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Questions & Answers for Nurse Practitioners

Updated April 24, 2008


New legislation affecting Nurse Practitioners passed on Aug. 29, 2007.

The following document provides answers to some of the most commonly asked questions the College has received on the impact of the change. The College has held a number of teleconferences over the past several months to keep our members informed of developments, and updates these Questions & Answers regularly.

 

Sections

 

Section A: Background Information

1. What are the changes to the Nurse Practitioner (NP) role in the new regulations?

Changes to regulations under the Nursing Act allow for new specialty certificates in the Extended Class:

  • NP-Paediatrics;
  • NP-Adult; and
  • NP-Anaesthesia.

These are in addition to the NP-Primary Health Care (NP-PHC) role, which has been regulated in the Extended Class since 1998. The new regulations also expand further on the NP title protection provisions introduced in the Nursing Act. Now, only individuals registered in the Extended Class can use the title Nurse Practitioner. Title protection is important because it protects the public and promotes role clarity.

Resources:

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Section B: Job Titles

2. Do employers need to create new interim job titles for advanced practice nurses in acute care roles until they obtain their Extended Class registration?

Yes. Only individuals registered in the Extended Class can use the title Nurse Practitioner. NP title protection helps the public understand who is providing their care and what to expect from the care provider. However, employers may introduce temporary job titles until their employees meet the requirements to register in the Extended Class. Subject to collective agreement provisions, the most common interim title being used is advanced practice nurse (APN). RN(EC)s, commonly known as NPs, have the authority to perform more controlled acts than other nurses. These additional controlled acts, which include communicating diagnoses and prescribing medications, can pose a risk to the public. The College must ensure these acts are performed by individuals who have met specific education and regulation requirements.

 

3. I graduated from an acute care nurse practitioner (ACNP) education program, but I am not yet registered in the Extended Class. Can I use ACNP as part of my credential?

A credential is a certificate, degree or diploma awarded by an educational institution to recognize a specific course of study. Because the Nurse Practitioner title is now legally protected, it can only be used by individuals who are registered in the Extended Class. Nurses must meet all of the requirements for registration in the Extended Class to use the newly protected Nurse Practitioner title.

Resources

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Section C: Registering in the Extended Class

4. How do I register in the Extended Class?

Extended Class registration is available to RNs who successfully complete an approved educational program, pass a registration examination and meet the requirements for evidence of safe practice. The NP registration guide has been updated and is available on line: Click here to request an application package, or contact Customer Service at 416 928-0900 or 1 800 387-5526.

 

5. How will the Registration Committee assess my education and experience? Why does the College ask for different information from different people?

To initiate the assessment process, you must complete an application package.

The assessment focuses on the applicant’s demonstration of the Canadian NP core competencies (English: French:). The College assesses each application individually. As a result, the College may require additional information about programs and practice. This information may include, but not be limited to, nursing course outlines, a job description, CV and/or a list of medical directives that the nurse has used. The College uses this information to complete a comprehensive assessment of each applicant.

For more information about your application or the application process, contact Customer Service at 416 928-0900 or 1 800 387-5526.

 

6. What is the evidence of safe practice requirement?

Evidence of safe practice is a non-exemptible registration requirement, defined as two years of nursing experience within the last five years. One of those two years must be in an advanced practice role in which the applicant was required to use advanced knowledge and decision-making skills in assessment, diagnosis and health care management.

 

7. Is there any benefit to obtaining more than one specialty certificate? Do I need more than one?

You only need to meet the requirements of one specialty certificate for registration in the Extended Class. However, some NPs may feel they need to register in more than one specialty because it is important for their practice. As well, specific specialties may be required by employers. If relevant to your practice, you may choose to apply for another specialty certificate, but you must meet the registration requirements for that specialty, including graduation from an approved program, passing the examination for that specialty, demonstrating evidence of safe practice and maintaining Quality Assurance requirements. If you have not graduated from an approved program for that specialty, the Registration Committee may consider additional education and experience as being equivalent to an approved program. Contact the College for more information.

Resources

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Section D: Educational Requirements

8. What programs has the College approved to date for registration in the Extended Class?

An up-to-date list of approved programs, according to specialty, is posted here.

9. The website says programs are approved as of Sept. 26, 2007. I graduated from an approved program prior to that date. Does this mean I have not met the educational requirement?

Not necessarily. Applicants who graduated from an approved program prior to Sept. 26 will be assessed by the Registration Committee. To facilitate registration for existing advanced practice nurses, the College is reviewing the historical curricula of Ontario-based programs, for which there is a critical mass of graduates in the province. If the curricula meet the criteria, including the requirement that they embed the national NP core competencies, these programs will be recommended to Council for approval. This includes curricula offered through McMaster University, University of Toronto and the University of Western Ontario prior to September 2007. Once these historical Ontario programs have been reviewed, the College will consider U.S.-based programs, particularly those located in border communities.

10. I graduated from an approved acute care nurse practitioner education program, but I’ve been practising in primary health care (PHC) for the past five years and would like to write the PHC exam. Do I have to take another program?

Not necessarily. The Registration Committee will assess your combined education and experience to determine program equivalency. This means that the Registration Committee may consider your past education and professional experience to be the equivalent of an approved program for the Primary Health Care specialty certificate. If you meet all of the other requirements for registration in this specialty, including passing the exam, you will be eligible for a PHC specialty certificate.

11. Why doesn’t the College distinguish between a master’s NP and a post-baccalaureate NP?

The College of Nurses of Ontario and other Canadian regulatory bodies assess competencies, not credentials. In Ontario, the Canadian NP core competencies are embodied in both primary health care and acute care programs and are common to the practice of each specialty certificate. To ensure that all nurses entering the Extended Class possess the necessary competencies to practise in the role, each applicant for the Extended Class must write an approved examination that assesses core competencies.

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Section E: General Examination Information

12. Will applicants be required to write an exam to register in the Extended Class?

Yes, applicants must successfully complete an approved examination. They also have to meet other registration requirements. There are specific examinations for each specialty. On Sept. 26, 2007, the College’s Council approved exams. Click here for the list.

13. What is the latest information about the NP exams?

For the latest information about exams, including dates and locations, click here. The College will continue to post information about the exams on the CNO website as it becomes available.

14. The approved exams listed on www.cno.org are date specific. What do these dates mean?

These dates correspond to when the College was able to confirm they meet the Canadian NP core competencies. The College’s Council approved these exams, as of a certain date, because the examination content met College criteria. Applicants who have successfully completed the exam in the year posted or after have met the exam registration requirement.

15. I wrote the exam prior to the stated date, but maintained my competency with credentialling agencies in other ways; for example, I met continuing education requirements and completed portfolios. Do I still need to write an approved entry exam to obtain an NP specialty certificate in Ontario?

Yes, you will still need to write an approved exam to meet the requirements to obtain an NP specialty certificate in Ontario. The entry exam is a non-exemptible registration requirement. You cannot fulfil that requirement by meeting continuing competency requirements or quality assurance mechanisms, such as continuing education or completing portfolios.

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Section F: ANCC Exam Information

16. Why must Ontario nurses write a U.S exam?

Currently, there are no Canadian Nurse Practitioner examinations for Adult and Paediatric entry-to-practice assessment. The ANCC exams have been assessed to ensure that they reflect the Canadian NP core competencies (the same competencies taught in our approved NP education programs). The core competencies are:

  • health assessment and diagnosis;
  • health care management and therapeutic intervention;
  • health promotion and the prevention of illness, injury and complications; and
  • professional role and responsibility.

The ANCC exams are currently used in other Canadian jurisdictions. The exams are adjusted during the scoring process to remove questions that are not applicable to nursing practice in Canada. In addition, the College of Nurses of Ontario and other Canadian regulators are required to facilitate inter-provincial mobility. Taking a national approach to NP examinations helps to meet this obligation.

17. If questions are being removed in the scoring process, does this mean I only have to answer some of the questions?

No, you should attempt to answer every question. It is not possible to know beforehand which questions will be removed in the scoring process.

18. How long are the ANCC NP exams?

Candidates are allowed 3.5 hours to write the ANCC exams.

19. What supports are provided to write the ANCC exams?

Study resources are available on the ANCC’s website to help you prepare for the ANCC exams.

You can also access a haematology conversion table here and chemistry conversion table here to study before the exam. You cannot take your own copies into the exam, but the tables, as well as the necessary formulas to convert height, weight and temperature values, will be available to help you convert imperial units to the metric system.

No other resources or study aids are allowed into the exam room. Many of the exam questions already include height, weight and temperature in both imperial and metric formats.

20. Can more time be allowed to write the ANCC exams to account for the fact that we have to convert lab values?

No. The time allocated for the ANCC exams is 3.5 hours. While U.S. writers are expected to answer 175 questions in this time frame (150 exam questions and 25 experimental questions), Canadian candidates are required to answer only 150 questions because the experimental questions will not be included.

21. Is there a pass/fail cut-off or are the ANCC exams bell-curved? What details will I receive about my performance on the exam?

There is a pass/fail cut-off. The cut-off is established by a national exam committee with the guidance of the psychometrician scoring the exam. Candidates who pass will receive a report indicating that they have passed. Candidates who fail will receive additional information about their performance in relation to the major content areas in order to assist them in future preparation.

22. How do I schedule my ANCC exam?

Once the College has assessed you as exam-eligible, you must submit your exam application and pay the exam fee. The ANCC will then provide you with the information you require to schedule your own exam directly with the Ontario writing centres within the timeframes posted here. Candidates should ask the writing centre about hours of operation and seating capacity as they differ at each of the centres.

23. Does writing the ANCC exam make me eligible for certification in the U.S.?

No. Canadian candidates who write the ANCC exam at a Canadian centre to apply for registration in Canada are not eligible for certification in the U.S. through the ANCC. Successful completion of the exam is solely to support the registration process in Canada. To be eligible for U.S. certification, the candidate must apply to write the exam through the ANCC directly and meet the ANCC’s criteria for certification. Canadian candidates who have obtained the ANCC certification by writing the exam (in 2002 or later) are considered to have met the College’s exam requirement for NP registration in Ontario.

24. What is the process for further “Canadianizing” the ANCC exams?

Exam modifications are subject to future collaboration among Canadian jurisdictions and the CNA, and negotiations with the ANCC, the exam owner.

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Section G: Scope of Practice

25. If I register in the Extended Class, will I be able to practise without delegation or medical directives?

If you work in a hospital in-patient setting, the answer is no. Currently, Regulation 965 under the Public Hospitals Act does not give NPs the authority to diagnose, prescribe for and treat in-patients. However, NPs who work in outpatient settings – such as emergency departments or ambulatory clinics – are authorized to diagnose, prescribe for and treat hospital outpatients. The College has recommended to government changes to Regulation 965 to permit NPs to practise to their legal scope of practice when providing health services to hospital in-patients. These recommendations are currently under review by the Health Professions Regulatory Advisory Council (HPRAC). Until further notice, NPs who practise in public hospitals with in-patients must practise under orders (direct orders and medical directives) and delegation. See the Federation of Health Regulatory Colleges of Ontario’s An Interprofessional Guide on the Use of Orders, Directives and Delegation for Regulated Health Professionals in Ontario.

26. Under the authority of a medical directive, will any NP be permitted to write prescriptions and order lab tests to be filled in a community pharmacy or laboratory for an in-patient who is being discharged from hospital?

Yes, NPs working in in-patient areas can write prescriptions and order lab tests using medical directives from physicians, dentists or midwives, which can be processed in community labs and pharmacies. For tools and templates, see the Federation of Health Regulatory Colleges of Ontario’s An Interprofessional Guide on the Use of Orders, Directives and Delegation for Regulated Health Professionals in Ontario.

27. I’m an advanced practice nurse in an acute care role who works in an emergency department. When I register in the Extended Class, will I be able to order the same diagnostic tests and prescribe the same drugs as NPs?

Yes, NPs have access to specific drugs and diagnostic tests designated in various regulations and statutes. Those who practise in outpatient settings such as emergency departments or ambulatory clinics can order these tests and drugs.

28. Will the current list of drugs and tests NPs can prescribe be eliminated?

The College’s recommendations to remove the requirement to have lists of drugs and tests are under review by HPRAC. However, recent amendments to the Nursing Act allow the College to designate categories of drugs (in addition to listing the specific drugs) that NPs can prescribe. At this time, categories of drugs have yet to be defined. The College will work with the membership, the Ministry and other stakeholders to develop regulations regarding drugs and laboratory and diagnostic tests that will promote client access to care and better reflect the new specialties. The College will update the membership as information becomes available.

29. Can NPs prescribe opiates?

Currently, NPs do not have the authority to prescribe opiates, including derivatives or synthetic formulations. The Controlled Drugs and Substances Act is federal legislation that governs the practice of prescribing controlled drugs in Canada. In March 2004, Health Canada’s Drug Strategy and Controlled Substances Programme announced plans to begin consultation on potential regulatory amendments under the Controlled Drugs and Substances Act that would expand prescriptive authority to other health professions, including NPs. In June 2006, the Government of Canada sought feedback on proposed regulations to permit NPs to prescribe controlled substances. The College provided feedback to the federal government on the draft regulations.

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