January 31, 2024
January 2024

Dear CNO

There is a growing number of questions around orders via electronic messaging, like texts and WhatsApp. We outline the standards you must consider.

Some nurses I work with have been communicating with and receiving orders from physicians via text messages and messaging apps like WhatsApp. Is this an appropriate way to receive orders? Thanks for clarifying!

As technologies evolve, the ways health care professionals communicate do too! However, it is important that client safety and privacy remain at the forefront.

CNO does not specify what form of telecommunication you must use to receive an order as long as the modality meets the privacy and security criteria outlined in the Personal Health Information Protection Act, 2004 (PHIPA). We recognize that organizations use various methods to share and receive information related to client care, and those means must be flexible enough to meet specific practice needs. 

Whatever means of telecommunication are used, you should consider several questions, such as:

  • Can you ensure this information is secure, especially if it contains personal health information? Does it comply with the Confidentiality and Privacy practice standard?
  • How will this information be documented and transcribed, and does it meet the Documentation practice standard?
  • What are the potential risks to client safety?
  • What does your organizational policy state about the use of specific technology, such as texting?
  • What device would be used for texting, for example, personal or professional device?

If you receive orders via text message or over a messaging app, you must ensure the order is clear, complete and appropriate, as noted in the Medication practice standard. If it isn't, then you must not carry out the order and must follow up with the physician in a timely manner.

Lastly, CNO strongly encourages nurses to collaborate with employers to develop clear policies that align with CNO practice standards and explain nurses’ accountabilities when using electronic methods of communication

Thanks for writing,

Yvonne Yu, RN, BScN, MScN, Advanced Practice Consultant

Further reading: Electronic Documentation 

 

Have a question for our Practice Quality team? You can reach out to them at Practice Support Form. 

Do you have a question you would like featured in Dear CNO? Email us at editor@cnomail.org.

About CNO

The College of Nurses of Ontario (CNO) is the regulator of the nursing profession in Ontario. It is not a school or a nursing association. CNO acts in the public interest by:

  • assessing qualifications and registering individuals who want to practice nursing in Ontario.
  • setting the practice standards of the profession that nurses in Ontario are expected to meet.
  • promoting nurses' continuing competence through a quality assurance program.
  • holding nurses accountable to those standards by addressing complaints or reports about nursing care.

The College was founded in 1963. By establishing the College, the Ontario government was acknowledging that the nursing profession had the ability to govern itself and put the public's well-being ahead of professional interests.

For the latest information, please see our Nursing Statistics page.

Anyone who wants to use a nursing-related title — Registered Nurse (RN), Registered Practical Nurse (RPN) or Nurse Practitioner (NP) must become a member of CNO.

Frequently Asked Questions

Go to the public Register, Find a Nurse, to conduct a search for the nurse. Contact us if you can't find the person you are looking for.

All public information available about nurses is posted in the public Register, Find a Nurse, which contains profiles of every nurse in Ontario. Publicly available information about nurses include their registration history, business address, and information related to pending disciplinary hearings or past findings.

Unregistered practitioners are people who are seeking employment in nursing or holding themselves out as being able to practice nursing in Ontario, but who are not qualified to do so. They are not registered members of CNO. Only people registered with CNO can use nursing-related titles or perform certain procedures that could cause harm if carried out by a non-registered health professional. CNO takes the issue of unregistered practitioners seriously. See Unregistered Practitioners for more information.

To ensure procedural fairness for both the patient (or client) and the nurse, the Regulated Health Professions Act requires that information gathered during an investigation remain confidential until the matter is referred to the Discipline Committee or Fitness to Practise Committee. CNO will not disclose any information that could identify patients (or clients) or compromise an investigation. See Investigations: A Process Guide for more information.

Information obtained during an investigation will become public if the matter is referred to a disciplinary hearing. If a complaint is not referred to a hearing, no information will be available publicly.

See CNO's hearings schedule, which is updated as hearing dates are confirmed. Hearings at CNO are open to the public and the media. For details on how to attend a hearing, contact the Hearings Administration Team.

A summary of allegations and the disciplinary panel outcomes can be found on the public Register, Find a Nurse. Full decisions and reasons are also available.

Where a disciplinary panel makes a finding of professional misconduct, they have the authority to reprimand a nurse, and suspend or revoke a nurse's registration. Terms, conditions and limitations can also be imposed on a nurse's registration, which restricts their practice for a set period. Nurses can also be required to complete remedial activities, such as reviewing CNO documents and meeting with an expert, before returning to practice.

For detailed information see the Sexual Abuse Prevention section.

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