In Ontario, nursing is one profession with two categories: Registered Nurses (RNs) and Registered Practical Nurses (RPNs).

Both RNs and RPNs study from the same body of nursing knowledge. RNs study for a longer period of time, allowing for greater depth and breadth of knowledge in clinical practice, decision-making, critical thinking, leadership, research and resource management. RPNs study for a shorter period of time, resulting in a more focused body of knowledge in the same areas.

In Ontario, all RN applicants require a baccalaureate degree from an approved Ontario nursing program or an equivalent in order to register. All RPN applicants must have a diploma from an approved Ontario practical nursing program or an equivalent.

Scope of practice and controlled acts

Nursing is just one of many health professions in Ontario that are regulated by the Regulated Health Professions Act (RHPA). Nursing in Ontario is also regulated by the Nursing Act, 1991.

Each health profession has a scope of practice statement that describes what the profession does and the methods it uses. For nurses, it’s:

The practice of nursing is the promotion of health and the 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.

Regulated health professionals are allowed to perform controlled acts, which are actions that are considered potentially harmful if performed by unqualified persons. The RHPA defines 13 controlled acts that can only be performed by a regulated health professional or under specific circumstances. Nurses are authorized to perform three of these acts:  

1. performing a prescribed procedure below the dermis or a mucous membrane;
2. administering a substance by injection or inhalation; and
3. putting an instrument, hand or finger:
   1. beyond the external ear canal;
   2. beyond the point in the nasal passages where they normally narrow;
   3. beyond the larynx;
   4. beyond the opening of the urethra;
   5. beyond the labia majora;
   6. beyond the anal verge; and
   7. into an artificial opening into the body.

Nurses may perform procedures within these controlled acts under the following two circumstances:

1. A medical doctor, dentist, midwife or chiropodist orders the procedure.
2. The procedure is “self-initiated” by a member who has met the conditions for self-initiation included in the regulations within the Nursing Act.

There are exemptions under which unregistered individuals may perform these acts:

• when providing first aid or temporary assistance in an emergency;
• when, under the supervision or direction of a member of the profession, a student is learning to become a member of that profession and the performance of the procedure is within the scope of the profession’s practice;
• when treating a member of a person’s household and the procedure is within the second or third controlled act authorized to nursing;
• when assisting a person with his or her routine activities of living and the procedure is within the second or third controlled act authorized to nursing; or
• when treating a person by prayer or spiritual means in accordance with the religion of the person giving the treatment.