On this page
Key facts for nurses and midwives
- Regulators
- e.g. College of Nurses of Ontario, BCCNM (nurses and midwives in BC), CRNA and CLHA (Alberta), OIIQ and OIIAQ (Quebec), College of Midwives of Ontario
- Law
- Ontario RHPA 1991, Nursing Act 1991 and Midwifery Act 1991; BC HPOA (from April 1, 2026); Alberta Health Professions Act; Quebec Professional Code
- Ethics reference
- CNA Code of Ethics plus your college's practice standards and code of conduct
- Common sources
- Employer reports, patient and family complaints, college-initiated investigations
- Possible outcomes
- No action, advice, caution, education or remediation, undertaking, referral to discipline or to a health process
- First step
- Contact CNPS (or your liability provider) and your union before you reply
Start here: the core remediation set for nurses and midwives
Core course 1Ethics
Ethics for Nurses and Midwives
Ethics for nurses and midwives: the CNA Code and college standards applied to consent, boundaries, end of life, birth choices and candour.
Core course 2Professionalism
Professional Standards for Nurses and Midwives
Professional standards for Canadian nurses and midwives: college codes, communication and SBAR, speaking up about unsafe orders, delegation, social media, gifts and candour.
Which one do I need?
| Compare | Ethics for Nurses and Midwives | Professional Standards for Nurses and Midwives |
|---|---|---|
| Focus | Values, reasoning and ethical dilemmas | Conduct, standards, scope, records and accountability |
| The question it answers | What is the right thing to do here, and why? | What do my standards require, and how do I show it? |
| Choose it when | A decision, a dilemma or your judgement is in question | Behaviour, systems, scope of practice or records are in question |
Not sure? Many concerns and most CPD plans need both: take them together for a complete picture.
The core set is eight courses. It works whether you are a registered nurse, registered or licensed practical nurse, registered psychiatric nurse, nurse practitioner or midwife, and whether the concern came from a patient, a family member, your employer or the college itself.
Ethics and Ethical Standards for Nurses and Midwives covers the reasoning behind care: the four principles, the CNA Code of Ethics and provincial standards, consent and shared decision-making, truth-telling and disclosure of errors, end-of-life and maternity ethics including MAID, and what a college looks for when an ethical concern is raised. It includes worked cases on informed choice in labour and on a late medication entry. Professionalism and Professional Standards for Nurses and Midwives covers conduct on the unit and in the community: accountability, communication and SBAR, delegation and supervision, digital conduct, conflicts of interest, the duty of candour, and what a college looks for in a response to a concern.
- How to Deal with a Complaint or Investigation: how screening works, cooperating with investigators and writing a measured response.
- Module on Insight: moving from minimization or defensiveness to genuine ownership.
- Module on Reflection: structured reflective writing using Gibbs, Rolfe or Johns.
- Module on Remediation: turning learning into a plan with goals someone else can check.
- Ensuring a Mistake or Misconduct Is Not Repeated: safeguards for the systems and habits behind the concern.
- Rebuilding Trust: with patients and families, your team, your employer and the college.
Every course is two hours, CA$95, online and self-paced, with a 10-question final assessment (80% to pass) and a certificate of completion that carries your reflective account.
Core setComplete the set with these
Medication errors, documentation and late entries
Medication events are the most common clinical reason a nurse's practice is reviewed: a dose given twice, the wrong patient, a missed allergy, an infusion programmed incorrectly, or an omission that was never charted. Colleges usually want to know three things: what happened, whether you were honest about it at the time, and what you have changed. The record often decides the answer. A late entry that is clearly marked is accepted practice; a backdated or altered entry is a dishonesty concern, and colleges treat it far more seriously than the original error.
Use the documentation course for charting, late entries and corrections, the candour course for disclosure to the patient and the team, and the prescribing course if you are a nurse practitioner or your role includes medication orders under a directive.
RecommendedStart with these
Further relevantAdd if they fit the concern
Assessment, escalation, scope and delegation
Some of the most serious complaints involve deterioration that was not recognized or not escalated: vital signs recorded but not acted on, a physician or nurse practitioner not called, or concerns raised but not documented. Others involve scope: performing an activity your category of registration does not authorize, accepting an assignment beyond your competence without saying so, or delegating or teaching a task without the right supervision.
Scope rules differ by province and by category, so read your college's standard alongside the courses. The clinical competence course covers clinical reasoning and responding to deterioration; the teamwork course covers handover, escalation and speaking up through hierarchy; the professionalism course covers delegation and supervision.
RecommendedStart with these
Further relevantAdd if they fit the concern
Conduct towards patients, families and colleagues
Colleges treat verbal, emotional and physical abuse of patients as among the most serious conduct concerns, and they include rough handling, threats, humiliating comments and neglect. Conduct towards colleagues matters too: bullying, harassment or a pattern of conflict on the unit can lead to an employer report and a college investigation. The nurse-client relationship rests on a power imbalance, so standards ask the nurse, not the patient, to keep the relationship professional.
Start with the professionalism course for nurses and midwives. Add communication for concerns about tone or manner, teamwork for conflict with colleagues, and boundaries where the concern is about a relationship, gifts or personal contact with a client.
RecommendedStart with these
Further relevantAdd if they fit the concern
Privacy breaches and social media
Looking at the health record of a family member, a neighbour, a colleague or a patient in the news, without a clinical reason, is one of the most frequent reasons nurses are reported. Electronic records keep audit trails, so these breaches are usually found. In Ontario, PHIPA applies; other provinces have equivalent health-information statutes. A privacy breach can lead to employer discipline, a privacy commissioner's investigation and a college complaint for the same events.
Social media concerns include photos taken on the unit, comments about patients or the workplace, and contact with patients through personal accounts. The confidentiality course and the social media course are the core of this group.
RecommendedStart with these
Further relevantAdd if they fit the concern
Midwifery: informed choice, consultation and transfer of care
Concerns about midwives often centre on informed choice and on the point at which care should have been shared or transferred: a client's decisions about place of birth or intervention, the information they were given about risks, and whether consultation with a physician or transfer to hospital happened when the standard required it. Documentation of each discussion, and of the client's decision, is often decisive.
The nursing and midwifery ethics course includes a worked case on informed choice in labour. Pair it with the consent and chaperone course, the communication course and the documentation course. Where the concern involves teamwork with hospital staff during a transfer, add teamwork.
RecommendedStart with these
Further relevantAdd if they fit the concern
Health, impairment and medication diversion
When a concern relates to a nurse's own health, including substance use, colleges generally aim to support safe practice rather than to punish. Health matters may be dealt with through a separate fitness-to-practise or incapacity process, often with monitoring and treatment requirements. Diversion of drugs from the workplace, however, also raises honesty and patient-safety concerns that are handled as conduct.
If health is part of the picture, get advice first and take care of your treatment. The fitness to practise course explains how health, conduct and competence fit together; probity and preventing recurrence help you show that the safeguards you have put in place are real.
RecommendedStart with these
Further relevantAdd if they fit the concern
Match the concern to a course
The concerns that most often lead to complaints and investigations, how they are viewed, and the courses that address each one.
Medication error
Reviewed for what happened, whether it was disclosed and documented honestly, and what has changed; honest disclosure weighs heavily.
Backdated or altered charting
Late entries must be identified as late; changing or fabricating entries is treated as dishonesty, often more seriously than the event behind it.
Accessing a health record without a clinical reason
Detected through audit trails; a breach of provincial health-information law and a frequent reason for employer reports to the college.
Verbal or physical abuse of a patient
Colleges treat abuse of clients, including rough handling and demeaning remarks, as serious misconduct regardless of the patient's behaviour.
Failure to assess or escalate a deteriorating patient
Usually explored as competence, with attention to what was observed, recorded and reported and to whom.
Practising outside your category's scope
Scope differs between RNs, practical nurses (RPNs in Ontario, LPNs elsewhere), registered psychiatric nurses and NPs, and between provinces; colleges expect you to know and work within yours.
Personal relationship or gifts from a client
Standards place responsibility for boundaries on the nurse because of the power imbalance; social contact and online messaging are included.
Midwife's informed-choice discussion or transfer of care questioned
Committees look at what the client was told, what they chose, and whether consultation or transfer happened when the standard required it.
Diversion or impairment
Health issues may go to a separate fitness or incapacity process; diversion also raises honesty and patient-safety concerns.
How a concern about a nurse or midwife is handled
Nursing and midwifery are regulated by provincial and territorial colleges, and in several provinces different categories of nurse have different regulators. The process depends on your province and your registration category.
Ontario: CNO and the College of Midwives of Ontario
Concerns reach the College of Nurses of Ontario as complaints from the public, as reports from employers and facilities, or through a registrar's investigation. Employers must report to the college when they terminate, suspend or restrict a nurse for professional misconduct, incompetence or incapacity. CNO gives the nurse a minimum of 30 days to respond. A panel of the Inquiries, Complaints and Reports Committee can take no action, issue advice, require the nurse to attend to be cautioned, require continuing education or remediation, accept an undertaking, make inquiries into the nurse's health, or refer allegations to the Discipline Committee. Complaint decisions can be reviewed by the Health Professions Appeal and Review Board. Midwives in Ontario go through the same steps with the College of Midwives of Ontario.
British Columbia: BCCNM under the new Act
The BC College of Nurses and Midwives regulates nurses of every category and midwives. Since April 1, 2026, under the Health Professions and Occupations Act, the college still investigates, but discipline in serious cases is decided by independent panels set up by a director of discipline, and licensees have a duty to report discrimination.
Alberta: CRNA and CLHA
Registered nurses and nurse practitioners are regulated by the College of Registered Nurses of Alberta, and licensed practical nurses by the College of LPNs and HCAs of Alberta (CLHA). Under the Health Professions Act, a complaints director can resolve a complaint informally or through alternative resolution, investigate, dismiss or refer it to a hearing tribunal, and dismissals can be reviewed by a complaint review committee.
Quebec: OIIQ and OIIAQ
Registered nurses belong to the Ordre des infirmières et infirmiers du Québec and auxiliary nurses to the Ordre des infirmières et infirmiers auxiliaires du Québec. Under the Professional Code, the syndic investigates and can file a complaint before the disciplinary council, propose conciliation, or decide not to proceed; appeals go to the Tribunal des professions.
Liability protection and union support
The Canadian Nurses Protective Society provides professional liability protection and legal advice for nurses who are its beneficiaries. In Alberta, holding CNPS professional liability protection matching your protected title is a condition of practice for RNs and NPs. Practical nurses and midwives may have liability coverage through an association, insurer or employer instead. Your union can also advise and attend meetings with you, particularly where an employer investigation runs alongside the college matter.
Your province: who handles a concern
Your college depends on your province and your registration category, and in several provinces registered, practical and psychiatric nurses and midwives each have their own regulator. Find yours below before you read any guidance on process, because terms such as ICRC, SCERP or syndic belong to particular provinces.
| Province or territory | Regulator of nurses and midwives | Law and complaint route |
|---|---|---|
| Ontario | College of Nurses of Ontario (RNs, RPNs, NPs); College of Midwives of Ontario | Nursing Act, 1991 and Midwifery Act, 1991, with the Health Professions Procedural Code under the Regulated Health Professions Act, 1991. An Inquiries, Complaints and Reports Committee (ICRC) panel screens complaints and reports and can give advice, require a caution, require a SCERP or accept an undertaking; HPARB can review complaint decisions. |
| British Columbia | BC College of Nurses and Midwives (all nursing categories and midwives) | Health Professions and Occupations Act, in force since 1 April 2026. The college investigates; serious matters go to independent discipline panels rather than to the college. |
| Alberta | College of Registered Nurses of Alberta; College of LPNs and HCAs of Alberta (CLHA); College of Registered Psychiatric Nurses of Alberta; College of Midwives of Alberta | Health Professions Act. A complaints director decides how a complaint is handled, from resolution to investigation; serious matters go to a hearing tribunal. |
| Quebec | Ordre des infirmières et infirmiers du Québec; Ordre des infirmières et infirmiers auxiliaires du Québec; Ordre des sages-femmes du Québec | Professional Code. The syndic investigates and may file a complaint before the disciplinary council; appeals go to the Tribunal des professions. |
| Saskatchewan | College of Registered Nurses of Saskatchewan; College of Licensed Practical Nurses of Saskatchewan; College of Registered Psychiatric Nurses of Saskatchewan; Saskatchewan College of Midwives | Saskatchewan statutes for each profession. |
| Manitoba | College of Registered Nurses of Manitoba; College of Licensed Practical Nurses of Manitoba; College of Registered Psychiatric Nurses of Manitoba; College of Midwives of Manitoba | Registered nurses are regulated under The Regulated Health Professions Act (Manitoba), since 31 May 2018; check your own college for the other categories. |
| Nova Scotia | Nova Scotia Nursing and Midwifery Regulator (LPNs, RNs, NPs and midwives) | Regulated Health Professions Act (2023), which applies in full to each profession once its regulator has migrated to it. |
| New Brunswick | Nurses Association of New Brunswick; Association of New Brunswick Licensed Practical Nurses | Its own provincial statute for the profession, with complaint, investigation and hearing stages. |
| Prince Edward Island | College of Registered Nurses and Midwives of Prince Edward Island; College of Licensed Practical Nurses of Prince Edward Island | Its own provincial statute for the profession, with complaint, investigation and hearing stages. |
| Newfoundland and Labrador | College of Registered Nurses of Newfoundland and Labrador; College of Licensed Practical Nurses of Newfoundland and Labrador | Its own provincial statute for the profession, with complaint, investigation and hearing stages. |
| Territories | Yukon Registered Nurses Association; Registered Nurses Association of the Northwest Territories and Nunavut; practical nurses are licensed by the territorial governments | Territorial legislation. |
Names and processes change: Nova Scotia is moving its health professions under one Act, and British Columbia's new Act came into force on 1 April 2026. Always confirm on your own regulator's website before you rely on a summary, including ours.
What a college looks for in a nurse's response
- Accountability: do you describe your own actions plainly, without blaming the patient, staffing or a colleague?
- Insight into impact: do you understand how the event affected the patient, the family and the team?
- Honest records: are your entries accurate, timely and unaltered, with late entries clearly marked?
- Specific learning: which standards have you reread, which courses have you completed and what did you take from them?
- Changed practice: what do you now do differently on every shift, and who could confirm it?
- Context without excuse: workload and system pressures are relevant when they are explained, not used to avoid responsibility.
Remediation in practice: choosing, reflecting and presenting your evidence
Whether your matter sits with an ICRC panel at CNO, a complaints director at CRNA or CLHA, a BCCNM investigation or the syndic of the OIIQ or OIIAQ, the people deciding it ask the same practical question: has this practitioner understood the concern and done enough, in a way someone else can check, to make a repeat unlikely? Remediation is how you answer it. This is what that usually means in practice.
What decision-makers typically look for
- Learning that matches the concern, not a general CPD list: the topic in the letter, the standard that applies and the risk it created.
- Insight in your own words: what happened, why it mattered to the patient, and your part in it, without minimizing or blaming others.
- A change in practice that is specific, dated and still in place, rather than an intention.
- Verification: certificates, audits, procedures and feedback from someone who has seen you work since.
- Honesty and timing: learning described accurately, completed before you rely on it, and a response sent on time.
Choosing courses for the concern
Copy each allegation from the letter into a list. Beside each one, note the standard it engages and the course that addresses it, using the concern table on this page. Add the core set: the complaint course and the insight course first, then reflection and remediation. Two to four targeted courses plus the core set usually tell a clearer story than a long list of unrelated certificates. If an undertaking, a SCERP or an order already names the education required, follow its terms and ask the college before you add anything to it.
Writing your reflective account
Each course ends with a guided reflective account that is printed on your certificate. A credible reflection usually covers, in this order:
- What happened, in factual terms and without patient identifiers.
- The standard that applied, named from your own college's code or practice standard.
- The impact on the patient, the team and trust in the profession.
- Your part, stated plainly, with system factors explained but not used as an excuse.
- What you learned from this course, in specifics rather than general statements.
- What you now do differently, since when, and how someone could confirm it.
Presenting your evidence
| Item | What it shows | Practical tip |
|---|---|---|
| Short covering summary | How each item answers each concern | One page, one line per allegation, written with CNPS counsel, your union representative or your lawyer |
| Certificates of completion | That defined learning took place and was assessed | Keep the dates; show learning completed after the events, not promised |
| Reflective accounts | Insight and the link to your practice | Revise before submitting; a reflection written in the first days can read as defensive |
| Practice evidence | That the change is real and has lasted | For example a medication administration competency sign-off, feedback from a preceptor, manager or clinical educator, an audit of your own documentation, and the unit procedures or checklists you now follow |
| An index | That the file is complete and easy to follow | Number each item and keep copies of everything you send |
No college, ordre, committee or tribunal has approved or accredited our courses, and we do not say that any of them accepts our certificates. A course cannot guarantee an outcome. Whether learning is relevant or satisfies a requirement is for the decision-maker, so discuss timing and content with CNPS counsel, your union representative or your lawyer before you submit anything.
How certificated learning supports a nurse's response
A college does not expect a nurse to have been perfect; it expects you to understand what went wrong and to have done something about it. Certificates show that the learning took place and was assessed. Your reflective account shows what you learned and how you apply it. Together they give CNPS counsel, your union representative or your lawyer something concrete to present.
Courses are online and self-paced, so they fit around shift work, and you can start the day you enrol.
If a college has set specific remediation or an undertaking, only the college can confirm whether a course satisfies it.
From the college letter to a certificate: five steps
- Get advice. Contact CNPS or your liability provider, and your union if you have one, before you reply. Keep a copy of the letter and note the deadline.
- Match each concern. Sort the allegations into the groups above and pick two to four courses alongside the core set.
- Study around your shifts. Courses are self-paced, and nobody is told you have enrolled.
- Write the reflection. Link each course to the concern and to specific changes in your practice.
- Share it through your adviser. If they agree it helps, include certificates and your reflection with your response.
Support while a complaint is open
- CNPS or your liability provider for legal advice on the college process.
- Your union for employer meetings, discipline at work and return-to-work arrangements.
- Your employee assistance program or family doctor for stress, sleep and mental health.
- 9-8-8: call or text 988, any time, if you are in crisis or thinking about suicide.
Start your remediation set
Begin with the nursing and midwifery ethics and professionalism courses, then add the courses for your concern.
Questions
My employer reported me to the college. Which courses should I start with?
Start with the nursing and midwifery professionalism course, How to Deal with a Complaint or Investigation, and the insight module. Then add courses for the specific issue in the report, such as documentation, medication safety through the clinical competence course, or confidentiality. Talk to CNPS and your union before you write anything to the college.
Does CNO, BCCNM or CRNA accept your certificates?
No college approves or accredits our courses, and we do not say they do. When a college reviews your response, it considers what you have learned and changed, and a certificate with a reflection is evidence of that. If a committee has required specific remediation, only the college can say whether a course meets it.
How long do I have to respond to the College of Nurses of Ontario?
CNO's investigations guide says the nurse has a minimum of 30 days to respond. Check the deadline in your own letter, because it is the one that applies. If you need more time, ask early and explain why. Use the time to get advice and to complete relevant learning, but do not let study delay a factual reply.
I looked at a family member's chart. Is that really a college matter?
Yes. Accessing a record without a clinical reason is a privacy breach even when the person would not mind, and colleges treat it as professional misconduct. Take the confidentiality course and the probity course, and in your reflection explain why access rules protect patients and what you now do when a relative is admitted.
Can a midwife use these courses?
Yes. The ethics and professionalism courses are written for nurses and midwives, and the ethics course includes maternity care and a worked case on informed choice in labour. Midwives are regulated by BCCNM in BC, the College of Midwives of Ontario, the College of Midwives of Alberta and the Ordre des sages-femmes du Québec, among others.
Do I need CNPS?
It depends on your province and category. In Alberta, CRNA requires RNs and NPs to hold CNPS professional liability protection that matches their protected title. In other provinces nurses may get CNPS through an association or arrangement, or have coverage elsewhere. Check with your college and union, and contact your liability provider as soon as a complaint arrives.
What is the difference between a complaint and a report?
In Ontario, a complaint comes from someone such as a patient or family member and its scope is set by their concerns. A report, often from an employer, can lead the registrar to appoint an investigator. Both are reviewed by the ICRC. Only complaint decisions can be taken to the Health Professions Appeal and Review Board.
Will the college tell my employer I have taken courses?
No. We do not tell anyone you have enrolled. You decide whether to share certificates, usually through your adviser as part of your response. Many nurses choose to share them with their manager as well, because showing learning can help with a return to full duties.
The concern is about a single medication error. Is the full core set necessary?
Not always. For an isolated error that was disclosed promptly, a focused set such as the professionalism course, documentation, candour and preventing recurrence may be enough. Your adviser can help you judge. What matters is that the learning addresses the actual cause and that your reflection shows a real change.
Can courses help if the concern is about my health?
They can support, but not replace, treatment and any monitoring the college requires. The fitness to practise course explains how health concerns are handled and how they differ from conduct. Focus first on your health and on the college's process; add learning where it shows insight into how the health issue affected your practice.
Do these hours count for my college's quality assurance program?
Most nursing colleges ask you to reflect on practice and set learning goals each year, and relevant learning can usually be recorded as part of that. The program rules are set by your college, not by us. Each certificate shows the two hours (estimated) and includes your reflection.
A colleague and I disagreed loudly in front of a patient. Which course fits?
Start with the professionalism course for nurses and midwives and the teamwork course, which covers conflict, psychological safety and speaking up appropriately. Add the communication course if the patient or family was affected. Your reflection should show you understand the effect on the patient and the team, not only who was right.
I work as an RPN in Ontario and the concern is about scope. Where do I begin?
Read CNO's guidance on the scope of practice for your category, then take the professionalism course for nurses and midwives, which covers accountability and delegation, and the teamwork course for role clarity. Your reflection should describe how you now decide whether an activity, or a patient's complexity, is within your role.
Should I apologize to the patient's family?
Disclosure and a sincere expression of regret are part of good practice after harm, and provincial apology laws generally protect an apology from being treated as an admission of liability. How and when to do it in a complaint setting is a question for your adviser. The candour and rebuilding trust courses cover the conversation itself.
How should I present my courses and reflection to the decision-maker?
As part of a short, indexed evidence file: a one-page summary linking each concern to what you have done, your certificates, the reflective account from each course, and evidence that your practice has changed, such as an audit, a revised procedure or feedback from a supervisor. Agree the content and timing with CNPS counsel, your union representative or your lawyer first.
Official sources
Checked October 2026. Rules and processes change, so confirm the current position with the official source. This page is general information, not legal advice.
- College of Nurses of Ontario: Investigations process guide
- Ontario e-Laws: Regulated Health Professions Act, 1991 (including the Health Professions Procedural Code)
- Ontario e-Laws: Personal Health Information Protection Act, 2004
- College of Physicians and Surgeons of BC: Health Professions and Occupations Act
- College of Registered Nurses of Alberta: Professional liability requirement
- Government of Alberta: Regulated health professions
- Gouvernement du Québec: Recours disciplinaires contre un membre d'un ordre professionnel
- LégisQuébec: Code des professions (chapitre C-26)
- 9-8-8 Suicide Crisis Helpline
- BC Health Regulators: Regulatory reform and the Health Professions and Occupations Act
- Government of Saskatchewan: Health regulators
- Manitoba Fair Registration Practices Office: Regulator contact list (June 2026)
- Government of Nova Scotia: Health profession regulators
- Government of Nova Scotia: Regulated Health Professions Act overview
- Manitoba Health: The Regulated Health Professions Act
- College of LPNs and HCAs of Alberta: The CLPNA is becoming the CLHA
- Government of Prince Edward Island: College of Registered Nurses and Midwives of PEI
- Government of Newfoundland and Labrador: College of Licensed Practical Nurses of Newfoundland and Labrador annual report
How these courses are built
Official sources only
Every legal and regulatory point comes from primary sources: provincial and territorial health professions statutes, the regulatory colleges' standards and codes, and federal and provincial privacy law. Anything we cannot confirm is left out.
Original, edition by edition
Lessons, scenarios and assessment questions are written by us for each edition separately, then checked for accuracy, teaching quality and fair assessment before publication.
Reviewed when rules change
When a code, standard or law changes, the affected courses are reviewed and updated. Reported errors in legal or regulatory facts are corrected first.