assetsCNODocumentsStandard and LearningPractice Standards49040 Code of Conduct - PDF 2
assetsCNODocumentsStandard and LearningPractice Standards49040 Code of Conduct - PDF 2
Code
of Conduct
CONTENTS
What is the Code of Conduct? 3
Principle 1 5
Principle 2 6
Principle 3 8
Principle 4 10
Principle 5 12
Principle 6 14
Glossary 16
References 20
The Code of Conduct (Code) is a practice standard describing the accountabilities all nurses
registered in Ontario have to clients, employers, colleagues and the public. It explains
what people can expect from nurses. The Code also describes what nurses must do to maintain
professionalism, competence and ethical behaviour to deliver safe client care. All nurses
(Registered Nurses, Registered Practical Nurses, and Nurse Practitioners) are expected to uphold
this practice standard, regardless of their role, title or responsibility.
To maintain public trust and confidence in the nursing profession’s integrity and care, the Code
outlines safe and ethical practice requirements based on current evidence. The Code is also
informed by legislation, such as the Ontario Human Rights Code and recommendations in the
Truth and Reconciliation Commission of Canada: Calls to Action (2015).
The Code puts clients at the centre of nursing care and includes principles of diversity, equity
and inclusion to ensure client care is safe, compassionate, equitable and discrimination free.
Throughout the Code, we use the word “client” broadly, to include individuals, substitute decision-
makers, families, caregivers, groups, communities and populations who receive nursing care.
Nurses are expected to use the Code along with other CNO practice standards. The Code applies to
any method a nurse uses to deliver health care services, such as in-person, virtually or by telephone.
CNO considers the Code in regulatory processes and in reviewing the practice of nurses such as
in Quality Assurance and Professional Conduct processes. Nursing practice is considered in
its working context and circumstances.
The 2019 version of this document was adapted with the permission of the Nursing Council of
New Zealand from the Council’s Code of Conduct for Nurses (2012). This document is a substantial
revision of the previous adaptation.
2. Nurses provide inclusive and culturally safe care by practicing cultural humility.
Each principle is supported by a set of statements of core behaviours all nurses are accountable
for. All principles have equal importance and work together to describe the conduct, behaviour,
and professionalism necessary for safe and ethical nursing practice in Ontario.
PRINCIPLE
In this principle, nurses work together with clients with respect and sensitivity to client needs.
To do this, nurses are expected to model the following core behaviours:
1.2 Nurses prioritize clients’ health and well-being in the therapeutic nurse-client relationship.
1.3 Nurses act in clients’ best interests by respecting their care preferences, choices and decisions.
1.4 Nurses respect clients’ rights and involve and support clients in making care decisions.
1.5 Nurses listen and respond to clients’ concerns by collaborating with clients and any person
or community the client wants involved in their care.
1.6 Nurses maintain clients’ privacy and dignity, regardless of where the client receives care
or of its mode of delivery. This includes after the nurse-client relationship ends.
1.7 Nurses communicate to clients, clearly and timely, the care details they propose to offer.
1.8 Nurses obtain informed consent from clients, or from their substitute decision-makers
when clients are unable to do so, as set out in CNO’s Consent guideline and the
Health Care Consent Act, 1996.
1.9 Nurses identify when their own personal beliefs conflict with a client’s care plan, and provide
safe, compassionate and timely care to those clients, until other arrangements are in place.
PRINCIPLE
care by practicing cultural humility
In this principle, nurses demonstrate cultural humility through self-reflection and evaluating
their own behaviour. They advocate for equitable and culturally safe care that is free from
discrimination. This includes understanding how personal attributes and societal contexts,
such as disabilities, sexual identity, anti-Indigenous and anti-Black racism, influence client
care. To achieve this principle, nurses are expected to model the following core behaviours:
Self-reflection
2.1 Nurses self-reflect on and identify how their privileges, biases, values, belief structures,
behaviours and positions of power may impact the therapeutic nurse-client relationship.
2.2 Nurses do not act on any stereotypes or assumptions they may have about clients.
2.3 Nurses seek feedback from clients, the health care team, and others to evaluate their
own behaviour and culturally safe practice.
2.4 Nurses recognize that many identity factors and personal attributes, including those
identified in the Ontario Human Rights Code, may impact a client, their lived experience
and perspective on health care.
Continued >
2.6 Nurses ask clients if they are open to sharing their lived experiences.
2.7 Nurses address clients by their preferred name, title and pronoun.
2.8 Nurses actively listen to and seek to understand the client’s lived experiences.
2.9 Nurses assess clients to determine their risk for health inequities and take steps
to ensure the best client outcomes.
2.10 Nurses give care that focuses on clients’ resilience and strengths. Nurses work with
clients to achieve their health and wellness goals.
2.11 Nurses take proper action to prevent discrimination and when they observe or identify
PRINCIPLE
discrimination against a client.
2.12 Nurses participate and advocate for culturally safe and inclusive practice environments.
2.13 Nurses continually seek to improve their ability to provide clients culturally safe care.
2.14 Nurses undertake continuous education in many areas, including Indigenous health care,
determinants of health, cultural safety, cultural humility and anti-racism.
Parts of Principle 2 have been adapted with permission from BCCNM’s Indigenous Cultural
Safety, Cultural Humility, and Anti-Racism practice standard (British Columbia College of Nurses
and Midwives, 2022)
PRINCIPLE
In this principle, nurses work within the limits of their legal scope of practice, education, experience,
knowledge, skill and judgment to ensure safe and competent nursing care. To do this, nurses are
expected to model the following core behaviours:
3.1 Nurses identify themselves to clients consistent with CNO’s public register, using their name,
title (RN, RPN, NP) and their role within the health care team.
3.2 Nurses recognize and work within the limits of their legal scope of practice and their
knowledge, skill and judgment.
3.3 Nurses identify when clients’ therapeutic needs are outside of their legal scope of practice
or individual competence and support clients to seek services from the proper health care
professionals.
3.4 Nurses seek and use the best available evidence to inform their practice.
3.5 Nurses conduct research ethically, including placing client well-being above all other
research objectives.
3.6 Nurses use their knowledge, skill and judgment when giving nursing care. Nurses modify
client care plans, together with clients and the health care team.
Continued >
3.9 Nurses advocate for and support clients in accessing timely health care that meets
clients’ needs.
3.10 Nurses are accountable for engaging in safe medication practices as set out in
CNO’s Medication practice standard, including having proper legal authority and requisite
knowledge, skill and judgment.
3.11 Nurses are accountable for maintaining, and keeping clear, complete, accurate and
timely documentation as set out in CNO’s Documentation practice standard. Nurses do
not document false or misleading information.
3.12 Nurses in independent practice conduct appropriate business practices as set out in
CNO’s Independent Practice guideline, including accurate record keeping, informing clients of
PRINCIPLE
fee components and charging fitting and reasonable fees.
3.13 Nurses discontinue nursing services if the client requests it. Nurses arrange timely
alternative or replacement services or provide clients a reasonable opportunity to arrange
alternative services.
PRINCIPLE
team to best meet clients’ needs
In this principle, nurses are accountable to one another and are expected to build and maintain
respectful relationships with the health care team. To do this, nurses are expected to model the
following core behaviours:
4.1 Nurses self-reflect on how their privileges, biases, values, belief structures, behaviours and
positions of power may impact relationships with health care team members.
4.2 Nurses identify and do not act on any stereotypes or assumptions they may have about
health care team members.
4.3 Nurses address health care team members by their preferred name, title and pronoun.
4.4 Nurses recognize many identity factors and personal attributes, including those identified
in the Ontario Human Rights Code, may impact a health care team member, their lived
experience and perspective on nursing and health care.
4.5 Nurses demonstrate professionalism and treat all health care team members with respect
in all contexts, including on social media.
4.6 Nurses collaborate and communicate with the health care team in a clear, effective,
professional and timely way to provide safe client care.
Continued >
4.8 Nurses support, mentor and teach health care team members.
4.9 Nurses assess the learning needs of health care team members they are teaching, supervising
and/or assigning. Nurses determine whether individuals have the proper knowledge, skill and
judgment to perform safe nursing care.
4.10 Nurses delegate nursing care so it upholds the expectations outlined in the Nursing Act, 1991.
Nurses do not direct health care team members to perform nursing care they are not adequately
educated for or competent to perform.
4.11 Nurses provide and accept feedback from the health care team to support positive client
outcomes and effective team performance.
PRINCIPLE
4.12 Nurses contribute to a safe organizational culture.
PRINCIPLE
In this principle, nurses are honest and fair practitioners who strive to build a trustworthy, therapeutic,
nurse-client relationship. To do this, nurses are expected to model the following core behaviours:
5.1 Nurses fairly divide and advocate for resources. Nurses objectively arrange care, based on
health-related needs.
5.2 Nurses protect the privacy and confidentiality of clients’ personal health information as set
out in CNO’s Confidentiality & Privacy – Personal Health Information practice standard and
the Personal Health Information Protection Act, 2004.
5.3 Nurses do not share clients’ personal health information, unless for therapeutic reasons and
only in compliance with laws and standards of practice governing privacy and confidentiality.
5.4 Nurses do not act as attorneys for personal care or as substitute decision-makers for their
clients in accordance with the Health Care Consent Act, 1996.
5.5 Nurses identify, prevent and do not practice in situations that cause a conflict of interest.
If a conflict of interest exists or arises at any point during the therapeutic nurse-client
relationship, nurses explore alternative services with clients.
5.6 Nurses place their professional responsibilities ahead of their personal gain.
5.7 Nurses initiate, establish and maintain professional boundaries with clients and terminate
the nurse-client relationship as set out in CNO’s Therapeutic Nurse-Client Relationship
practice standard.
Continued >
5.9 Nurses strive to protect clients from any type of harm, neglect or abuse. This includes taking
action to stop and refrain from unsafe, incompetent, unethical or unlawful practice.
5.11 Nurses identify moral or ethical situations and proactively address conflict, dilemmas and/or
distress of clients in their care.
5.12 Nurses promote healthy relationships with clients, their caregivers, advocates and members
of the health care team by managing and resolving conflict for best client care.
PRINCIPLE
College of Nurses of Ontario | Practice Standard: Code of Conduct 13
6
Nurses maintain public confidence in
PRINCIPLE
the nursing profession
In this principle, nurses promote dignity and respect for the nursing profession by portraying
professionalism and showing leadership. To do this, nurses are expected to model the following
core behaviours:
6.1 Nurses understand and practice in compliance with relevant laws and standards of practice
and do not breach them.
6.2 Nurses are accountable for their own decisions, actions, omissions and related outcomes.
6.3 Nurses take accountability for their errors and learn from them.
6.4 Nurses report any error, unsafe behaviour, unethical conduct or system issue to relevant
individuals, including employers, CNO and other regulatory colleges, whether or not harm
has occurred.
6.5 Nurses participate and advocate for improving the quality of their practice setting to support
safe client care.
6.6 Nurses do not steal, misuse, abuse or destroy the property of their clients, health care team
or employers.
6.7 Nurses self-reflect on health and seek help if their health affects their ability to practice safely.
Continued >
6.9 Nurses self-reflect, identify learning needs in their practice and engage in continuous learning
to improve their competence.
6.10 Nurses participate in and keep records of their participation in CNO’s Quality Assurance Program.
6.11 Nurses do not publicly communicate health care statements that contradict the best
available evidence.
6.13 Nurses cooperate with CNO, including cooperation in investigations and offering complete
and accurate information.
PRINCIPLE
College of Nurses of Ontario | Practice Standard: Code of Conduct 15
GLOSSARY
Appropriate business practices: Reasonable actions that nurses in independent practice carry out
for client safety. This includes, but is not limited to, record keeping, setting reasonable fees, getting
professional liability protection, using accurate advertising and developing proper staffing policies.
Boundaries: The points when a relationship changes from professional and therapeutic to
unprofessional and personal. Therapeutic nurse-client relationships put clients’ needs first. Crossing
a boundary means a nurse is misusing their power and trust in the relationship to meet personal
needs or is behaving in an unprofessional manner with the client. Crossing a boundary can be
intentional or unintentional. See CNO’s Therapeutic Nurse-Client Relationship practice standard.
Client: An individual, family, group, community or population receiving nursing care, including, but
not limited to, “patients” or “residents.”
Conflict of interest: When a nurse’s personal interests improperly influence their professional
judgment or conflict with their duty to act in clients’ best interest. This includes financial and non-
financial benefit, whether direct or indirect.
Cultural humility: An unending process where health care providers engage in self-reflection and
self-critique to minimize power differentials between them and their clients. It helps clinicians build
skills to understand a client’s cultural context through the client’s perspective and emphasizes the
importance and value of others’ perspectives and cultures (Zinan et al., 2021; Virkstis et al., 2021).
Cultural safety: Effective client care by a health care provider who has undertaken a process
of reflection on their own cultural identity and recognizes the impact of their own culture on
their practice. It addresses issues of inequality rooted in historical and structural violence and
discrimination leading to power differences and imbalances. Instead, it focuses on safe systems,
clinical settings and interactions (Gower et al., 2022; Withall et al., 2021).
Determinants of health: The broad range of personal, social, economic and environmental
factors determining individual and population health. The main determinants of health include
income and social status, employment and working conditions, education and literacy, childhood
experiences, physical environments, social supports and coping skills, healthy behaviours, access
to health services, biology and genetic endowment, gender, culture or race/racism (Government
of Canada, 2022).
Documentation: Health records, which may be in a variety of forms (for example, paper, electronic,
audio), used to reflect the client’s needs or goals, the nurses’ inactions, actions and decisions,
communication with other health care providers and the outcomes and evaluation of those
inactions, actions or decisions.
Health inequities: Differences in health status or in the distribution of health resources among
different population groups, arising from the social conditions in which people are born, grow, live,
work and age. (World Health Organization, 2018)
Independent practice: Nurses in independent practice are self-employed (for example, operating
their own economic enterprise) for the purposes of offering nursing services and/or operating their
own nursing business.
Informed consent: As described under the Health Care Consent Act, a person’s consent is
informed if the person receives information about a treatment that a reasonable person in the
same circumstances would require to make a decision and if the person receives responses
to their requests for additional information about the treatment.
The information must include the treatment’s nature, expected benefits, material risks and side
effects; alternative courses of action; and likely consequences of not having the treatment.
Medication practices: Client-centred practices of the most safe and effective medication therapy.
Practices may include but are not limited to the following activities: administration, prescribing,
dispensing, medication storage, inventory management and disposal of medications.
Nursing care: Nursing care given to a client, which includes, but is not limited to, assessment,
planning, delivery, monitoring, evaluation and care coordination.
Personal gain: Advantage or benefit, financial or otherwise, a nurse receives. A personal gain
can be monetary (cash, gifts, or rewards) or give the nurse other personal advantages. A personal
gain includes the nurse’s family’s interests, charitable causes or organizations the nurse supports.
It does not include a nurse’s salary or benefits.
Quality Assurance Program: A CNO program in which nurses demonstrate their commitment to
continuing competence and quality improvement of their knowledge, skill, and judgment through
assessing themselves, their practice and peers. CNO’s Quality Assurance Program is mandated by the
Regulated Health Professions Act, 1991.
Report: The legal and organizational requirement to disclose safety issues related to health care
professionals’ individual practice, or issues impacting practice settings. Examples of legal reporting
requirements include reporting to proper authorities any health care team member whose actions or
behaviours toward clients are unsafe or unprofessional according to applicable legislation, including,
but not limited to, the Fixing Long-Term Care Homes Act, 2021, Child, Youth and Family Services
Act, 2017 and the Public Hospitals Act, 1990. Another example is reporting a regulated health
professional’s sexual abuse of a client to the registrar of the proper regulatory college according
to the Regulated Health Professions Act, 1991. An example of an organizational reporting
requirement is reporting medication near-misses.
Self-reflection: An intentional and continuous process nurses engage in to critically think about
their practice. Reflecting on practice daily helps nurses identify strengths and any learning needs.
See CNO’s Quality Assurance program for more information.
Scope of practice: The expectations and limitations of nurses’ duties and responsibilities.
Nurses are legislated, educated and authorized to perform roles, responsibilities and functions, as
reflected in the controlled acts authorized to nurses in the Regulated Health Professions Act, 1991
and in Section 3 and 4 of the Nursing Act, 1991, and those acts’ regulations. The scope of practice
is further defined in Section 3 of the Nursing Act, 1991: “The practice of nursing is the promotion
of health and assessment of, the provision of, care for and the treatment of, health conditions by
supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain
optimal function.”
Social media: Community-based online communication tools (websites and applications) used for
Standards of practice: Expectations for how a competent nurse should perform. Standards of
practice describe nurses’ expected behaviour and contribute to public protection.
Substitute decision-maker: Person, identified by the Health Care Consent Act, 1996, who makes
a treatment decision for someone who cannot make their own decision. See CNO’s Consent
guideline for more information.
Truthfulness: Speaking or acting without intending to deceive. Truthfulness also refers to giving
accurate information. Intentional omissions are as untruthful as false information.
College of Nurses of Ontario. (2022). Confidentiality and Privacy: Personal Health Information.
https://www.cno.org/globalassets/docs/prac/41069_privacy.pdf
McGough, S., Wynaden, D., Gower, S., Duggan, R., & Wilson, R. (2022). There is no health without
Cultural Safety: Why Cultural Safety matters. Contemporary Nurse: A Journal for the Australian
Nursing Profession, 58(1), 33–42. https://doi.org/10.1080/10376178.2022.2027254
Virkstis, K., Whitemarsh, K., Rewers, L., & Paiewonsky, A. (2021). A 4-Part Strategy to Engage
Frontline Nurses in Cultural Humility. JONA: The Journal of Nursing Administration, 51(12),
597–599. https://doi.org/10.1097/NNA.0000000000001080
Withall, L., Ryder, C., Mackean, T., Edmondson, W., Sjoberg, D., McDermott, D., & Wilson, A.
(2021). Assessing cultural safety in Aboriginal and Torres Strait Islander Health. Australian Journal of
Rural Health, 29(2), 201–210. https://doi.org/10.1111/ajr.12708
Zinan, N. (2021). Humility in health care: A model. Nursing Philosophy, 22(3), 1–8.
https://doi.org/10.1111/nup.12354
[email protected]
416 928-0900
Toll-Free in Canada
1 800 387-5526
JAN 2025
2025-01-1