A former Ontario nurse who refused to comply with a regulatory order and repeatedly used the restricted title “Nurse Practitioner” after she was no longer qualified to do so has agreed to permanently resign from the profession1. On May 6, 2025, a Discipline Committee panel of the College of Nurses of Ontario, or CNO, accepted a joint submission that saw Kristal Nicole Pitter receive an oral reprimand after she formally admitted to four allegations of professional misconduct. This resolution was reached in conjunction with an undertaking from Pitter, effective April 30, 2025, in which she agreed to permanently give up her nursing registration and never practice nursing in Ontario again.
The case brought before the committee involved two distinct sets of misconduct. The first set, comprised of three allegations, related to Pitter holding herself out as a Nurse Practitioner, or NP, when she was no longer registered in the Extended Class required for that title. The second set involved a single, separate allegation that Pitter engaged in disgraceful, dishonourable, or unprofessional conduct by failing to comply with a previous order from the CNO’s Inquiries, Complaints, and Reports Committee, known as the ICRC. Pitter, who was first registered as a Registered Nurse in 1996 and held NP status from 2007 until December 23, 2020, admitted to all allegations. By the time of the hearing, she had already been administratively suspended for non-payment of fees in February 2024 and had resigned her certificate in March 2024.
The events leading to the hearing began in 2020 when Pitter was employed as a nurse in the inspection branch of the Ministry of Health and Long-Term Care. In July 2020, the Ministry filed a report with the CNO concerning Pitter’s activity on her public social media accounts. The report alleged that in June and July 2020, Pitter identified herself as a “Nurse Practitioner” while making posts about the COVID-19 pandemic. In these posts, she allegedly discouraged public health measures like masking, claiming they did not work or could cause harm. She was also alleged to have promoted non-scientific theories, including that COVID-19 vaccines would be used to track and manipulate individuals’ thoughts and that mask mandates were “negligent and dangerous.”
The ICRC investigated the Ministry’s report, considered Pitter’s social media posts, and reviewed her response, in which she asserted there was truth to her statements. The committee expressed concern that four of her posts were plainly false, inaccurate, or misleading, and that she had inappropriately used her nursing title to lend legitimacy to those statements. As a result, on October 6, 2021, the ICRC ordered Pitter to complete a Specified Continuing Education or Remediation Program, or SCERP, and to appear for an oral caution. The remediation program required her to register for and complete the CPEP PROBE: Ethics & Boundaries Program, meet with a regulatory expert to discuss the incidents, and review CNO standards, including the webcast on social media use.
Pitter was formally provided with the ICRC decision on November 18, 2021, and received detailed instructions on how to comply the next day. She was advised that failure to complete the order within nine months could result in a referral to the Discipline Committee. Instead of complying, Pitter sought a judicial review of the ICRC’s decision. On January 26, 2022, the CNO received notice of her application to the Divisional Court. On February 4, 2022, the court issued an order on consent, staying the ICRC’s decision until the judicial review was decided. The hearing took place on September 13, 2022. On September 30, 2022, the Divisional Court dismissed Pitter’s application, upholding the ICRC’s decision. The court also ordered Pitter to pay $17,500 in costs to the CNO.
Following the court’s decision, the stay on the ICRC order was lifted. On October 4, 2022, the CNO wrote to Pitter and her counsel, advising that the order was again in effect and providing updated instructions and deadlines. Pitter was required to register for the PROBE course by January 3, 2023, and complete it by April 3, 2023. Pitter’s counsel subsequently gave notice of a motion seeking leave to appeal the Divisional Court’s decision to the Court of Appeal, which was filed in November 2022. However, Pitter did not perfect her motion. The court notified her in January 2023 that her motion would be dismissed for delay if not perfected, and the motion was formally dismissed on July 31, 2024.
Pitter did not comply with the ICRC order after her judicial review was unsuccessful. She failed to provide confirmation of her registration in the PROBE program by the January 3, 2023 deadline. Between January and June 2023, the CNO’s Monitoring team made numerous attempts to contact Pitter and her counsel to remind her of the requirements and provide additional opportunities to comply. This included letters sent on January 18, February 6, March 23, and April 12, as well as phone calls. On May 1, 2023, Pitter’s counsel advised that she would be requesting an extension due to recovery from surgery. The CNO’s Monitoring team replied on May 15 with instructions on how to formally request an extension, setting a new deadline of June 5, 2023. After receiving no response, the team followed up again by voicemail on June 12, 2023.
By July 26, 2023, Pitter had still not complied with the order or formally requested an extension. The CNO commenced a new investigation into her failure to comply, notifying her the same day. On August 17, 2023, a CNO Investigator interviewed Pitter’s counsel, who provided several reasons for her non-compliance, including her moral views, a medical condition, and lack of financial resources. However, counsel stated that the “ultimate reason” was that Pitter could not “morally accept the Order.” According to the investigation, Pitter viewed compliance as a “partial admission” and had no intention of complying “from a moral standpoint.” As of the hearing date, she had still not completed the SCERP or received the oral caution.
While the dispute over the ICRC order was ongoing, Pitter was also engaging in the separate misconduct of improperly using the “Nurse Practitioner” title. Her registration in the Extended Class, which permitted her to use the NP title, had expired on December 23, 2020. Despite this, she continued to publicly identify herself as a Nurse Practitioner on numerous occasions throughout 2021. These instances included a public speech in front of the CNO building in Toronto on April 14, 2021; another public speech in London, Ontario, on May 17, 2021, which was recorded and posted on Facebook; and a video interview on June 4, 2021, where she introduced herself as a “Nurse Practitioner in Ontario.” Furthermore, until at least September 21, 2021, her biography on the “Canadian Frontline Nurses” website, where she was a board member, described her as a “Nurse Practitioner.” During the same period, she signed a statement by “Professionals Against Lockdowns” on the “Liberty Coalition Canada” website, identifying herself as a “Nurse Practitioner (Active).” Finally, until at least December 9, 2021, her personal, publicly accessible Facebook profile described her as a “Nurse Practitioner.”
At the May 6, 2025, discipline hearing, Pitter admitted that this conduct constituted professional misconduct. The Discipline Panel accepted her plea, finding that the evidence supported findings of misconduct for all four allegations. The panel found that by publicly holding herself out as a Nurse Practitioner when she was not registered as such, she contravened the CNO’s Code of Conduct and Professional Standards, which require nurses to be accountable, meet legislative requirements, and identify themselves accurately. The panel found her conduct in this regard to be unprofessional and dishonourable, stating it “demonstrated an element of dishonesty, deceit and moral failing.” Regarding her failure to comply with the 2021 ICRC order, the panel found this conduct was also unprofessional and dishonourable, demonstrating a “serious and persistent disregard for her professional obligations” and an “element of moral failing.”
The College and Pitter’s counsel presented a joint submission on penalty, proposing an oral reprimand. This submission was paired with the Undertaking and Agreement, signed by Pitter, for her permanent resignation. This Undertaking prohibits Pitter from ever applying for membership with the CNO in the future and revokes her right to use the title “Nurse,” “Registered Nurse,” “Registered Practical Nurse,” or “Nurse Practitioner.” College Counsel noted that aggravating factors included the seriousness of the misconduct and her stated intention to never comply with the ICRC order on moral grounds. Mitigating factors included her co-operation with the discipline proceeding by agreeing to the facts, which saved the College the expense of a contested hearing, and her lack of a prior discipline history.
Pitter’s counsel, agreeing with the College’s submissions, added that while there was no evidence of intentional or malicious intent to misuse the title, it still constituted misconduct. He stated that Pitter’s ethics and morals no longer align with the College, leading to her decision to permanently resign.
The Discipline Panel accepted the joint submission, concluding it was not contrary to the public interest. The panel found that the proposed penalty was reasonable, as the permanent resignation effectively protected the public, making specific deterrence like a suspension unnecessary. The panel noted that the oral reprimand, combined with the public nature of the findings, satisfied the principle of general deterrence, sending a clear message to the profession. The panel concluded that “had the Member’s situation been different and no Undertaking given, the Panel would have ordered a suspension” in line with previous similar cases.
