Starting safely

The College's registration process helped me prepare to practice safely for all my clients by ensuring I had the appropriate education and competencies. To maintain my skills, knowledge and judgment as a nurse, I continue to create learning goals and participate in a variety of educational studies and reflective practice. Amy Taylor, who entered nursing practice in 2015 as a Registered Practical Nurse

Before someone begins working as a nurse in Ontario, they must assure CNO that they’re able to provide safe and ethical care by meeting specific requirements. These requirements include: specific education, practice and passing an entry exam. (See Registration Requirements for the full list.)

In 2016, CNO continued working to add efficiencies to the time an applicant takes to complete the registration process. For example, we changed the exam for those applying to become RPNs from paper based to computer based.

Testing for knowledge, skills and judgment

As Ontario's nurse regulator, we're responsible for ensuring a new nurse is ready to care for you safely. One way we do that is through testing.

The RN exam

Applicants to CNO who want to practise as a Registered Nurse (RN) in the province must pass an entry exam as one requirement for registration. CNO uses the National Council Licensure Examination (NCLEX-RN). To pass this exam, the writer must meet an ability level that shows they have knowledge, skills and judgment to provide safe care when they begin their first year of practice. In 2016, 4,971 applicants to CNO wrote the NCLEX-RN at least once.

To pass the exam, the applicant will need to show they can do all of the following: assess and respond to changes in vital signs; perform comprehensive health assessments; assess a client’s need for pain management; perform calculations needed to safely administer medications; and maintain client confidentiality and privacy. They won’t be able to pass the exam unless they have gained this knowledge in all areas.

In 2016, more than 80 per cent of Ontario writers passed the exam on their first attempt (a significant increase from approximately 69 per cent in 2015). By the end of 2016, almost 85 per cent of writers had passed after one or more attempts.

You can read the full results of this and other exams here, including a breakdown by nursing school programs.

The RPN exam

Everyone who wants to practise as a Registered Practical Nurse (RPN) in Ontario must first pass the Canadian Practical Nurse Registration Examination (CPNRE). In 2016, 4,917 applicants to CNO wrote the CPNRE at least once.

In May 2016, after collaborating with our regulatory colleagues in Canada, we implemented computer-based testing for the CPNRE, replacing the previous paper-based test. Technology is being used increasingly to deliver exams of this type, and we wanted to take advantage of the opportunities offered. For example, computer-based testing allows test writers to take the CPNRE in more cities across Canada.

By the end of 2016, almost 93 per cent of Ontario-educated RPN applicants had passed the CPNRE.

You can read the full results of this and other exams here, including a breakdown by nursing school programs.

NP exams

Nurse Practitioners (NPs) are RNs who have specific additional education and an expanded scope of practice. They have authority to diagnose, prescribe medication, perform procedures, and order and interpret diagnostic tests. CNO offers three specialty certificates for NPs: Adult, Paediatrics and Primary Health Care.

In 2016, 278 applicants to CNO wrote one of the approved NP exams at least once, with 90.5 per cent passing on their first attempt.

New entry-level competencies for NPs

As part of the Canadian Council of Registered Nurse Regulators, we worked with our regulator colleagues in other jurisdictions to develop new competencies NPs need when entering their first year of NP-related practice. Regulators across Canada will be applying these new competencies, which will begin being used in Ontario in 2018. We’re releasing a document describing the competencies one year early to give stakeholders time to prepare. For example, universities will have time to update their curricula.

Improving the registration process

Everyone wanting to work as a nurse in Ontario must go through CNO’s registration process, which involves meeting several requirements (See Registration Requirements for the full list.)

Registration can be a complex and time-consuming process for some. This is particularly true for those applying to work in Ontario from other jurisdictions around the world where requirements differ from ours, and whose nursing education programs need to be assessed. We’ve been working to address the timeline elements for which we have control. For example, early in the process we’re advising applicants of the requirements, the documentation needed and how they can move through the process more efficiently.

The time it took applicants to register increased in 2016, despite there being no changes to processes that would have caused this increase. We’re conducting research to gain a better understanding of the delays in gaining membership with CNO. In addition, the application process remained paper-based during 2016; we’ll be implementing technology improvements in 2017 that should allow applicants to move more quickly through the application process. We expect an impact on the timelines by 2018.

We’ve been collaborating with the Council of Ontario Universities (COU) and the Council of Ontario University Programs in Nursing (COUPN) to inform the development of education for internationally educated RN applicants. Courses will be available in 2017 for applicants with educational gaps in the following areas: self-regulation, professional accountability and responsibility, service to the public and ethics.

The Office of the Fairness Commissioner (OFC) regularly audits CNO’s registration practices. Created under the Fair Access to Regulated Professions Act (2006), this government agency works with regulated professions and compulsory trades in Ontario to ensure their registration processes are transparent, objective, impartial and fair. CNO regularly seeks out areas for improvement in registration practice, and every year we review our practices and submit a Fair Registration Practices Report to the OFC. In turn, the OFC creates a list of recommendations for us to put into practice. You can review CNO’s 2016 report at Fair Registration Practices Report, 2016.

Enhancing program approval

Meeting and consulting regularly with representatives from Ontario’s nursing schools is a priority for CNO. The new Academic Reference Group is helping us with better planning for changes in nursing curriculum and regulation. Anne Marie Shin, CNO’s Manager, Education, a new role created in 2016 to work on academic-sector matters

Program Approval is a process CNO uses to evaluate nursing education programs to make sure they prepare graduates with the needed competencies. We currently use multiple approaches to approve RPN, RN and NP programs, including a range of approval structures, evaluation reviewers and frequencies of program evaluation.

In 2016, CNO’s Council agreed to change the way we approve nursing education programs. Making the change means that all nursing programs will be evaluated using the same standardized approach. This change came after consulting with experts, including those in education. We’ll review NP programs first, and select a third-party vendor to help implement evaluation tools and processes.