Whose duty is it to care?

from CBC News

Nursing CareLike many professionals, nurses frequently move between provinces, states and countries, looking for work. Unlike many other jobs, however, they can hold lives in their hands.

So who’s watching the caregivers to ensure they aren’t simply moving away from tainted pasts? As CBC learned while investigating an Ontario nurse with a revoked California licence, the answer is complicated.

Self-regulatory bodies in individual provinces or states monitor nurses to ensure they meet requirements to work in that jurisdiction. But there is no formal requirement across the board requiring one province’s college to notify others. Instead, the system largely relies on nurses to honestly report any potential problematic issues.

How often do nurses move?

Most registered nurses remain in the province where they were trained after graduating or eventually return later on. According to 2009 statistics, this is the case for nearly nine out of 10 registered Canadian-educated nurses.

British Columbia, Alberta and Ontario were high on destination lists for migrating nurses from across the country. In contrast, the Yukon and Newfoundland and Labrador received the least number of migrating nurses at around one per cent each.

About eight per cent of the registered nurses working in Canada in 2009, or 22,000 nurses, had graduated from an international nursing program.

Nearly a third of the internationally trained nurses came from the Philippines. Other countries where nurses were trained included the U.K., the U.S., India, Hong Kong, Poland and France.

Provinces with the highest concentration of internationally educated registered nurses in 2009 were British Columbia (16%), Ontario (12%) and Alberta (10%).

Do regulatory bodies communicate?

Colleges do speak to each other. This is especially true when a nurse first applies to a jurisdiction’s nursing regulatory body.

For example, the College of Nurses in Ontario, where about half of Canada’s registered nurses reside, says a first-time applicant must provide verification of registration from the place where they completed their basic training, plus any locations where he or she worked. Each area’s regulatory bodies would provide the college with information about the nurse.

This data may include whether the nurse’s registration or licence has ever been revoked, suspended, surrendered or restricted, and whether the person currently under investigation or involved in any proceedings of import.

Though colleges speak to each other, there is no formal mechanism for alerting each other about nurses who have been disciplined.

Who’s responsible for alerting colleges?

‘Some provinces are required by legislation to send this information, others are not.’—Deborah Jones, Ontario’s College of Nurses

The Ontario college says it works with regulators across North America and around the world to ensure public safety, but they encounter challenges such as privacy legislation and varying enforcement in jurisdictions. They also note that “nurses are becoming increasingly mobile.”

Indeed, there are estimated to be nearly 20,000 Canadian-educated nurses living in the United States.

The college says if an Ontario nurse moves elsewhere it will provide information about the nurse — if requested. There’s no requirement that they send out the information. “Each jurisdiction has different legislation and rules about what information is made public,” Ontario’s College of Nurses communications manager, Deborah Jones, wrote in an email. “Some provinces are required by legislation to send this information, others are not.”

In the end, the onus is on individual nurses to “self report” any legal hearings or disciplinary findings outside the province.

In Ontario, the nurse is required within 30 days to tell the college if they:

  • Are found guilty of an offence.
  • Have a finding of professional negligence or malpractice.
  • Are currently the subject of a proceeding in any other jurisdiction as a nurse or any health care professional.
  • Have a finding in any other jurisdiction as a nurse or any other health care professional.

Each time a nurse renews their licence, a yearly occurrence, they are also required to answer similar questions about their past.

The punishment if they don’t? The nurse can face a finding of professional misconduct for failing to inform the college. Misconduct findings can result in a reprimand, fine, suspension or restriction in practice or even revocation of licence.

How often are nurse licences revoked?

Over a 10-year period, from the beginning of 2000 until the end of 2010, 386 nurses in Ontario were found in disciplinary hearings to have committed professional misconduct. Three-quarters of the nurses — or 295 — were suspended or restricted in their practice. Thirty-seven nurses, less than 10 per cent, received a reprimand and/or fine.

And about 14 per cent of the nurses, or 54, had their licences revoked. Many of them were due to multiple allegations of misconduct, the college says. General reasons for the revocations are as follows:

  • 17 committed theft or fraud of clients/employers.
  • 11 sexually abused clients.
  • 12 cases were due to practice concerns.
  • 14 had criminal convictions (e.g. robbery).

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