How to Respond to a College of Nurses of Ontario Complaint: A Practical Guide for Ontario Nurses and Midwives

Understanding the College of Nurses of Ontario Complaint Process

The College of Nurses of Ontario is the regulatory body for registered nurses (RNs), registered practical nurses (RPNs), and nurse practitioners (NPs) in Ontario. Midwives in Ontario are regulated separately by the College of Midwives of Ontario; however, nurses who also practise as midwives may be subject to CNO oversight in their nursing capacity.

Under the Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991, the CNO has a statutory obligation to investigate complaints about its registrants and determine whether regulatory action is required.

Complaints to the CNO can be made by patients, family members, other healthcare professionals, or employers. The CNO may also initiate its own investigation in certain circumstances. In addition, the RHPA creates mandatory reporting obligations — certain employers and facility operators are legally required to report a nurse to the CNO in specified situations, such as termination in connection with professional conduct concerns. Mandatory reports follow a similar process to complaints.

Once a complaint or report is received, the CNO process moves through the following stages:

The majority of CNO complaints are resolved at the ICRC stage. A professional, factual, and reflective written response is one of the most important contributions you can make to a favourable outcome at this stage.

Ontario nurses and midwives seeking information about professional ethics and regulatory requirements can also review the professional development courses available for Ontario nurses and midwives on our provincial landing page.

What the CNO Expects in Your Written Response

When the CNO issues a notice of complaint, it provides you with the substance of the complaint — the specific concerns raised — so that you have a proper opportunity to respond. Your written response is your account of the events or conduct in question. The ICRC considers your response alongside the complainant's account and any other information gathered in the process.

A strong CNO complaint response addresses the following:

• A clear factual account of the clinical interaction or conduct. Set out your recollection of what occurred, supported by reference to your clinical documentation where relevant. Be precise and factual; do not speculate about matters you cannot recall.
• Reference to and consistency with your clinical records. The CNO will typically gather your clinical notes and documentation as part of its review. Your written account must be consistent with those records. Any inconsistency will undermine your response significantly.
• The nursing reasoning behind your decisions. The ICRC needs to understand the clinical and professional basis for the care you provided or the decision you made — not just what you did, but why.
• Acknowledgement of any shortfalls, where genuine. Where something did not go as well as it could have, acknowledging this in a professional and measured way can demonstrate the insight and reflection that the ICRC values. This should always be discussed with the CNPS before inclusion in your response.
• Any steps taken since the event. If you have reflected on the matter, completed relevant professional development, or changed your practice in response to the concerns, include this in your response.
• A professional, measured tone throughout. The CNO is assessing your professionalism and insight, not just the factual account. Avoid language that appears defensive, dismissive, or contemptuous of the complainant's experience.

Deadlines and Timeline: What Happens When

Ontario nurses and midwives typically have 30 days from the date of the CNO notice to submit a written response. The exact deadline will be stated in the notice you receive. This timeframe can feel short — particularly if you need to gather documentation, consult the CNPS, or take legal advice — which is why it is essential to act immediately.

• Day 1 to 2. You receive the CNO notice of complaint. Contact the CNPS immediately — before taking any other steps. Do not draft any response, speak to the complainant, or discuss the complaint with colleagues until you have spoken with the CNPS.
• Day 1 to 14. Gather and secure all relevant clinical documentation — nursing notes, assessments, care plans, communication records. Do not alter any records under any circumstances.
• Day 1 to 25. Work with the CNPS or your legal adviser to draft your written response. Allow time for review and revision before the deadline.
• By Day 30. Submit your written response to the CNO. If you genuinely require more time — for example, to obtain documentation from a previous employer — request an extension in writing as early as possible. Do not simply miss the deadline.
• After submission. The ICRC reviews the matter. You will receive written notification of the ICRC's decision. Timelines vary depending on the complexity of the complaint and the CNO's caseload.

Common Response Mistakes That Can Escalate Matters

The following errors are among the most common reasons that CNO complaints result in more serious ICRC outcomes — including written cautions, SCERPs, or referrals to the Discipline Committee:

1. Submitting without CNPS advice. The CNPS provides medico-legal support specifically for nurses and midwives in regulatory proceedings. Submitting a response without their input — even when the complaint appears minor — is a significant risk.
2. Responding emotionally or defensively. A response that reads as angry, dismissive of the patient's experience, or critical of the complaint process will negatively affect the ICRC's impression of your professionalism and insight.
3. Failing to address the specific concerns raised. A response that does not engage with the particular issues identified in the notice suggests you have either not taken the matter seriously or are avoiding the substance of the concerns.
4. Inconsistency with clinical records. If your written account differs from your documented clinical records, this creates a significant credibility issue. Review your records carefully before writing your response and ensure consistency throughout.
5. Contacting the complainant. Any direct or indirect contact with the complainant after receiving the CNO notice is a serious error that can introduce additional regulatory concerns independently of the original complaint.
6. No evidence of insight or reflection. Where a clinical error, communication breakdown, or professional lapse has occurred, a response that contains no acknowledgement or reflection misses the opportunity to demonstrate the qualities the ICRC is looking for.

When to Involve the CNPS or Professional Liability Provider

The Canadian Nurses Protective Society (CNPS) is the professional liability provider for nurses and nurse practitioners in Canada. If you are a CNPS member, contact them as the first step on receiving any CNO complaint notice or mandatory report notice — before you take any other action.

The CNPS provides the following support in CNO regulatory proceedings:

• Reviewing the complaint and your clinical documentation with you to understand the full picture
• Advising on the scope and content of your written response before you draft it
• Reviewing your draft response before submission to the CNO
• Advising on whether independent legal representation is appropriate in your specific circumstances
• Supporting you through the ICRC process and any subsequent steps

If you are not a CNPS member, contact your professional liability insurer or a lawyer experienced in CNO regulatory proceedings immediately. The timelines are tight and the consequences of an unguided response can be significant.

Midwives regulated by the College of Midwives of Ontario should contact their own professional liability provider — the CNPS does not cover midwifery practice. Nurses who practise in a dual capacity should seek advice on which regulatory process applies to the specific complaint.

After Your Response: What Ontario Nurses and Midwives Can Expect Next

Once your written response is submitted, the ICRC reviews the complaint alongside your response and any other information gathered. The ICRC is a statutory committee under the RHPA; it does not hold public hearings and its proceedings are not adversarial in the way a Discipline Committee hearing is.

The possible ICRC outcomes for Ontario nurses and midwives, in order from least to most serious, are as follows:

• No action taken. The ICRC determines there is no basis for action. This is the outcome in a significant proportion of CNO complaints.
• Written advice. The ICRC provides written guidance on professional practice without any formal finding. This is not a caution and does not constitute a record of professional misconduct.
• Written caution. A formal written caution is issued and recorded on your CNO registration record. The ICRC may require you to appear before the Committee in person before the caution is issued.
• Specified Continuing Education or Remediation Program (SCERP). The ICRC requires you to complete a defined educational or remediation program relevant to the concerns raised in the complaint.
• Referral to the Discipline Committee. In serious cases, the matter is referred for a formal public hearing before a Discipline Committee panel. This applies to a minority of CNO complaints and involves allegations of professional misconduct or incompetence.
• Referral to the Fitness to Practise Committee. Where health concerns may affect a nurse's ability to practise safely, the ICRC may refer to the Fitness to Practise Committee rather than the Discipline Committee.

You will receive written notification of the ICRC's decision. Both you and the complainant have rights of review in relation to certain ICRC outcomes. The CNPS can advise on whether a particular decision is reviewable and whether pursuing a review is appropriate in your case.

Key Regulatory Bodies for Ontario Nurses and Midwives

For accurate, up-to-date information on the CNO complaint process, always refer directly to the College's official resources and your professional bodies:

• College of Nurses of Ontario (CNO) — The primary regulatory authority for RNs, RPNs, and NPs in Ontario. The CNO website contains detailed information on the complaints and investigations process, the ICRC, and the Discipline Committee.
• Canadian Nurses Protective Society (CNPS) — Provides medico-legal advice and liability protection for Canadian nurses and nurse practitioners. Contact the CNPS immediately on receiving a CNO complaint notice.
• Canadian Council of Registered Nurse Regulators (CCRNR) — The national body representing provincial and territorial nursing regulators across Canada.
• Canadian Nurses Association (CNA) — The national professional association for nurses in Canada, providing resources on professional practice and advocacy.

Frequently Asked Questions

How long do I have to respond to a College of Nurses of Ontario complaint?

The CNO typically provides 30 days to submit a written response to a complaint. The exact deadline will be stated in the notice you receive. Contact the CNPS immediately — they can advise on timing and help you request an extension if genuinely required. Do not simply miss the deadline.

Do I have to respond to a CNO complaint?

Yes. Under the Regulated Health Professions Act, 1991 (RHPA) and the Nursing Act, 1991, CNO registrants are required to cooperate with the College's processes. Failure to respond — or to cooperate with the process — can itself be considered a matter of concern about your professionalism and fitness to practise.

What is the CNPS and should I contact them about a CNO complaint?

The Canadian Nurses Protective Society (CNPS) provides nurses and nurse practitioners with medico-legal advice and liability protection in regulatory proceedings. Contact the CNPS as the first step on receiving a CNO complaint notice — before taking any other steps, including before drafting your written response.

What happens after I submit my written response to the CNO?

The CNO's Inquiries, Complaints and Reports Committee (ICRC) reviews your response alongside the complaint and any other information gathered. The ICRC may take no action, issue written advice, issue a written caution, require a SCERP, refer the matter to the Discipline Committee, or refer it to the Fitness to Practise Committee.

Can a CNO complaint affect my employment?

A CNO complaint does not automatically notify your employer at the initial stage. However, if the CNO imposes an interim order or makes a formal finding, disclosure obligations may arise — and findings at the Discipline Committee level are published on the public register. The CNPS can advise on the employment implications of a complaint in your specific circumstances.

What is the ICRC at the CNO?

The Inquiries, Complaints and Reports Committee (ICRC) is the CNO statutory committee responsible for reviewing complaints and reports about nurses and midwives under the RHPA. It reviews the available information and determines what action, if any, is required. Most CNO complaints are resolved at the ICRC stage without proceeding to a formal Discipline Committee hearing.

Can I see the complaint made against me at the CNO?

Yes. The CNO provides you with the substance of the complaint so that you have a proper opportunity to respond. You are entitled to understand the specific concerns raised — including the nature of the alleged conduct or incident — before preparing your written response.

What is a mandatory report to the CNO?

Under the RHPA, certain individuals and organisations — including employers and facility operators — are required to make a mandatory report to the CNO in specified circumstances, such as where a nurse has been terminated or resigned in circumstances connected to professional conduct concerns. Mandatory reports follow a similar process to complaints and are reviewed by the ICRC.

What is a Specified Continuing Education or Remediation Program (SCERP)?

A SCERP is a formal outcome the ICRC may impose, requiring you to complete a specific educational or remediation program directly relevant to the concerns raised by the complaint. It is not a finding of professional misconduct but is a formal regulatory requirement. Completion of the SCERP is recorded on your CNO registration record.

Can I contact the complainant after receiving a CNO notice?

No. You must not contact the complainant directly — or through a third party — after receiving a CNO complaint notice. Any such communication may be viewed as an attempt to influence the complaint process and can result in additional regulatory concerns being raised against you independently of the original complaint.

What happens if my CNO complaint is referred to the Discipline Committee?

A Discipline Committee referral results in a formal public hearing before a panel that considers specific allegations of professional misconduct or incompetence. Hearings are public and findings are published on the CNO's public register. Outcomes range from reprimand to suspension or revocation of registration. This applies to a minority of CNO complaints. The CNPS or a regulatory lawyer should represent you at any Discipline Committee hearing.

Does the CNO publish complaint outcomes?

Discipline Committee findings are published on the CNO public register and in the College's official communications. ICRC outcomes such as written cautions are recorded on your registration record but are not typically published publicly. Interim orders, suspensions, and revocations of registration are published on the public register and are publicly searchable.