The College of Nurses of Ontario (CNO) may resolve a concern about a nurse’s practice by having the nurse sign an undertaking – where it is in the public interest to do so.

What is an undertaking?

An undertaking is a formal promise given by a nurse to the CNO that she or he will comply with specific terms in order to acquire or maintain licensure with the CNO.

The CNO’s Monitoring team is tasked with ensuring that nurses who enter into an undertaking maintain their compliance with the terms of the agreement.

When are nurses presented with an undertaking?

Undertakings may be presented to a nurse in a number of different contexts.

For example, it may be offered as part of the process in resolving a disciplinary matter or during an inquiry into a nurses’ capacity (Fitness-to-Practice). An undertaking may also be presented to nurses whose application for registration is being reviewed by the CNO’s Registration Committee.

Undertakings may also be presented to a nurse early on in the proceedings. For instance, the Inquiries, Complaints, and Reports Committee (ICRC) – which acts as a screening body – may explore early resolution of cases through remedial dispositions. The ICRC has accepted remedial undertakings by some nurses, including undertakings to complete remedial education and undertakings to complete a competence assessment and remedial education. To be eligible for this type of undertaking, a nurse must demonstrate accountability for her nursing practice and a willingness to remediate the conduct or practice concerns raised – for example in an employer’s report.

What happens if a nurse fails to comply with an undertaking?

Whether you are a Registered Nurse (RN), Registered Practical Nurse (RPN), or Nurse Practitioner (NP), serious consideration ought to be given before signing an undertaking presented to you, as failure to comply with the terms can lead to a finding of professional misconduct and discipline.

Consider the hypothetical example of a nurse who signed an undertaking which includes a term that requires the nurse to advise their current, potential, and future employers of the undertaking and provide a summary of the undertaking. The nurse is offered a new position and fears that advising the employer of the undertaking would jeopardize the nurses’ ability to get or maintain the job. While the nurse might be tempted to keep the undertaking a secret from the employer, doing so would place this nurse at serious risk for further discipline.

Non-compliance with an undertaking can result in significant long-term implications for a nurse’s professional life. Where a failure to comply with the terms of an undertaking comes to the attention of the CNO, a nurse can be subject to a further discipline process that may result in potential of a reprimand, suspension, the imposition of additional Terms, Conditions, and Limitations (TCLs) being placed on their certificate of registration. In some cases, a breach of an undertaking may even result in revocation.

If you are faced with an undertaking or have questions about an undertaking that you have already signed, seeking legal advice is critical.

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Carina Lentsch is an Ontario health lawyer and an advocate for nurses. She helps nurses involved in CNO investigations, fitness-to-practice, and discipline matters.

Carina writes about legal issues affecting nurses and other health care professionals. To learn more about Carina’s law practice, click here. You can also subscribe to Carina’s newsletter and follow her on Facebook for updates @aclhealthlaw.