, 2 (a), (b), (c), (d), 4 (a) i, ii, 4(b) i, ii, iii, v, 4 (c) i and iv (unprofessional only) as set out in the Notice of Hearing. The Member changed her plea to not guilty with respect to the allegations as set out in paragraphs 1 (b) vi, 1 (d) i, ii, iii, 4 (b) iv, vi, and 4 (d) i, ii, iii of the Notice of Hearing. The panel received a written plea inquiry [ ] which was signed by the Member. The panel also conducted an oral plea inquiry and was satisfied that the Member s admission was voluntary, informed and unequivocal. Agreed Statement of Facts Counsel for the College advised the panel that agreement had been reached on the facts and introduced an Agreed Statement of Facts [ ], signed by the Member, which provided as follows: THE MEMBER 1. Daljit Mann (the Member ) obtained a nursing degree [ ] in The Member registered with the College of Nurses of Ontario (the College ) as a Registered Practical Nurse ( RPN ) on June 13, THE FACILITIES 3. The incidents set out below occurred at four different facilities between October 2, 2010 and February 3, [All four facilities are located in Ontario.] All four facilities provide long-term care to residents. INCIDENTS RELEVANT TO ALLEGATIONS OF PROFESSIONAL MISCONDUCT A. [Facility A]

6 5. The Member worked at [Facility A] through a nursing agency [ ]. She was employed by [the agency] from May 2010 until she was terminated on February 7, i. Insulin Overdose to [Client A] 6. On November 17, 2010, the Member was assigned to care for [Client A]. The physician s order for [Client A] was for eight units of insulin to be administered and for the physician to be called if the client s blood sugar reading was above When the Member determined that [Client A] s blood sugar reading was 25.9, the physician was called. The physician ordered an additional two units of insulin, for a total of 10 units. The Member administered the two additional units of insulin. 8. However, the Member in error had already administered nine units of insulin to [Client A], instead of the eight units specified in the original physician s order. As a result, a total of 11 units of insulin were administered rather than the 10 units that had been ordered. An incident report was prepared and signed by the Member regarding this error. 9. The Member acknowledges that she administered the wrong dose of insulin to [Client A] on November 17, If she testified, the Member would note that [Client A] did not suffer any ill effects from the overdose. The Member would also state that she recognizes that accurate dosing of medications, particularly drugs like insulin, is critical to the practice of nursing. ii. Medication Administration to [Client A] 10. On November 17, 2010, the Member was administering medication to clients in the dining room at breakfast time. 11. [Client A] was sitting at a table waiting to receive his oral medication. The Member placed the cup containing [Client A] s medication on the table. She was not sure which client was [Client A]. Another client seated at the table picked up the medication and, according to at least one witness, put it in his mouth. 12. When the Member discovered that the medi[c]ation had been administered to the wrong client, she grabbed the medication away from the other client and handed it to [Client A]. 13. [Client A] refused to take the medication because it had been handled by the other client. 14. The Member acknowledges that she should not have given medication that had been handled by another client to [Client A], whether the other client had put the medication in his mouth or not. She should have arranged for new medication to be provided to [Client A]. B. [Facility B] 15. The Member worked at [Facility B] from May 31, 2010, to February 3, 2011, when she was terminated.

7 i. Failure to Document Regarding [Client B] 16. On December 6, 2010, the Member worked the 07:00 to 15:00 shift. 17. [Client B] was on a Head Injury Routine (HIR). The facility s policy was that a tracking form was to be filled out on every shift for clients on a HIR. The Member failed to document her observations related to [Client B] s HIR on the tracking form or on the client s progress notes. 18. A chart entry in the progress notes by the dietician at 14:36 confirmed that [Client B] s dietary intake remained poor. However, the Member did not note anything in the progress notes regarding [Client B] s dietary intake or her refusal to take her medication during the shift. 19. In addition, there were no entries in [Client B] s progress notes regarding the HIR, or any other notations for the duration of the Member s shift. In contrast, entries by RPNs responsible for [Client B] s care, both before and after her shift, contained notations about the client s dietary intake and the HIR, even when there were no changes to the client s health. 20. The Member acknowledges that she should have charted observations regarding [Client B] during the shift, particularly with respect to the client s dietary intake and the HIR. ii. Inappropriate Communication with [Client G s Son] 21. On December 19, 2010, [ ] the son of [Client G] called the facility to inquire about his mother s comfort because she had been in the hospital over the weekend. [Client G] s ability to verbally communicate was limited due to her age and health problems. 22. The Member was providing care to [Client G] on that date. 23. When [Client G s son] asked the Member if his mother was receiving adequate pain management, the Member responded abruptly, How do you know she s in pain? She can t communicate, or words to that effect. 24. Following his call with the Member, [the son] expressed concern to the facility about his mother s care. His conversation with the Member cast doubt on whether his mother s pain was being appropriately managed, given her limited ability to communicate. 25. If she testified, the Member would state that she has no recollection of this incident. However, she recognizes that she is responsible for communicating appropriately with clients and their families and that she should be mindful of how her words are perceived. She also recognizes that a client lacking the ability to verbally communicate can and should be assessed for pain management, as required.

8 iii. Failure to Document Regarding [Client C] 26. On December 22, 2010, the Member worked the 10:30 to 15:00 shift. The Member was responsible for [Client C], who was placed on enteric outbreak isolation. During the previous shift, this change was charted in [Client C] s progress notes. 27. For the duration of her shift, the Member failed to document any observations in [Client C] s progress notes related to nausea or vomiting. In contrast, other staff members charted with respect to [Client C] s bowel movements and dietary intake following the Member s shift, beginning at 22:36 on December 22, The Member acknowledges that she should have charted observations for [Client C], particularly with respect to nausea or vomiting, symptoms associated with the condition that prompted [Client C] to be placed in isolation. iv. Failure to Document Regarding [Client D] 29. On December 31, 2010, the Member worked the 15:00 to 23:00 shift. The Member was responsible for [Client D]. The progress notes for the preceding shift indicated that isolation precautions were started for client [Client D]. 30. The Member did not document any observations in [Client D] s progress notes throughout her shift, despite the recorded concerns of the nursing staff on the previous shift about [Client D] s bowel movements. 31. The Member acknowledges that she should have charted observations in the progress notes during the shift, particularly with respect to the symptoms associated with the condition that prompted [Client D] to be placed in isolation. v. Failure to Document Regarding [Client E] 32. On January 6, 2011, the Member worked the 07:00 to 14:30 shift. The Member was responsible for [Client E,] who was on a HIR and in enteric outbreak isolation. The Member did not chart any observations in [Client E] s progress notes on January 6, The Member acknowledges that she should have charted observations regarding the client s condition, particularly with respect to the HIR and the symptoms associated with the condition that prompted [Client E] to be placed in isolation. vi. Insulin Overdose to [Client F] 34. On February 3, 2011, the Member worked the 15:00 to 23:00 shift. The Member was responsible for [Client F]. 35. Prior to February 2, 2011, [Client F] was receiving 95 units of Novomix 30 in the morning and 38 units at night, as noted in the MAR. The order was revised on February 2, The progress notes regarding the new order stated that no Novomix was to be administered to [Client F] if the client s blood sugar was below six. It is not clear whether

9 or not the new order was charted in the MAR at that time. However, the Member failed to notice the physician s order or the progress notes regarding the revised order, both of which were recorded on February 2, 2011, before she administered the insulin to [Client F]. 36. The Member administered the evening dose of Novomix 30 at approximately 16:00 when it was not required, contrary to the physician s order. The Member signed off in the MAR for the insulin but failed to document what time she administered the insulin to the client or with respect to any subsequent intervention after the medication error was brought to her attention. 37. The Member also failed to take action by filing an incident report when she learned of the insulin overdose from the charge nurse. 38. The Member acknowledges that she should have reviewed the progress notes and physician s order before administering insulin to [Client F]. Had she done so, she would have noticed the new order and the error would not have been made. Furthermore, the Member acknowledges that her response to the insulin overdose was inadequate. C. [Facility C] 39. The Member began working at [Facility C] on a casual basis on June 17, She was terminated on January 12, 2011 while still on probation. i. Early Administration of Medication to [Client H] 40. On October 2, 2010, the Member worked between 14:30 and 22:30. The Member was assigned to [Client H] who was to receive 80 mg of Lipitor orally at 21:00, according to the MAR. 41. Instead, the Member administered the Lipitor to [Client H] at 18:00, three hours before the medication was due to be administered. The Member completed an incident report with respect to this error. 42. The Member acknowledges that the medication should have been administered at the time indicated in the MAR and the physician s order and not at other times. ii. Failing to Administer Nutrition to [Client I] 43. On January 11, 2011, the Member worked from 14:30 to 22: The Member was assigned [Client I]. This client was ordered to receive a nutritional prescription of Isosource (1,200 ml/day) to be delivered via feeding tube three times daily at 08:00-09:00, 11:30-13:30 and 16:30-18: The Member failed to administer the nutrition ordered for [Client I] between 16:30-18:00. The RPN on the following day shift noticed that the Isosource bag left hanging was marked with January 11, 08:00 and 11:30, the shift prior to the Member s

10 shift on that date. [Client I] s nutrition was not administered until the following morning at 08:00, which was more than sixteen hours late. 46. Despite not administering the 16:30-18:00 dose of Isosource, the Member signed for the administration and documented in the MAR that the nutrition had been administered. 47. If she testified, the Member would state that she forgot to administer the nutrition to [Client I], as required. She would also state that she did not chart the medications in advance but rather she believed she had administered the nutrition to [Client I]. The Member acknowledges that she was responsible for administering all medications to the client, including the nutrition. D. [FacilityD] 48. The Member worked part-time at [Facility D] from June 7, 2010 to November 12, 2010 when she was terminated during her probationary period. i. Leaving Shift Early 49. On October 24, 2010, the Member worked from 13:00 to 23:00. She was the only registered staff on duty during the evening shift. She was responsible for a 32-bed dementia floor. 50. At 22:45, the Member was observed by the charge nurse on the night shift, sitting in the lobby with her coat on. The Member did not have permission to leave early. 51. As a result, the Member s clients were left without nursing care, for at least 15 minutes, until the responsibility for clients was assumed by the night shift staff. As well, the Member waited until 23:00 to punch out, which meant she was paid for 15 minutes she did not work. 52. If she testified, the Member would state that she may have been in the lobby but did not actually leave the workplace before the end of the shift. However, she acknowledges she could not have completed a proper shift turnover with the RPN on the oncoming shift if she was already in the lobby when that person arrived at the facility. ii. Inappropriate Comments about [Client J] and other Clients 53. On November 2, 2010, the Member was responsible for [Client J]. While applying a dressing to [Client J] s blister, the Member stated, in front of [Client J] s daughter, Your mom beats everybody up but at least she takes her pills. Nobody else does. [Client J] s daughter was offended by the Member s remark she felt it was unprofessional and she reported it to the facility. 54. Later the same day, the Member exhibited inappropriate behaviour in front of [Client J] s daughter in order to elicit negative reactions from other clients. For instance, the Member stood in front of a client as he walked down the hall. She placed the client s pills and

11 water in front of him. The client reacted by swatting the pills away. The Member did the same thing to another client in front of [Client J] s daughter that same day. 55. [Client J] s daughter felt that the Member s comments and actions made her question the care [Client J] was receiving at the facility. She characterized the Member s actions as disrespectful and confrontational. 56. If she testified, the Member would state that she did not have any negative feeling about the clients. However, she acknowledges that she should not have communicated with the family member of a client about these issues, or done anything to elicit negative reactions from clients. ADMISSIONS OF PROFESSIONAL MISCONDUCT 57. The Member admits that she committed the acts of professional misconduct as alleged in the Notice of Hearing, as set out in paragraphs: 1 (a) i and ii; 1 (b) i, ii, iii, iv, v and vi; 1(c) i and iv; 1(d) i, ii and iii; 2(a), (b), (c) and (d); 4 (a) i and ii; 4 (b) i, ii, iii, iv, v and vi; 4(c) i and iv; 4(d) i, ii and iii, in that her conduct was unprofessional only. 58. With leave of the Discipline Committee, the College withdraws the allegations of professional misconduct alleged in the Notice of Hearing, as set out in paragraphs: 1(c) ii and iii, 3, and 4(c) ii and iii, and with respect to conduct being characterized as disgraceful or dishonourable, The College also withdraws the allegations of incompetence in paragraph 5 of the Notice of Hearing. As described above, despite the Member having signed the Agreed Statement of Facts and presumably having agreed to its contents (in particular paragraph 57), the Member resiled from her original agreement with regard to the allegations set out in 1(b) vi, 1(d) i, ii, iii, 4(b) iv, vi, 4(d) i, ii, iii. College Counsel chose to proceed with the matter on the basis of the Agreed Statement of facts and the Member s revised plea.

12 Decision The panel considered the Agreed Statement of Facts and the Member s revised plea and finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed acts of professional misconduct as alleged in paragraphs 1(a) i, ii; 1(b) i, ii, iii, iv, and v; 1(c) i and iv; 2(a), (b), (c), (d); 4(a) i, ii; 4(b) i, ii, iii, v; and 4(c) i, iv of the Notice of Hearing. The panel also found that members of the profession would reasonably regard the Member s conduct as set out in paragraphs 4(a) i, ii; 4(b) i, ii, iii, v; and 4(c) i, iv as unprofessional. The panel did not make findings with respect to allegations 1(b) vi; 1(d) i, ii, iii; 4(b) iv, vi; 4(d) i, ii, iii. Reasons for Decision The panel accepted that the Member committed the acts as set out in the Agreed Statement of Facts and that those acts constitute professional misconduct. The panel also accepts that the conduct would reasonably be regarded as unprofessional by members of the profession. The panel is satisfied that the Member s error in administering correct dosages, failure in correctly documenting and attempting to administer medication that was already handled by another client, constitutes professional misconduct. Penalty Counsel for the College advised the panel that a Joint Submission as to Order had been agreed upon. The Joint Submission as to Order provides as follows: 1. Requiring the Member to appear before the Panel to be reprimanded within three months from the date this Order becomes final. 2. Directing the Executive Director to impose the term, condition and limitation on the Member s certificate of registration that she not engage in the practice of nursing until the Member, at her own expense, successfully completes a Refresher Course approved by the Director, with a minimum passing grade of 65%, which covers all basic nursing skills, including [client] assessment and documentation, and evaluates the Member s performance through both a clinical component and a written examination. 3. Directing the Executive Director to impose the following additional terms, conditions and limitations on the Member s certificate of registration: a) The Member will attend three sessions with a Nursing Expert (the Expert ) at her own expense. The Member is required to attend the first session within six months of successfully completing the Refresher Course. Once the Member has attended the first session, she will complete sessions two and

13 three within six months of the first session. To comply, the Member is required to ensure that: i. The Expert has expertise in [self-]regulation, [and] has been approved by the Director of Professional Conduct (the Director ) in advance of the meetings; ii. At least seven days before the first meeting, the Member provides the Expert with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Order, and 5. if available, a copy of the Panel s Decision and Reasons; iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules: 1. Professional Standards (Revised 2002), 2. Therapeutic Nurse-Client Relationship (Revised 2006); 3. Medication (Revised 2008); 4. Documentation (Revised 2008). iv. Before the first meeting, the Member reviews and completes the College s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses Workbook; v. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses Workbook; vi. The subject of the sessions with the Expert will include: 1. the acts or omissions for which the Member was found to have committed professional misconduct, 2. the potential consequences of the misconduct to the Member s clients, colleagues, profession and self, 3. strategies for preventing the misconduct from recurring, 4. the publications, questionnaires and modules set out above, and

14 5. the development of a learning plan in collaboration with the Expert; vii. Within 30 days after the Member has completed the last session, the Expert forwards his/her report to the Director, in which the Expert will confirm: 1. the dates the Member attended the sessions, 2. that the Expert received the required documents from the Member, 3. that the Expert reviewed the required documents and subjects with the Member, and 4. the Expert s assessment of the Member s insight into her behaviour; viii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration; b) For a period of 24 months from the date the Member completes the refresher course and returns to the practice of nursing, the Member will notify her employers of this decision. To comply, the Member is required to ensure that: (i) (ii) The Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position; [The Member provides] her employer(s) with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Order, and 5. a copy of the Panel s Decision and Reasons, once available; (iii) Within 14 days of the commencement or resumption of the Member s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm: 1. that they received a copy of the required documents, and 2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and

15 3. that they agree to conduct random spot audits of the Member s practice at the following intervals: a. the first audit shall take place within three months from the date the Member returns to clinical nursing practice; b. the second audit within six months from the date the Member returns to clinical nursing practice, and; c. the third audit within 12 months from the date the Member returns to clinical nursing practice. 4. the audits shall, on each occasion, involve: a. Observing the Member complete a medication pass to verify that the Member is administering medication in a manner that meets College Standards; b. Conducting a review of the Member s documentation to verify that the Member is documenting and charting in a manner that meets College Standards, and; c. Providing the Director with a report after each of the audits confirming when it was completed and whether the employer is satisfied with the results. c) The Member shall only engage in the practice of nursing at place(s) of employment where she is not the only registered staff on duty for the shifts she works for a period of 12 months upon her return to nursing practice. 4. All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will retain. Penalty Submissions College Counsel submitted that the Joint Submission on Order [ ] has an emphasis on rehabilitation and remediation. It reflects the serious deficiencies in the Member s skills and attitude, while at the same time protecting the public. The Joint Submission offers an order that is fair to the Member as it allows her return to nursing upon completion of the various remedial terms. It also reflects the profession s ability for self governance and it offers a deterrence to other members of the profession. Penalty Decision The panel accepts the Joint Submission as to Order and accordingly orders:

16 1. The Member to appear before the Panel to be reprimanded within three months from the date this Order becomes final. 2. The Executive Director to impose the term, condition and limitation on the Member s certificate of registration that she not engage in the practice of nursing until the Member, at her own expense, successfully completes a Refresher Course approved by the Director, with a minimum passing grade of 65%, which covers all basic nursing skills, including [client] assessment and documentation, and evaluates the Member s performance through both a clinical component and a written examination. 3. The Executive Director to impose the following additional terms, conditions and limitations on the Member s certificate of registration: a) The Member will attend three sessions with a Nursing Expert (the Expert ) at her own expense. The Member is required to attend the first session within six months of successfully completing the Refresher Course. Once the Member has attended the first session, she will complete sessions two and three within six months of the first session. To comply, the Member is required to ensure that: i. The Expert has expertise in [self-]regulation, [and] has been approved by the Director of Professional Conduct (the Director ) in advance of the meetings; ii. At least seven days before the first meeting, the Member provides the Expert with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Order, and 5. if available, a copy of the Panel s Decision and Reasons; iii. Before the first meeting, the Member reviews the following College publications and completes the associated Reflective Questionnaires and online learning modules: 1. Professional Standards (Revised 2002), 2. Therapeutic Nurse-Client Relationship (Revised 2006); 3. Medication (Revised 2008); 4. Documentation (Revised 2008). iv. Before the first meeting, the Member reviews and completes the College s self-directed learning package, One is One Too Many, at her own expense, including the self-directed Nurses Workbook;

17 v. At least seven days before the first meeting, the Member provides the Expert with a copy of the completed Reflective Questionnaires, online participation forms and Nurses Workbook; vi. The subject of the sessions with the Expert will include: 1. the acts or omissions for which the Member was found to have committed professional misconduct, 2. the potential consequences of the misconduct to the Member s clients, colleagues, profession and self, 3. strategies for preventing the misconduct from recurring, 4. the publications, questionnaires and modules set out above, and 5. the development of a learning plan in collaboration with the Expert; vii. Within 30 days after the Member has completed the last session, the Expert forwards his/her report to the Director, in which the Expert will confirm: 1. the dates the Member attended the sessions, 2. that the Expert received the required documents from the Member, 3. that the Expert reviewed the required documents and subjects with the Member, and 4. the Expert s assessment of the Member s insight into her behaviour; viii. If the Member does not comply with any of the requirements above, the Expert may cancel any session scheduled, even if that results in the Member breaching a term, condition or limitation on her certificate of registration; b) For a period of 24 months from the date the Member completes the refresher course and returns to the practice of nursing, the Member will notify her employers of this decision. To comply, the Member is required to ensure that: (i) (ii) The Director is notified of the name, address, and telephone number of all employer(s) within 14 days of commencing or resuming employment in any nursing position; [The Member provides] her employer(s) with a copy of: 1. the Panel s Order, 2. the Notice of Hearing, 3. the Agreed Statement of Facts, 4. this Joint Submission on Order, and

18 5. a copy of the Panel s Decision and Reasons, once available; (iii) Within 14 days of the commencement or resumption of the Member s employment in any nursing position, the employer(s) forward(s) a report to the Director, in which it will confirm: 1. that they received a copy of the required documents, and 2. that they agree to notify the Director immediately upon receipt of any information that the Member has breached the standards of practice of the profession; and 3. that they agree to conduct random spot audits of the Member s practice at the following intervals: a. the first audit shall take place within three months from the date the Member returns to clinical nursing practice; b. the second audit within six months from the date the Member returns to clinical nursing practice, and; c. the third audit within 12 months from the date the Member returns to clinical nursing practice. 4. the audits shall, on each occasion, involve: a. Observing the Member complete a medication pass to verify that the Member is administering medication in a manner that meets College Standards; b. Conducting a review of the Member s documentation to verify that the Member is documenting and charting in a manner that meets College Standards, and; c. Providing the Director with a report after each of the audits confirming when it was completed and whether the employer is satisfied with the results. c) The Member shall only engage in the practice of nursing at place(s) of employment where she is not the only registered staff on duty for the shifts she works for a period of 12 months upon her return to nursing practice. 4. All documents delivered by the Member to the College, the Expert or the employer(s) will be made by verifiable method of delivery, the proof of which the Member will retain. The panel has ordered that the Member attend the College in person to receive the reprimand. Reasons for Penalty Decision

19 The panel concluded that the proposed penalty is reasonable and in the interest of the public. The Member has cooperated with the College and by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions. The panel notes that the penalty is appropriate in that it achieves the goals of remediation, rehabilitation, specific and general deterrence. The penalty includes elements of remediation and monitoring to ensure that the Member returns to practice safely which provides public protection. The 24-month period of employer notification and 12 months when the Member shall only work with other registered staff provides an additional safeguard to the public. In light of the seriousness of the Member s misconduct, the panel has ordered the Member to attend the College in person to receive the reprimand. I, Tammy Hedge, RPN, sign this decision and reasons for the decision as Chairperson of this Discipline panel and on behalf of the members of the Discipline panel as listed below: Chairperson Date Panel Members: Miranda Huang, RN Sandra Steele, RPN Debra Mattina Margaret Tuomi