DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO

DISCIPLINE COMMITTEE OF THE COLLEGE OF NURSES OF ONTARIO PANEL: David Bishop Chairperson Dennis Curry, RN Member Marcia Taylor, RN Member Cheryl McMaster, RPN Member Linda Bracken Public Member BETWEEN: COLLEGE OF NURSES OF ONTARIO ) GLYNNIS BURT for ) College of Nurses of Ontario - and - ) ) ) DENISE GRUCHY ) MARY HART for Registration No. 8725749 ) Denise Gruchy ) ) Heard: October 26, 2005 DECISION AND REASONS This matter came on for hearing before a panel of the Discipline Committee on October 26, 2005 at the College of Nurses of Ontario (the College ) at Toronto. The Allegations At the request of the Panel Chair, counsel for the College and counsel for Denise Gruchy, RN (the Member ) confirmed that allegation #2 should be noted as withdrawn, and not dismissed. The remaining allegations against the Member as stated in the Notice of Hearing dated September 26, 2005 (Exhibit # 1) were as follows: 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 paragraph 1.01 of Ontario Regulation 799/93, in that, while employed by [the Hospital] as a Registered Nurse in the Intensive Care Unit at the Hospital, and while providing care on or about the 13 th day of April 2003 to a 71 year old [ ] patient in the ICU, [the

client], you contravened a standard of practice of the profession or failed to meet the standards of practice of the profession in that you: (a) (b) spoke to [the client] with an inappropriate tone of voice that was raised and frustrated and/or angry; and you slapped [the client] on the hand. 3. 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 paragraph 1.37 of Ontario Regulation 799/93, in that, while employed by the Hospital as a Registered Nurse in the Intensive Care Unit at the Hospital, and while providing care on or about the 13 th day of April 2003 to a 71 year old [ ] patient in the Intensive Care Unit, [the client], you engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by Members as disgraceful, dishonourable or unprofessional, in that you: (a) spoke to [the client] with an inappropriate tone of voice that was raised and frustrated and/or angry; and (b) you slapped [the client] on the hand. Member s Plea Denise Gruchy, RN, admitted the allegations set out in paragraphs #1 and # 3 in the Notice of Hearing. The panel conducted a 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 which provided as follows: BACKGROUND 1. D. Gruchy, ( the Member ) has been registered as a Registered Nurse with the College of Nurses of Ontario ( the College ) since June 1987. Prior to 1987, the Member had worked as a nurse in [ ] where she graduated from a three-year nursing diploma program in 1981, followed by successful completion of a postgraduate program in critical care Nursing in 1982 and a Bachelor of Nursing in 1989. 2. The Member has worked in critical care nursing at various institutions and in various locations for most of her professional life, since 1981.

3. The Member was employed as a Registered Nurse on a part-time basis at the [the Hospital s] Intensive Care Unit (ICU) from March 3, 2003 to April 13, 2003. 4. [ ]. The Hospital s ICU is a 25-bed unit that provides care to both adult and paediatric clients. Approximately 75-85% of the clients in the ICU are ventilated. 5. Following the incidents described below, the Member resigned from her position at the Hospital on April 15, 2003. Since resigning, the Member worked for [ ] from June 2003 to February 2004 on a contractual basis. Since June 2004, the Member has been teaching technology health care at [ ]. EVENTS OF APRIL 13, 2003 6. On April 13, 2003, the Member was assigned to provide one-on-one care to [the client] in ICU Room #11. The Member was scheduled to work an eight hour shift from 07:00 to 15:00. This was the Member s first regular shift at the Hospital following her orientation to the ICU. 7. At the time of the incident, [the client] was [71 years old and] recovering from complications following an elective abdominal aortic aneurysm repair performed at the Hospital on March 25, 2003. After the surgery, [the client] developed hypotension, myocardial infarction, cardiogenic shock, acute renal failure (requiring dialysis), pulmonary edema, and respiratory failure (which eventually required a tracheotomy). 8. On April 13, 2003, [the client] was ventilated and receiving full strength Nepro, a liquid dietary supplement, via kangaroo pump. According to the Member s initial patient assessment, [the client] was opening [the client s] eyes to commands and was moving all limbs. [The client] appeared to understand when spoken to and had restraints loosely applied to address [a] tendency to pull at [the client s] various tubes and lines. [The client s] level of sedation was assessed as 1 (awake, restless, agitated) on this day. 9. The same day shift, [RN A] was assigned to provide one-on-one care to the client in ICU Room #12. ICU Room #12 was immediately adjacent to ICU Room #11, where the Member was assigned to care for [the client]. The rooms are separated by a glass door as well as privacy curtains. Prior to April 13, 2003, [RN A] had not worked with or met the Member. 10. If [RN A] were to testify, she would say that the glass dividing doors between ICU Rooms #11 and #12 as well as the door to the hallway from Room #11 were at least partially open allowing her to hear what was transpiring in Room #11. [RN A] would further testify that the tone and volume of the Member s voice became increasingly inappropriate when speaking to [the client] over the course

of her shift. [RN A] would testify that she heard the Member repeatedly tell [the client] not to pull at [the client s] tubes and to keep [the client s] hands down. According to [RN A], she could tell from the Member s tone of voice that the Member was becoming increasingly frustrated and/or annoyed with [the client]. 11. [RN A] would also testify that at approximately 10:45, because of her concern with the Member s increasingly harsh tone, she decided to approach the Member to see if she could provide any assistance. [RN A] would state that, as she reached the doorway of ICU Room #11, she saw the Member walk to the foot of the bed and tell [the client], in a harsh tone, not to pull at [the client s] tubes while she slapped [the client s] right hand as it neared [the client s] mouth. According to [RN A], the Member had to lean over in order to slap [the client s] hand. In response to this, [RN A] would say that she saw [the client] look at the Member with startled eyes. 12. Following this incident, [RN A] immediately reported what she had seen to the Charge Nurse and then filled out an Incident Report (attached). 13. As a result of the incident, the Member was asked to finish her shift early and told that she would be suspended, with pay, during the investigation of the incident. Another R.N. was assigned to care for [the client] at approximately 12:15 and the Member left the Hospital shortly thereafter. 14. During a subsequent meeting with the Member on April 15, 2003, the Hospital accepted the Member s resignation. 15. If she were to testify, the Member would say that she has very little recollection of the events giving rise to the allegations set out in the Notice of Hearing. The Member would state, however, that it is not her normal practice to speak to clients in an inappropriate tone. The Member would also agree that, while she intended to use a warning tone when communicating to [the client] that [the client] should not pull at [the client s] tubes and/or lines, this tone could have reasonably been perceived as angry or frustrated. 16. The Member would further testify that, while she did not intend to slap [the client], she may have, in her effort to prevent [the client] from pulling out lifesaving equipment, reached for [the client s] hand with excessive force. The Member would agree that her actions in this regard could have reasonably been perceived as a slap. The Member would testify that her actions in this regard were not the result of anger or frustration with [the client], but rather, an effort to keep [the client] safe. ADMISSIONS 17. The Member acknowledges that she committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions

Procedural Code of the Nursing Act, S.O. 1991, c.32, as amended, and defined in subsection 1(1) of Ontario Regulation 799/93 while employed at [the Hospital] as a Registered Nurse in the Intensive Care Unit in that she contravened a standard of practice of the profession or failed to meet a standard of practice of the profession while providing care to [the client], on or about April 13, 2003, in that: (i) (ii) the Member spoke to [the client] with an inappropriate tone of voice that was raised and frustrated and/or angry; and the Member slapped [the client] on the hand. 18. The Member also acknowledges that she committed an act or acts of professional misconduct as provided by subsection 51(1)(c) of the Health Professions Procedural Code of the Nursing Act, S.O. 1991, c.32, as amended, and defined in subsection 1(37) of Ontario Regulation 799/93 while employed at [the Hospital] as a Registered Nurse in the Intensive Care Unit, in that, she engaged in conduct or performed an act or acts relevant to the practice of nursing that, having regard to all of the circumstances, would reasonably be regarded by Members as disgraceful, dishonourable or unprofessional while providing care to [the client] on or about April 13, 2003, in that: (i) (ii) the Member spoke to [the client] with an inappropriate tone of voice that was raised and frustrated and/or angry; and the Member slapped [the client] on the hand. Decision 19. The College seeks leave of the Discipline Committee to withdraw allegation #2 in the Notice of Hearing. The panel considered the Agreed Statement of Facts and finds that the facts support a finding of professional misconduct and, in particular, finds that the Member committed an act of professional misconduct as alleged in paragraphs #1 and #3 of the Notice of Hearing in that the Member: a) spoke to [the client] with an inappropriate tone of voice that was raised and frustrated and/or angry; and b) slapped [the client] on the hand. Penalty

Counsel for the College advised the panel that a Joint Submission as to Penalty had been agreed upon. The Joint Submission as to Penalty provides as follows: Denise Gruchy ( the Member ) and the College of Nurses of Ontario ( the College ) respectfully submit that, in view of the circumstances set out in the Agreed Statement of Facts and the Member s admissions of professional misconduct, the Panel of the Discipline Committee ( the Panel ) should make an Order as follows: 1. Requiring the Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three months of the date that the Order becomes final. 2. Directing the Executive Director to suspend the Member s certificate of registration for a period of 30 days. The 30 day suspension shall commence on the date that the Order becomes final if the Member has returned to clinical practice by that date. If the Member has not returned to clinical practice by the date that the Order becomes final, the 30 day suspension shall commence on the date that the member returns to clinical practice. Regardless of when the suspension commences, the suspension shall run continuously so long as the Member both (i) maintains a current registration, and (ii) is practicing nursing in a clinical setting. In the event that the Member fails either to maintain a current registration or to continue practicing nursing in a clinical setting, any portion of the suspension which has not yet been served, shall be served commencing on the day that the registration is renewed. 3. Directing the Executive Director to impose the following terms, conditions and limitations on the Member s certificate of registration: a) The Member shall complete the College s One is One Too Many abuse prevention program within three months of the date that the Order becomes final; and b) The Member shall meet with a College Practice Consultant, at the Consultant s convenience, to discuss the One is One Too Many abuse prevention program as related to the conduct for which the Member was found to have committed an act of professional misconduct and how to prevent such conduct from occurring in the future. Counsel submitted that the proposed penalty would serve as a general deterrent, sending a message to other members of the nursing profession that this type of behaviour will not be tolerated. On that basis, it was submitted that the goal of protecting the public interest would be met through imposition of this penalty order. Penalty Decision

The panel accepts the Joint Submission as to Penalty and accordingly orders: 1. The Member to appear before the Panel to be reprimanded at a date to be arranged but, in any event, within three months of the date that the Order becomes final. 2. The Executive Director to suspend the Member s certificate of registration for a period of 30 days. The 30 day suspension shall commence on the date that the Order becomes final if the Member has returned to clinical practice by that date. If the Member has not returned to clinical practice by the date that the Order becomes final, the 30 day suspension shall commence on the date that the member returns to clinical practice. Regardless of when the suspension commences, the suspension shall run continuously so long as the Member both (i) maintains a current registration, and (ii) is practicing nursing in a clinical setting. In the event that the Member fails either to maintain a current registration or to continue practicing nursing in a clinical setting, any portion of the suspension which has not yet been served, shall be served commencing on the day that the registration is renewed. 3. The Executive Director to impose the following terms, conditions and limitations on the Member s certificate of registration: c) The Member shall complete the College s One is One Too Many abuse prevention program within three months of the date that the Order becomes final; and d) The Member shall meet with a College Practice Consultant, at the Consultant s convenience, to discuss the One is One Too Many abuse prevention program as related to the conduct for which the Member was found to have committed an act of professional misconduct and how to prevent such conduct from occurring in the future. The panel concluded that the proposed penalty is reasonable and in the public interest. The Member has co-operated with the College and, by agreeing to the facts and a proposed penalty, has accepted responsibility for her actions, signalled her readiness to undertake remediation of her clinical practice and has avoided unnecessary expense to the College. The panel accepted the Joint Submission as to Penalty given that it meets the requirements of general deterrence, specific deterrence and remediation as specified by both counsel. I, David Bishop, Public Member, 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: Dennis Curry, RN Marcia Taylor, RN Cheryl McMaster, RPN Linda Bracken, Public Member