A discipline panel of the College of Nurses of Ontario has found a Sudbury nurse, Tristen MacNeil, guilty of professional misconduct for failing to cooperate with the College’s mandatory Quality Assurance program1. The hearing, held by videoconference on May 21, 2025, also determined that the nurse’s conduct was reasonably capable of being regarded by her peers as both dishonourable and unprofessional. As a result of the findings, Ms. MacNeil’s certificate of registration will be suspended for two months, and she must undergo a formal reprimand and remedial education.
The College of Nurses of Ontario, like other professional regulatory bodies in the province, is mandated by the Health Professions Procedural Code to operate a Quality Assurance program. This program is administered by the College’s Quality Assurance Committee, known as the QA Committee. The purpose of the program is to promote lifelong learning and help nurses maintain and enhance their professional competence throughout their careers. Participation in the program, which can include self-assessments, peer assessments, and practice assessments, is a professional requirement for all registered nurses.
The decision in Ms. MacNeil’s case was based on an Agreed Statement of Facts presented jointly by the College and her legal representative. According to these facts, Ms. MacNeil first registered with the College as a Registered Nurse on July 6, 2010, and has been employed at Health Sciences North, Ramsey Lake Health Centre in Sudbury since that time.
The panel heard that this was not the first instance of Ms. MacNeil failing to participate in the QA program. The agreed facts detailed a previous incident that served as important background. On March 5, 2018, Ms. MacNeil was randomly selected for a Practice Assessment as part of the QA Program. This selection required her to complete and submit a 2018 Learning Plan and to take objective multiple-choice tests by a deadline of April 8, 2018. Ms. MacNeil did not complete these requirements by the deadline. She was subsequently provided with additional extensions but failed to meet those deadlines as well. Due to her lack of participation, the matter was referred to the College’s Inquiries, Complaints and Reports Committee, or ICRC, on July 17, 2018. After reviewing the case, the ICRC directed that Ms. MacNeil be cautioned regarding the College’s Professional Standards. The panel noted that Ms. MacNeil had no other prior disciplinary findings.
The events that led to the 2025 discipline hearing began after the ICRC file from the 2018 matter was closed. On September 21, 2021, the QA Committee again directed Ms. MacNeil to complete a QA Assessment, this time for the new cycle. The requirements included submitting a 2021 Learning Plan and completing a Code of Conduct Practice Activity. The deadline for these tasks was set for October 28, 2021.
As this deadline approached, Ms. MacNeil contacted the QA Program Team. On October 25, 2021, she sent an email requesting an extension, which the College granted. A new deadline of November 22, 2021, was established. However, Ms. MacNeil did not complete the required activities by this new extended deadline. Three days later, on November 25, 2021, Ms. MacNeil emailed the QA team again, asking what would happen if she did not complete the activities. In this email, she informed the team that she had been on sick leave since October 1, 2021, and was scheduled to give birth on November 28, 2021. The next day, November 26, 2021, she formally requested another extension.
In response, a member of the QA Program Team provided Ms. MacNeil with a deferral form on November 29, 2021. This form would have allowed her to formally submit a request to defer her QA Assessment Activities. According to the agreed facts, Ms. MacNeil did not respond to this communication and did not return the form.
After several weeks of no contact, the QA Committee sent a letter to Ms. MacNeil dated January 20, 2022. The letter directed her to either return the deferral form or complete the outstanding QA Assessment Activities by a new deadline of February 17, 2022. The communication also included a reminder of the committee’s legislative powers should she fail to comply. Ms. MacNeil did not respond to the letter and did not complete the activities by the February 17 deadline.
The QA Program Team continued its efforts to secure her compliance. On February 24, 2022, a team member successfully reached Ms. MacNeil by telephone and reminded her of her outstanding obligations. This phone call was immediately followed by an email that summarized the conversation. On March 15, 2022, a team member called her again and left a voicemail message requesting a return call.
Following these unsuccessful attempts, the QA Committee sent another letter on March 24, 2022. This letter officially informed Ms. MacNeil of the committee’s decision to refer her case to the ICRC due to her continued lack of participation. The letter granted her a final 14-day window from that date to either submit her completed QA Assessment or provide a written submission to the committee regarding its decision. Ms. MacNeil did not respond to this final communication, and she ultimately never submitted the required QA Assessment Activities. As a result, the QA Committee formally referred her matter to the ICRC on June 13, 2022, a process that culminated in the discipline hearing.
At the hearing, Ms. MacNeil admitted to the two allegations against her. The panel conducted a plea inquiry and was satisfied that her admissions were voluntary, informed, and unequivocal. The Agreed Statement of Facts also included Ms. MacNeil’s explanation for her conduct. It stated that if she were to testify, she would explain that she had experienced serious complications arising from her pregnancy, which impeded her ability to complete the QA activities by the 2021 deadlines. Furthermore, she would testify that her post-partum conditions impacted her ability to respond to the College’s communications sent between January and March 2022. Through the agreed facts, Ms. MacNeil expressed remorse for her failure to follow up with the College and complete the program requirements in a timely manner. She also acknowledged that as a member of a regulated health profession, she was accountable for formally requesting a deferral instead of ignoring the communications.
The discipline panel accepted her plea and found that the evidence supported the findings of professional misconduct. For the first allegation, the panel found the facts clearly demonstrated that she failed to cooperate with the QA Committee. For the second allegation, the panel found her conduct relevant to the practice of nursing and determined it was unprofessional, as it “demonstrated a serious and persistent disregard for her professional obligations.” The panel also found the conduct to be dishonourable, reasoning that Ms. MacNeil “knew or ought to have known that her conduct was unacceptable and fell below the standards of the profession.” The panel’s reasons characterized her actions as including “an element of moral failing by not cooperating” when the requirements had been clearly and repeatedly communicated to her.
Counsel for the College and for Ms. MacNeil proposed a Joint Submission on Order, which the panel accepted. The penalty requires Ms. MacNeil to appear before the panel within three months for an oral reprimand. It also directs the College’s Executive Director to suspend her certificate of registration for a period of two months.
In addition to the suspension, the panel imposed several terms, conditions, and limitations on Ms. MacNeil’s registration. She is required to attend two meetings with a CNO-approved Regulatory Expert, at her own expense, within six months of the order becoming final. Before the first meeting, she must provide the expert with a copy of all the case documents, including the Notice of Hearing, the Agreed Statement of Facts, and the panel’s final decision. She is also required to review the College’s Code of Conduct publication and complete associated Practice Reflection Worksheets and online learning modules, which must also be given to the expert before the first session.
The sessions with the expert will focus on the misconduct, its potential consequences, strategies for preventing recurrence, and the development of a learning plan. Within 30 days of the final session, the expert must submit a report to the College confirming Ms. MacNeil’s attendance and assessing her insight into her behaviour. Finally, the order mandates that Ms. MacNeil must successfully complete all Quality Assurance Program requirements by new dates that will be communicated to her by the QA Committee.
In presenting the joint submission, College counsel noted aggravating factors, such as the extended period of misconduct and her failure to respond to offers of a deferral. Mitigating factors included her lack of a prior discipline record, her cooperation with the discipline proceeding, the serious medical complications related to her pregnancy and post-partum condition, and her expressed remorse.
The panel accepted the joint penalty, concluding it was not contrary to the public interest. The panel found the penalty met the goals of specific and general deterrence through the reprimand and suspension. It found the required meetings with the expert satisfied the goal of rehabilitation. Finally, the panel concluded that public protection would be met by ensuring Ms. MacNeil completes the QA activities, stating that “nurses must be committed to continuing competence” to protect the public.
Read more cases about proceedings in regulated professions here.
