The following are questions the College has received  about how the recently revised Registration Regulation affects Nurse Practitioners and applicants to the Extended Class.

In addition to the following information, individuals should be aware of changes that affect all applicants and members.   

Maintaining Membership in the Extended Class

1. Is there a requirement for me to practise as an NP in a clinical role in Ontario to maintain my Certificate of Registration as an NP?

Yes. Under the Registration Regulation, NPs must maintain clinical NP practice in Ontario to remain registered in the Extended Class. This clinical practice must include:

• direct interaction with the client population(s) consistent with each specialty certificate that the NP holds and
• the use of advanced nursing knowledge and decision-making skill in health assessment, diagnosis and therapeutics in the treatment of those clients.

Each year, NPs will be asked to declare if they have practised as described above in Ontario within the previous three years. NPs who do not meet this requirement will not be eligible to remain registered in the Extended Class.

2. What is the declaration of practice? When do I make this declaration?

While completing the Annual Membership Renewal form each year, and at any other time upon request by the College, NPs will be required to declare whether they practised as NPs, as described in the first question above, in Ontario within the previous three years. NPs who hold multiple specialty certificates in the Extended Class will be required to make this declaration for each specialty certificate they hold. Upon request by the College, members must provide evidence to support their declaration.

3. a) I am an NP-Primary Health Care (PHC) working in a Long-Term Care home. Am I required to practice with clients in all age groups to maintain my current certificate of registration?

No. Each NP specialty certificate represents a broad client population and a wide age range. The client population for the PHC specialty is “family all ages.” Therefore, you can meet the NP declaration of practice requirement by practising, as described in the first question above, with clients in any or all age groups within your specialty. As always, you are expected to meet the practice expectations for public protection described in the Nurse Practitioner practice standard.

b) I know I must fulfil the College's QA (Quality Assurance) obligations to maintain my certificate of registration. How will my practice within the NP-PHC specialty be assessed when I'm selected for practice assessment in the QA program?

To protect the public, the QA program requires each NP to demonstrate competence for the specialty certificate in which she or he is registered. This is because NPs may work in a wide variety of practice settings and a wide range of clients are covered by each specialty certificate. In addition, Ontario law requires Colleges to assess entry-to-practice competencies through their quality assurance processes.
When you are selected to participate in the College’s QA practice assessment, you will be required to demonstrate the core competencies and the use of advanced knowledge and decision-making skill in health assessment, diagnosis and therapeutics with a primary health care "family all ages" population.

4. The clinical practice requirement doesn’t recognize that NPs contribute to the health system in many ways beyond the provision of direct client care. Why is the College requiring NPs to engage in direct clinical practice with clients?

The College recognizes there are numerous ways in which nurses provide positive contributions to client care and the health system, and that nursing practice does not always involve direct interaction with clients. Examples include policy development, administration, research and education. The College appropriately and safely regulates these aspects of nursing practice through the General Class.

The Extended Class exists to authorize RNs who have met specific requirements to perform certain controlled acts (e.g., communicating diagnoses, prescribing medication) that are directly linked to clinical practice. To protect the public, NPs are expected to demonstrate and maintain competence to practise in a clinical NP role. This has been an expectation under the Nurse Practitioner practice standard since October 2011. Adding this requirement to the Registration Regulation reinforces the expectations and standards, and is consistent with those of other nursing jurisdictions across Canada. 

5. What happens if I have not practised in a clinical NP role in the previous three years in Ontario?

If you have not practised as an NP as described in the first question in the previous three years in Ontario, but have practised nursing in Ontario during that time, then your Extended Class certificate will be revoked and replaced with a General Class certificate. If you have not practised nursing in Ontario at all in the previous three years, then you must either register in the Non-Practising Class or resign from the College.

6. Do NPs have to practise for a minimum number of hours to meet the NP practice requirement?

The College does not specify the number of hours that NPs must practise in Ontario within the three-year timeframe. The amount of practice needed to maintain NP competence in the areas of health assessment, diagnosis and therapeutics in the treatment of clients will vary for individual NPs based on their experience, knowledge and skill level. It is up to each NP to determine how much practice is required to maintain that level of competence. NPs are also required to meet continuing competence requirements related to application of practice standards and related NP competencies.

7. Does the College provide a list of nursing positions that satisfy the NP practice requirement?

No. Nurse Practitioners work in roles that involve various dimensions of nursing practice, including clinical and nonclinical components. Therefore, what must be determined is whether an individual NP meets the requirement as outlined in the first question, irrespective of her or his position. NPs are expected to reflect on their nursing practice and determine whether it satisfies the practice requirement.

8. I am an NP and a faculty member in an approved NP university education program. Does my position meet the evidence of practice requirement?

The College does not determine whether a position fits the requirement; it is whether an individual NP meets the requirement. You are expected to reflect on your role as a faculty member and determine whether you satisfy the practice requirement for NPs as described in the first question.

9. Does volunteering in an NP role meet the NP practice requirement?

Providing nursing services in a volunteer capacity meets the requirement if it is consistent with the definition of NP practice as described in the first question. Keep in mind that you will have to provide evidence to support your declaration if the College requests it.  

10. I work in another jurisdiction. My NP practice allows me to maintain competence in the areas of health assessment, diagnosis and therapeutics. What is the rationale for not recognizing my NP practice in another jurisdiction?

The College’s mandate is to regulate nursing practice in Ontario. It does not have jurisdiction to govern a member’s practice in any other jurisdiction. If you are not practising in Ontario, but you wish to remain a member of the College, then you may register in the Non-Practising Class. If you join that class, then it will be clear on the public register that you are a member of the College but not currently practising nursing in Ontario. This ensures accurate and transparent information about you, as a nurse in Ontario, to the public. If you wish to return to NP practice in Ontario in the future, you will need to apply to have your Extended Class certificate reinstated.

11. I am registered as an NP and hold both Adult and Paediatrics specialty certificates. I work in a role that involves providing NP health care services to an adult population. Do I meet the evidence of NP practice requirement?

You must demonstrate practice, as described in the first question, with a client population that is relevant to each specialty in which you are registered. In this case, your Paediatrics specialty certificate will be revoked if you do not practise with paediatric clients in accordance with the practice requirement for NPs as described in the first question. Assuming your practice with adult clients is consistent with the NP practice requirement, your NP registration with the Adult specialty certificate will not be affected.

Reinstating NP Registration

12. If I receive a General Class certificate because I did not meet the practice requirement for NPs, what will I need to do if I want to resume practise as an NP in Ontario?

You will need to apply to reinstate your NP certificate and the specialty certificate that you previously held. To reinstate, you will have to demonstrate evidence of NP practice within the previous three years. That practice must be clinical and include:

• direct interaction with the client population(s) consistent with each specialty certificate you previously held and wish to have reinstated and
• the use of advanced nursing knowledge and decision-making skill in health assessment, diagnosis and therapeutics in the treatment of those clients.

If you have been practising as an NP in another jurisdiction, then your practice there will be assessed to determine whether it meets the above description. You may also be expected to meet other reinstatement requirements, such as successful completion of the jurisprudence exam.

Acquiring NP Registration

13. Do graduates of approved NP programs have to meet the practice requirements to become registered as NPs?

Yes. Evidence of practice in the NP role is a non-exemptible registration requirement. If you completed an approved NP program within the past three years, then you will satisfy the evidence of NP practice requirement.

If it has been more than three years since you completed an approved NP program, then you must demonstrate that you have practised within the past three years in a clinical NP role that included:

• direct interaction with client population(s) consistent with each specialty certificate for which you are seeking registration and
• the use of advanced nursing knowledge and decision-making skill in health assessment, diagnosis and therapeutics in the treatment of those clients.

If you have not practised accordingly, then you will be required to undergo an evaluation approved by the College’s Registration Committee to determine whether you meet the practice requirement. The evaluation may conclude that you meet the NP practice requirement for registration, or it may identify the need for you to complete further training, experience, examinations or assessments to meet the requirement.

14. I am an RN who is practising in Ontario and applying to register as an NP. Why do I have to successfully complete the jurisprudence exam if I am already practising nursing in Ontario?

The jurisprudence exam is a non-exemptible registration requirement for applifcants. The exam assesses an applicant’s awareness and understanding of the legislative and regulatory framework (i.e., laws, regulations, by-laws, practice standards and guidelines) that governs the nursing profession specifically in Ontario.

For NP applicants, the jurisprudence exam includes questions applicable to all nurses in Ontario and questions that are unique to NP practice. While many NP applicants are already practising nursing in Ontario as RNs in the General Class and would likely be familiar with the concepts assessed on the jurisprudence exam, they must demonstrate that they have this knowledge by successfully completing the RN(EC) Jurisprudence Examination before they can register in the Extended Class.