What is a “Caution”? When can the College of Nurses of Ontario (CNO) direct a nurse to attend a Caution meeting? What are nurses expected to do? How will a Caution affect my nursing career?

In our practice representing nurses in CNO investigations, we get lots of questions about Cautions and help many RNs and RPNs navigate the process confidently. Demystifying the whole process is what we are passionate about. Here are some answers to FAQs about cautions.

Who decides to caution a nurse?

The Inquiries Complaints and Reports Committee (ICRC) of the CNO is tasked with reviewing concerns about nurses that are brought to the CNO’s attention, either because of a complaint, a facility report, or some other means.  Once the concerns have been investigated, the nurse is given an opportunity to respond to the allegations, a panel of the ICRC meets to review the information and decides whether the CNO should take any regulatory action.

The Health Professions Procedural Code (the “Code”), which is a part of the Regulated Health Professional Act, governs the process and sets out what the ICRC may do. Section 26(1) of the Code sets out what a panel of the ICRC may do. In cases where the ICRC decides that it is not necessary to refer allegations of professional misconduct or incompetence to a hearing before the Discipline Committee, or for incapacity proceedings (health inquiry), the ICRC may “require the member to appear before a panel of the Inquiries, Complaints and Reports Committee to be cautioned.”

Will the CNO decide to caution me?

The ICRC will caution nurses in cases when the committee has determined that it is consistent with CNO’s mandate of public protection to require the nurse to appear before the committee to be cautioned in relation to specific CNO practice standards.

Many of our clients naturally wonder about the likely outcomes. Of course, each case is unique. Outcomes depend on the nature of the concerns, the information before the CNO, and several other factors. A lawyer can provide you with legal advice and discuss potential outcomes in your specific case. We have seen a lot and are pretty good at predicting what might happen. Unfortunately, we are just lawyers without a crystal ball and cannot guarantee any outcomes.

How do I find out if I am asked to attend a Caution?

After the ICRC has considered the information obtained during the investigation and made its decision, the nurse will receive a written decision that explains what the panel’s decision is and why the panel has come to its conclusions. If the ICRC requires a nurse to attend a caution meeting, this will be specifically stated in the decision.

Is a Caution intended to punish the nurse?

No. Although a decision that a nurse is to be cautioned is a serious outcome, it is not intended to be a punishment. Instead, the process is considered remedial in nature, to help the nurse reflect and learn from the concerns that were brought to the CNO’s attention.

It has been argued that the posting of a notation of a caution on the member’s public profile is punitive; however, the Courts have disagreed. See for example the case of Torgerson v. Health Professions Appeal and Review Board, 2021 ONSC 7416 (CanLII).

Where do CNO’s Caution meetings take place?

During the pandemic, the CNO started conducting caution meetings ordered by the Inquiries, Complaints and Reports Committee (ICRC) virtually by videoconference. For now, this practice is being continued. If the Caution meeting takes place by videoconference, the CNO will share a meeting link and instructions with the nurse and their legal counsel, if the nurse is represented.

If you have a question about how to attend a caution meeting, speak to your lawyer or contact the CNO for details.

Who attends the Caution meeting?

Caution meetings are attended by members of the ICRC and the nurse, and (if the nurse is represented) the nurse’s legal counsel

What happens during a Caution meeting?

There is no standard “script” for Caution meetings. Often, the members of the Committee will ask the nurse to speak with them directly about their reflections and what they have learned from the complaint or concerns raised with the CNO, the investigation, and how they have made changes to their nursing practice. The Committee members may provide their observations, concerns, and advice to the nurse, with a view to help the nurse improve their nursing practice and comply with CNO’s practice standards.

What happens if the nurse does not attend their Caution meeting?

When the ICRC has directed a nurse to attend a caution meeting, the nurse has a professional obligation to attend. If a nurse simply does not show up to their caution meeting, the CNO could start a new investigation and refer the nurse to the Discipline Committee. Failing to attend may be considered professional misconduct. If you cannot make it to a caution meeting for any reason, you need to make a request to reschedule the meeting. If you have a lawyer, they can help.

Will there be a notation made on my “Find a Nurse” profile?

Yes. When the ICRC has decided to direct a nurse to attend a Caution meeting, the CNO is required by law to add a note on the nurse’s public register profile. At this time, a notation about Caution will remain on the nurses’ public profile indefinitely. The details of what will be posted on the CNO’s website are usually outlined in the ICRC’s Decision and Reasons.

Can I appeal a decision of the ICRC?

ICRC decisions relating to a “complaint” (for example, by a patient, a patient’s family member, a co-worker, or another person) can be reviewed by the Health Professions Appeal and Review Board (HPARB).  If the ICRC’s decision follows a formal investigation and Registrar’s Report, the nurse would be required to bring an application for judicial review before the Courts to challenge the ICRC’s decision.

Initiating a review before the HPARB or the Courts can have significant consequences. If you are wondering about seeking a review of an ICRC decision, it is best to speak to a lawyer about your options.

Got more questions? Schedule a FREE initial consult to learn how we may help you.

Please note that our articles only provide general information. The law and regulatory processes change. To receive legal advice about your specific case and the most up-to-date information, speak to a lawyer directly.