Ontario · College of Nurses of Ontario

What happens during a CNO investigation?

The investigation stage is where the record is built — and where nurses are most often surprised by how broad the College’s powers are, and how few procedural protections apply compared with a hearing.

How an investigation starts

Once the College has a complaint or a report, it is obliged to investigate and act on it. An investigator may be appointed to gather the evidence. The scope varies enormously with the case: a straightforward documentation concern may need little more than the chart and your response, while an allegation of misconduct can involve the complainant, colleagues, your employer, and you.

What the investigator can do

Nurses are frequently taken aback by the breadth of these powers. An investigator can obtain records, attend at a practice site, and interview the complainant, witnesses and the nurse. You are obliged to cooperate with the process. And you have fewer procedural protections here than you would at a hearing — there is no cross-examination, no live testing of the evidence, and no adjudicator weighing it in real time. The material simply accumulates into a report.

One point catches nurses off guard more than any other: patient records. Under the Personal Health Information Protection Act, 2004, a health information custodian may disclose personal health information to the College without the patient’s consent for the purposes of the College’s regulatory work. You cannot resist a proper records request on the basis that the patient has not agreed to it.

Never touch the chart

The instinct to clarify a record once a complaint lands is understandable and dangerous. Altering, back-dating or “completing” documentation after you learn of a concern converts a defensible clinical case into an integrity case — and integrity cases are the ones that end in referrals. A late entry made properly, transparently and identified as a late entry is a different thing entirely from a chart quietly improved after the fact. If the record is imperfect, explain it in your response; do not fix it.

Section 75: the Registrar’s investigation

Alongside the ordinary complaints route, section 75 of the Health Professions Procedural Code allows the Registrar to appoint an investigator where there are reasonable and probable grounds to believe a member has committed professional misconduct or is incompetent. These Registrar’s investigations are considerably broader in scope than the standard process, and they are typically reserved for more serious matters.

The consequence matters for you: an ICRC decision made following a section 75 report is not reviewable by HPARB. Where a complaint decision can be taken to the Board, a Registrar’s report decision can only be challenged by judicial review in the Divisional Court, which is a slower, narrower and more expensive route.

Interim orders during the investigation

The ICRC can impose an interim order while the investigation is still running, where the concerns suggest that patients may be exposed to harm. This can mean terms, conditions or limitations on your certificate of registration, and it can extend to suspension for the duration of the case. It is a protective measure rather than a finding, but its practical effect on your employment is immediate.

How long does it take?

The Code sets a disposal target of 150 days from the receipt of the complaint. In practice that target is frequently extended, and the College is required to notify you and the complainant when it will not be met. Cases involving employer reports, multiple witnesses, or a section 75 investigation routinely run well beyond it. Delay is not, by itself, a defence — the courts have set a high bar, requiring delay that is inordinate and significantly prejudicial before it becomes an abuse of process — but a long investigation can be relevant to whether a remedial order still makes sense by the time the ICRC decides.

How it ends

The investigator’s report, the complaint or report that started it, and your written response go to a panel of the ICRC, which decides on the papers. The outcome can be no action, advice or recommendations, a written or oral caution, an undertaking, a SCERP, or a referral to the Discipline Committee or the Fitness to Practise Committee. Because the ICRC does not weigh credibility, a matter can be referred to discipline where there is admissible evidence on both sides — a fact that surprises many nurses who assume their account will simply be accepted.

For the mechanics of responding, read how to respond to a CNO complaint. For the corrective record that shapes what the ICRC does with the report, read remediation and reflection for Ontario nurses and midwives.

This guide describes the process of the College of Nurses of Ontario and, for midwives, the College of Midwives of Ontario. It is general information about how the regulator works and is not legal advice. Every case turns on its own facts. Before you respond to the College, contact the Canadian Nurses Protective Society (CNPS) or, for midwives, your professional liability protection provider, and consider a lawyer experienced in RHPA regulatory matters. Completing a course does not resolve a College matter and does not guarantee any outcome. Last updated July 14, 2026.