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Student # 822-664991

Scholarly Assignment
Student: Tanesha Smith
Student ID: 822 664 991
Date Submitted: November 4, 2014
NURS 217 OND: Legal and Ethical Concepts
Professor: Janet Jeffrey
Humber College ITAL

Introduction
The Discipline Committee, which consisted of a 5 member panel, of the College of
Nurses of Ontario (the College) in Toronto had a hearing on October 10, 2012 regarding

Student # 822-664991

allegations of misconduct. The hearing was between the College and registered practical nurse
Gillian Gamble (the Member). The Member was found by the College to have committed an
act of professional misconduct according to the Health Professions Procedural Code of the
Nursing Act, 1991 and the College of Nurses of Ontario (CNO) professional standards. Gillian
Gamble has admitted to the allegations in the Notice of Hearing that took place on September 13,
2012. The panel confirmed that the admission was voluntary as Gillian Gamble produced a
signed written plea that was followed up by an oral plea which was found to be informed and
unequivocal.
According to the College of Nurses (CNO) professional standards, Gillian Gamble was in
breach of the categories of registration and classes of certificates when she was performing
nursing acts at a facility, while working at [the Facility] in [ ] Ontario during the period from
April 24, 2003, to August 30, 2010, and while your certificate of registration with the College of
Nurses of Ontario was suspended effective April 24, 2003, for non-payment of fees, you signed
or issued in your professional capacity a document or documents that you knew or ought to have
known contained a false or misleading statement (Discipline committee, 2012, p.1-2). Ms.
Gamble violated this standard when she worked as a casual Charge Nurse at a long-term care
facility. The facility required a current certificate of registration for this position that Ms. Gamble
did not have. Moreover, Ms. Gamble also misrepresented her position and capacity to work as a
Charge Nurse. She inappropriately used terms and titles (G.Downs RPN) while providing
services to clients and signing entries in clients records when using this name not in the CNO
registered files and did not notify the College she was practicing under this name. The
professional misconduct was breached here when Ms. Gamble, as stated in the hearing on
September 13, 2012, signed Annual Registration Payment Cards for the years 2007, 2008 and/or

Student # 822-664991

2009 which you knew or ought to have known were altered or fabricated (Discipline committee,
2012, p.2). In addition to the above noted allegations of misconduct, the Member is also alleged
to falsify documents and took on an assumed name Gillian Downs. The Member was also in
violation of section 27 of the Regulated Health Professions Act, 1991, and Section 4 of the
Nursing Act, 1991, by performing controlled acts when administering a substance by injection.
The Member was also in violation of section 11 of the Nursing Act, 1991, when using the title
registered practical nurse or nurse when the member was not registered, or a qualified
member of the College.
The College took into consideration that the Member, as stated in the Discipline
Committees decision, was under great personal stress during the period of misconduct. There
were no other contributing factors that played a role in the nurses misconduct. Gillian Gambles
misconduct were in breach of the standard of practice and therefore I agree with the discipline
committees decision to order her to appear before the Panel for reprimand; the suspension of
certificate of registration for four months; the ordering of her to attend a session with a Nursing
Expert at her expense; and for her to review College publication and complete the associated
Reflective Questionnaire and online learning module on Professional Standards (Revised 2002);
and for a period of 12 months from the date she resumes employment as a nurse, she will notify
her employers of disciplinary committees decision, and furthermore, in order for her to comply,
she is required to ensure that the College 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.
Body

Student # 822-664991

According to CNO, Ethics 2008 Standard, RPN Gillian Gamble contravened the
following specific ethical values and principles: truthfulness and veracity, client choice and
autonomy, client well-being and beneficence and maintaining commitments.
Truthfulness and veracity were values and principles that Gillian Gamble violated.
truthfulness means speaking or acting without intending to deceive (CNO, 2009, p.13). She
violated this value when she falsified documents and used the term nurse and the title RPN
which is a misrepresentation of her position and standing with the College. in Ontario, only
members of the College can use the titles of nurse, registered nurse, registered practical nurse
(CNO, 1991, p.2).
Client choice and autonomy are values and principles that were contravened by Gillian
Gamble. The clients she treated were not aware of her performing without the proper
registration. They were not given a choice to refuse care by this nurse. client choice means selfdetermination and includes the right to the information necessary to make choices and to consent
or refuse care (CNO, 2009, p.6).
Client well-being and beneficence were violated when she performed a controlled act on
a patient when she administered a substance by injection to a patient although she was not
authorized to do so. control acts are activities that are considered to be potentially harmful if
performed by unqualified persons (CNO, 2014, p.3). Ms. Gamble violated controlled act #5
established in the RHPA. administering a substance by injection or inhalation (CNO, 2014
p.3).
Maintaining commitments to the nursing profession were violated because Ms. Gamble
didnt abide by the rules and regulations of the nursing act and professional standards as outlined

Student # 822-664991

in the CNO Ethics document. nurses have a duty to uphold the standards of the profession,
conduct themselves in a manner that reflects well on the profession (CNO, 2009, p.11). Being a
registered member with CNO nurses are also responsible to self-regulate. self-regulation is a
privilege, and each nurse is accountable for the responsibilities that accompany this privilege.
(CNO, 2009, p.11). Ms. Gamble broke this commitment and did not self-regulate by not
reporting renewing her registration with the College from 2007 to 2009.
There are two ethical theories that would apply to this case which are Utilitarian and
Deontological ethics. Utilitarian ethics is based on the premise that an action or practice is right
if it leads to the greatest possible balance of good consequences or to the least possible balance
of bad consequences (Gibson, 1993, p.2003-2004). The personal stress that Ms. Gamble was
under may have been due to financial stress and therefore she may not have been able to afford
to renew her registration with the College. Ms. Gamble may have felt that falsifying her
documents would allow her to continue to work and to possibly help her to recover from her
financial strain. She may have felt that this course of action may have been the only possible
solution. consequences are evaluated in terms of usefulness, cost-effectiveness and efficiency so
that the greatest good for the greatest number is realized. In Utilitarianism the end justifies the
means (Gibson, 1993, p.2004).
Deontological ethics focuses on binding obligations or duties in which the justification
of principles and actions is irrespective of consequences (Gibson, 1993, p.2004). Ms. Gamble
was performing her job duties with the facility that she worked for and disregarded the principles
and values of the College as she was not properly registered. CNO specifically outlines that in
order for a nurse to practice nursing duties they must be properly certified and registered with the

Student # 822-664991

College annually. only individuals with a valid certificate of registration and current College
membership are legally entitled to practice nursing in Ontario (CNO, 2012, para. 2).
One strategy I would suggest to prevent similar occurrence would be to make it a CNO
mandatory policy for any health care facility that employs nurses to do a reference check with
the College before hiring a nurse as well as annual checks. This CNO mandatory action would
ensure that nurses are keeping up with their commitments and self-regulation, as well as prevent
fraud and thus protect the facility and the public. Should a facility breach this policy they would
be held accountable by the College as nurses are held accountable. mandatory reporting
ensures that the college is alerted if there is a concern that the nurse is not practicing safely
(CNO, 2012, p.3). The reason why this CNO mandatory policy would work is because it not only
leaves the reporting obligation up to the nurse but also to the facility to ensure compliance with
CNO. Making it mandatory for facilities to do a reference check will also help CNO keep track
of nurses registration with the College. This would also help reduce the number of unreported or
unregistered nurses that are practicing without the proper certificate.
The other strategy I would suggest is for CNO to implement an embossed certificate or
embossed letter verifying registration. The nurse would have to provide the hiring facility with
an original embossed copy of the certificate that would be used as a condition of employment.
The facility has the right to contact CNO for confirmation of certificate if the nurse does not
have an embossed certificate or embossed letter. This would work because it would prevent
misrepresentation and fraud by eliminating the opportunity for nurses to photocopy or
manipulate in anyway their certificate of registration. it is the responsibility of the individual
nurse to represent the truth about her/his qualifications and abilities (CNO, 2014, p.9).

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Conclusion
Registered Practical Nurse, Gillian Gamble was found guilty by the Discipline
Committee at the College of Nurses of Ontario in Toronto on October 10, 2012 for professional
misconduct. Gillian Gambles certificate of registration with the College was suspended for nonpayment of renewal fees. However, she continued to practice as a RPN and has held employment
for a period of three years even though her registration was under suspension. Within this
violation Ms. Gamble also inappropriately used term, title or designation that did not reflect her
status at the time when practicing as an RPN. The College took into consideration that the
Member, as stated in the Discipline Committees decision, was under great personal stress during
the period of misconduct.
The ethical values and principles contravened were: truthfulness and veracity, client
choice and autonomy, client well-being and beneficence and maintaining commitments. She did
not show commitment to the profession when she neglected to renew her membership with the
College for a period of three consecutive years.
To prevent similar occurrence I would make it a CNO mandatory policy for any health
care facility that employs nurses to do a reference check with the College before hiring a nurse.
This ensure that nurses are keeping up with their commitments and self-regulation, as well as
prevent fraud and thus protect the facility and the public. Another proposed solution is for CNO
to implement an embossed certificate or letter verifying registration.
Gillian Gambles misconduct were in breach of the standard of practice and therefore I
agree with the discipline committees decision to discipline her by suspending her certificate and
by ordering her to complete training on professional standards, as well as, ongoing reporting.

Student # 822-664991

Reference
College of nursing of Ontario. (CNO). (2012). Fact Sheet: Introduction about the college of
nurses. Retrieved from
http://www.cno.org/Global/docs/general/45002_SpectrumService.pdf

College of nursing of Ontario. (CNO). (2014). Fact sheet: Legislation and regulation: An
introduction to the nursing acts, 1991. Retrieved from
http://www.cno.org/Global/docs/prac/41064_fsNursingact.pdf

College of Nurses of Ontario. (CNO). (2009). Practice Standard: Ethics. Retrieved from
http://www.cno.org/Global/docs/prac/41034_Ethics.pdf

College of Nurses of Ontario. (CNO). (2012). Process Guides: Mandatory Reporting. Retrieved
from http://www.cno.org/Global/docs/ih/42006_fsMandReporting.pdf

College of Nurses of Ontario. (CNO). (2002). Practice Standards: Professional Standards,


revised 2002. Retrieved from
http://www.cno.org/Global/docs/prac/41006_ProfStds.pdf

College of nursing of Ontario. (CNO). (2014). Reference document: Legislation and regulation,
RHPA: Scope of practice, controlled acts model. Retrieved from
http://www.cno.org/Global/docs/policy/41052_RHPAscope.pdf

Student # 822-664991

College of nursing of Ontario. (CNO). (2014). Reference document: Professional conduct,


professional misconduct. Retrieved from
http://www.cno.org/Global/docs/ih/42007_misconduct.pdf

Gibson, C H. (1993). Underpinnings of ethical reasoning in nursing. Journal of advance nursing,


18, 2003-2007.