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 Extended Class: Present and Future  

Last modified: May 26, 2005

Acute Care Nurse Practitioners
and the Extended Class

In its role to regulate the nursing profession in the public interest, the College of Nurses of Ontario is exploring the inclusion of Acute Care Nurses Practitioners (ACNP) in the Extended Class. (ACNPs are currently registered in the General Class.)

In Ontario, Extended Class registration provides nurses with the legislated authority to autonomously perform controlled acts not available to Registered Nurses (RN) and Registered Practical Nurses (RPN) in the General Class. Currently, only RNs who graduate from an approved nurse practitioner program in primary health care are eligible to apply for Extended Class registration.

ACNPs are advanced practice nurses who, in addition to advanced-practice nursing, incorporate, with appropriate authorization, activities that fall within the traditional scope of medical practice.

There are approximately 300 nurses educated in graduate or post-graduate nurse practitioner programs practising as ACNPs in Ontario.

Registering ACNPs in the Extended Class will ensure that all nurses who refer to themselves as ACNPs will have successfully completed an educational program, an entry to practice examination(s) based on identified core competencies and that they practice in accordance with standards specific to their role.

Currently, all RN(EC)s are primary health care nurse practitioners. Though Nurse Practitioner (NP) is a commonly-used term in health care settings, it is not yet a term regulated by CNO and, therefore, is not a protected title.

Title protection of Nurse Practitioner — for all members of the Extended Class — would protect the public from unqualified NPs who inappropriately refer to themselves as something that by education, experience and competence, they are not.

The College began working in 2002 with the Canadian Nurses’ Association (CNA) and other Canadian nursing jurisdictions to develop the Canadian Nurse Practitioner Core Competencies. These competencies, designed for all primary and acute care nurse practitioners, were finalized in May 2004.

The College then hosted focus groups to confirm that these national core competencies were congruent with the College’s RN(EC) competencies. In March 2005, the College’s Council approved replacing the RN(EC) competencies with the national core competencies.

The first national NP examination based on the core competencies will be held in the fall of 2005. The College is participating in developing the exam, but no decision has been made yet about making it the entry exam(s) for the Extended Class in Ontario.

The College continues its work to describe the context of ACNP practice and lay the foundation for the ACNP regulatory framework. The national core competencies will be used as a component of the regulatory framework. Using focus groups with NPs and nursing educators and administrators, the College has outlined the characteristics of ACNP client populations and practice settings. This outline forms the description of ACNPs that will be presented to the College Council in June, 2005, for discussion on including ACNPs in the Extended Class.

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