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 Extended Class: Present and Future  

Last modified: Jan. 31, 2006

FAQs: Regulating Acute Care Nurse Practitioners

  1. Why is the College of Nurses of Ontario (CNO) exploring the inclusion of Acute Care Nurse Practitioners (ACNP) as Registered Nurses in the Extended Class [RN(EC)]?
  2. What needs to be done to regulate ACNPs in the Extended Class?
  3. What is involved in making these changes to regulations and practice standards?
  4. What process will the College use to move the regulation of ACNPs from the General Class to the Extended Class?
  5. When will the expansion of the Extended Class occur?
  6. What is the relationship between the College and the Canadian Nurse Practitioner Initiative (CNPI)?

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1. Why is the College of Nurses of Ontario (CNO) exploring the inclusion of Acute Care Nurse Practitioners (ACNP) as Registered Nurses in the Extended Class [RN(EC)]?

The College is trying to include ACNPs as RN(EC)s in order to fulfill its mandate of public protection.

Regulating ACNPs as RN(EC)s protects the public by ensuring that nurses who refer to themselves as ACNPs meet Extended Class requirements. These include successful completion of an appropriate education program, practice examination(s) based on Canadian Nurse Practitioner Core Competencies (which the College adopted for all members of the Extended Class in 2005) and practice in accordance with RN(EC) standards.

Regulation as an RN(EC) will grant ACNPs the legislated authority to independently perform a number of controlled acts without a medical directive or doctor’s orders. The expanded scope of practice may include communicating a range of diagnoses, prescribing a range of drugs and ordering a range of laboratory and diagnostic tests.

Title protection will be sought so that only primary health care, adult acute care or child acute care nurse practitioners may refer to themselves as Nurse Practitioners (NP). This will protect the public from unqualified NPs who inappropriately refer to themselves as something that by education, experience and competence, they are not.

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2. What needs to be done to regulate ACNPs in the Extended Class?

First, the College clarified the differences in the Canadian Nurse Practitioner Core Competencies when applied in the context of primary health care, adult acute care and child acute care nurse practitioners.

Second, education program requirements and entry to practice examination(s) for adult acute care and child acute care nurse practitioners need to be determined and/or developed.

Finally, the College will review and revise the Registered Nurses in the Extended Class practice standard and seek legislated authority for ACNPs.

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3. What is involved in making these changes to regulations and practice standards?

Changing regulations and revising or developing standards are complex processes that involve a wide range of stakeholders.

It begins with inviting stakeholders to participate in discussions and reviews of regulations, standards and processes as they are developed. For this project, the key stakeholders include the Ministry of Health and Long-Term Care (MOHLTC), the public, other health care professional associations and regulatory bodies, employers and educators.

CNO Council is kept informed of the progress and provides approval at key stages. Once the ground work is done, revised standards are drafted and, with legal counsel, changes to the regulation are proposed that allow ACNPs to join the Extended Class. This includes reviewing the impact of proposed changes on other legislation and, if necessary, recommending further changes to other legislation.

The proposed regulation changes are published in The Standard and all members are asked to comment. Based on the feedback, the suggested changes are sent to Council for approval.

In the last step of the process, the College sends a formal recommendation to the MOHLTC that the proposed changes be accepted, and works closely with the ministry to support the implementation of the regulation changes.

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4. What process will the College use to move the regulation of ACNPs from the General Class to the Extended Class?

CNO is using a consultation process that brings together College staff and external stakeholders such as nurses, physicians and other health care professionals, employers and educators. As well, representatives from government and professional associations and regulatory colleges both within and outside of Ontario will participate in the discussions.

The process began in 2004, when focus groups were held with RN(EC)s, ACNPs, nursing educators and administrators to develop the ACNP regulatory framework. The discussions explored:

  • client population characteristics;
  • nursing practice opportunities and challenges; and
  • controlled acts/scope of practice.

In 2006, the College will continue to consult with stakeholders discussing legislation and regulation, standards of practice, entry-to-practice requirements, quality assurance and professional conduct mechanisms.

Visit the College’s website (www.cno.org) and read upcoming issues of The Standard for opportunities to provide feedback.

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5. When will the expansion of the Extended Class occur?

The College can’t give an exact date for the expansion because of the legislation process. Members can track the progress by visiting the College’s website and reading The Standard.

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6. What is the relationship between the College and the Canadian Nurse Practitioner Initiative (CNPI)?

The College is a supportive participant of CNPI, a project sponsored by the Canadian Nurses’ Association (CNA) and funded by Health Canada’s Primary Health Care Transition Fund.

A detailed description of CNPI can be found on the organization’s website (www.cnpi.ca).

In 2005, CNPI developed a Family/All Ages nurse practitioner examination similar to the Extended Class Registration Exam used in Ontario. The Family/All Ages examination is based on the Canadian Nurse Practitioner Core Competencies that the College and other national nursing partners developed with the CNA.

The College participated in the development of the national exam but has not yet made a decision about changing Ontario’s Primary Health Care Nurse Practitioner entry examination.

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