Fair Registration Practices Report

Nurses (2008)

The answers that you submitted to OFC can be seen below.

Provision of Information About Registration Practices (1 / 13)
Describe how you make information about registration practices available to individuals applying or intending to apply for registration. Specify the tools used to provide information, and the manner in which you make that information available, current, accurate and user friendly in each of these subcategories:
a) steps to initiate the registration process- The College website has an entire section under the tab "Registration" that provides comprehensive information about initiation of an application to be registered, including a specific section on "Applying for Registration". Additional resources on the web include: Fact Sheets, an Application Guide and an FAQ section.

- The website is updated regularly as new information becomes available.

- The website includes a glossary of registration terms.

- The College also has the Application Guide, Fact Sheets and the Application Form in printed form.

- For any questions or concerns regarding the Registration process, web users are also invited to contact the Customer Service Department directly by email, by phone or to visit the College and speak to a Customer Service Representative.

- The College has a Call centre with Customer Service Representatives that can assist prospective applicants in accessing the web or they will collect basic demographic information for mailing prospective applicants an application package immediately, regardless of where in the world a prospective applicant is located.

- A person walking into the College can speak with a representative at the Customer Service Desk who will assist them with any information requests and provide them with hard copies of an application, supporting guide and other documents.
b) requirements for registration- In addition to the information noted in a), there are specific documents that address each of the specific requirements for prospective Registered Nurses (RNs), Registered Practical Nurses (RPNs) and those seeking a temporary registration, and are available to download.

- In addition the website includes links to testing facilities and organizations that support applicants with preparation programs and contacts for responding to inquiries.
c) explanation of how the requirements for registration are to be met, such as the number of years of schooling required for a degree to be deemed equivalent to an Ontario undergraduate degree, length and type of work experience, credit hours or program content- The website includes specific information on what is required to meet each requirement and the documented evidence to verify the information provided.

- In addition to the above the website has a section entitled "Registration Guide for Internationally Educated Nurses". which is also available for download. It provides information to prospective applicants intuitively, based on responses to a series of questions related to the registration requirements on how to meet these requirements. This provide a prospective applicant all of the information necessary to identify what is required of them to meet the requirements for registration.
d) any education or practical experience required for registration that must be completed in Ontario or practice that must be supervised by a member of the profession who is registered in Ontario- The College has a current safe practice requirement. However, the current safe practice is not required to be completed in Ontario. The College does not require applicants to practice in Ontario prior to becoming registered.

- The College is in the process of redesigning its website at which time the above 'non-requirement' information will be included.

- However, Applicants can call, email or visit the College in person to obtain this information.
e) requirements that may be satisfied through acceptable alternatives- The registration requirements are written in Regulation in a form that is flexible. E.G. 'equivalent to an Ontario program' or 'with reasonable fluency'. This information is on the website and in the guide.

- The website and guide indentify how each requirement can be met, including, for example, acceptable tests and test scores for fluency and accepted exams to meet the exam requirement.

- Of note, there are three "Non-Exemptible Requirements": Programs, Evidence of Safe Practice and Examination. While the measurement for meeting these three requirements is flexible, an applicant must meet each of these three requirements.

- Generally all requirements must be met. However, there are many alternatives allowed in meeting each of the requirements, i.e. multiple fluency tests accepted, nursing program is not required to be an Ontario nursing program, safe practice is not required to be in Ontario, etc.
f) the steps in the assessment process- Under the section on the website entitled "Registration" is listed the steps in the assessment process as well as more detailed information in the following guides that relate to particular types of applications.

- For applicants outside Canada, web users are invited to access the "Registration Guide for Internationally Educated Nurses." An e-interactive Fact Sheet is available for applicants to complete a self-assessment to determine eligibility.

- For information about Temporary Registration, web users are invited to access "Temporary Registration Instruction Guide."

- For information on the College's Extended Class registration, webusers are invited to review the Fact Sheet: "Primary Health Care Nurse Practitioners and the Extended Class for RNs"(#45025), or to contact the College at cno@cnomail.org.

- Again, if a prospective applicant phones, emails or visits the College this information is provided by a representative.
g) the documentation of qualifications that must accompany each application; indicate which documents, if any, are required only from internationally trained applicants- This information is contained on the website under the Registration tab and specifically, as previously mentioned, in a separate section titled "Registration Guide for Internationally Educated Nurses" for international applicants and includes the identification of 2 groups of forms, their purpose, and process.

- An application and guide can also be mailed on request by phone or by email or provided upon visit to the College.

- Application packages (including the Guides) are taylored to Ontario and International applicants individually. Each specifies the process and individual forms required to be completed and submitted.
h) alternatives to the documentation if applicants cannot obtain the required documentation for reasons beyond their control- The process of providing documentation via a statutory declaration is explained clearly on the College's website under the Registration tab.

- This information is available in speaking by phone or in person to the College, and in the application guide.
i) how applicants can contact your organization- Applicants can contact the College by phone, email, fax, through the website or visit by appointment on site.

- We have a Customer Service call centre operational during business hours that is able to provide updates to applicants.
j) how, why and how often your organization initiates communication with applicants about their applications- The College is in the process of redesigning its website. The objective of the new design is to provide information in language and format that meets the needs of different stakeholders. There will be a specific section for applicants that addresses how the College initiates communication with applicants.

- At this time, Applicants can call, email or visit the College in person to receive information.
k) the process for dealing with documents provided in languages other than English or French- On the website and in print in the guide "Registration Guide for Internationally Educated Nurses" under the section Registration Forms and Fees is a sub tab labelled "Other Fees" which describes how the College handles documents in languages other than English or French.

- This information is also available by phone, email or in person.
l) the role of third-party organizations, such as qualification assessment agencies, organizations that conduct examinations or institutions that provide bridging programs, that applicants may come into contact with during the registration process- The College is in the process of redesigning its website. The objective of the new design is to provide information in language and format that meets the needs of different stakeholders. There will be a specific section for applicants that addresses the role of third party organizations.

- At this time the website only identifies organizations and and contacts that relate to specific requirements. The role is not clearly articulated.

- Applicants can call, email or visit the College in person to obtain information on a third-party organization's role.
m) any timelines, deadlines or time limits that applicants will be subject to during the registration process- Information concerning examination timelines, deadlines and dates is available under the tab "Examinations" which is accessible from the webpage "Registration".

- This information is available when applicants contact the College by phone, email or in person.

- The website and guide identify the safe nursing practice within the 5 years prior to registration requirement.
n) the amount of time that the registration process usually takes- The College is in the process of redesigning its website. The objective of the new design is to provide information in language and format that meets the needs of different stakeholders. There will be a specific section for applicants that addresses the amount of time the registration process takes along with the significant factors that affect the time.

- The College will only be able to identify a range of average time, as each application is unique. The timeframe between receipt of an application and registration is as much in the control of the applicant as it is in the control of the College. i.e. an applicant is the sole determiner of when they will write the national exam, ther is no time limit; also, receipt of documents from third parties is dependent on organization such as schools, employers, other registration bodies and the country; and documents that require translation add time to the process.
o) information about all fees associated with registration, such as fees for initial application, exams and exam rewrites, course enrolment or issuance of licence- All of this information is available on the website under the section entitled "Registration" and in the printed guide.

- This information is also available to anyone who calls, emails or visits the College in person.
p) accommodation of applicants with special needs, such as visual impairment- Information about special accommodation required in writing the exam is available on the website under the Examination webpage in the Registration section of the website.

- This information is also available to anyone who calls, emails or visits the College in person.
Amount of Fees (2 / 13)
Are any of the fees different for internationally trained applicants? If yes, please explain.- The application fees payable by internationally educated applicants is $163.55 versus $46.73 paid by in province and out of province applicants.

- The difference in the fees charged is to compensate for the additional costs incurred by the College in assessing international applications which includes assessment of an individuals specific program, evidence of safe practice and other registration requirements; Ontario education programs are approved by bodies accepted by Council prior to students being enrolled, as a result graduates are only from an approved program and do not require individual assessment of their program. This is the same for practice and fluency as each requirement is met through their Ontario program.

- The fee also includes the cost of services incurred by the College from third party providers such as WES, which is used for credential level determination.
Provision of Timely Decisions, Responses and Reasons (3 / 13)
a) What are your timelines for making registration decisions- It takes 15 business days for an applicant to be registered provided that all the documents have been received by the College and the applicant has met all non-exemptible and exemptible requirements.

- If an application is being refused, by regulation a notice of this intent ('notice of referal') is mailed to the applicant 30 days before the Registration Committee meets to review the application.
b) What are your timelines for responding to applicants in writing- Applicants receive a letter within three weeks of the College's receipt of the application forms and payment of the required registration fees.

- The letter informs the Applicant that the College is in receipt of the Applicant’s application and identifies any outstanding documentation that the College requires to process their application.

- The College issues a letter to the Applicant informing them of the status of their registration within 15 weeks of receipt of the application and payment of the required registration fees.

- In some circumstances, the letter to the Applicant may also include a request for further documentation or information.

- Applicants who do not meet the registration requirements will receive a Notice of Referral indicating that their application is being referred to the Registration Committee.

- Simultaneously, the applicant will also receive a letter informing them that they have an opportunity to provide written submissions for consideration by the Registration Committee for which they have thirty days to submit. This is in accordance with the Regulated Health Professions Act.

- Applicants who require additional time to gather and provide their written submissions are asked to contact the College to accommodate this request.
c) What are your timelines for providing written reasons to applicants about all registration decisions, internal reviews and appeal decisions- The Order issued by the Registration Committee along with their decision and reasons is mailed to the Applicant within thirty days of the Registration Committee meeting where the review of the Applicant's file occurred.

- The Applicant also receives a letter of direction from the Executive Director of the College indicating what steps they will need to complete to meet any outstanding registration requirements.
d) Explain how your organization ensures that it adheres to these timelines.- All submitted applications are stamped with the date of receipt and logged in the College’s internal database.

- The date the Applicant pays the required registration fees is also logged in the College’s internal database. The file is then organized by date of receipt of the application and payment of the application fee.

- College staff organize the Applications by date of receipt of the Applicant’s application and payment of the required registration fees.

- Each activity that occurs with an applicant's file is dated on the data base - physical file is creation date; application referral to the Registration Committee date; communications to applicant dates, etc.

- Reports on applications and their receipt date are run against the data base to ensure the timelines that are benchmarked are achieved.

- College crafted spreadsheets also record the date of file creation to ensure files are assigned within twelve weeks of receipt of the file.

- Files are sent to the Registration Committee unless there is a request for an extension. All information is captured on the internal database and any information that is received from the Applicant is physically date stamped.

- Following each Registration Committee, the College mails the Registration Committee’s decision within one month from the date that their file was reviewed by the Committee.

- Staff receive a report of the Registration Committee's decision and reasons in advance of the Registration Committee informing the Applicant. This information is recorded.

- When the Committee’s decision and reasons are mailed, a record is kept in the College’s internal database.
Access to Records (4 / 13)
a) Describe how you give applicants access to their own records related to their applications for registration.- The regulations provide that the Registrar will provide a copy of the entire file to an Applicant upon request. Sec 16. (1) of the Health Professions Procedural Code reads: "The Registrar shall give an applicant for registration, at his or her request, all the information and a copy of each document the College has that is relevant to the application."
b) Explain why access to applicants’ own records would be limited or refused.N.A.
c) State how and when you give applicants estimates of the fees for making records available.- Applicants are informed of the relevant fees when they make the request to the College by phone, email or come to the College and speak with a representative. This includes any fees required for a copy of transcripts.

- The website and printed information contain all fixed fees; variable fees such as copying are identified on request for the service.
d) List the fees for making records available.- The fee for transcripts is $20.00 plus GST.

- Applicants who request the documents be faxed are informed there is an additional cost of $5.00 plus GST.
e) Describe the circumstances under which payment of the fees for making records available would be waived or would have been waived.- The fee is very rarely waived as the costs are low and it represents the time and effort required to extract the information and mail it to the individual. Any waiver of fees would be based on the applicant's unique circumstances. Applicants who fail to receive their mailing are not assessed a fee for the second mailing. For any service request cancelled by the applicant, the fees are refunded.
Resources for Applicants (5 / 13)
a) List and describe any resources that are available to applicants, such as application guides, exam blueprints or programs for orientation to the profession.The following resources are available:

Guides:
Registering as a Nurse in Ontario
Registration in the Extended Class for Nurses in Ontario
Temporary Registration Instruction Guide
Registration Guide for Internationally Educated Nurses

Fact Sheets:
What is CNO?
Practising Nursing
Preparing to write the Registered Nurse and Registered Practical Nurse examinations
E-interactive fact sheets

Examination Guides:
Canadian Registered Nurse Examination and Initial Registration Handbook
Canadian Registered Practical Nurse Examination and Initial Registration Handbook

Preparation exams and guides are also available from the Canadian Nurses Association for Registered Nurses and Assessment Strategies Inc for the Registered Practical Nurses examination.

A detailed list of the Competencies that are required for both Registered Nurses and Registered Practical Nurses are listed on our website under the Publications tab.

A flyer accompanies the letter to Applicants who are made examination eligible containing information re: the CARE examination preparation program.

The international application package includes a flyer from Health Force Ontario and their services.

Schools with Nursing Bridging Programs in Ontario along with a contact and e-mail link.

The Colleges website contains links to the organizations identified above.

Representatives from the College participate in Community Outreach sessions and both distribute and explain information relating to Registration in Ontario.

Applicants can have sit down session with a College representative and obtain guidance on filling out forms, courses to attend, etc.
b) Describe how your organization provides information to applicants about these resources.- Information is available on our website.

- We also have links within the province through the Ministry of Citizenship and Immigration website which links to our website for the interactive fact sheets and other information.

- Applicants who call, fax, email or visit the College in person may speak with a Representative.

- The application guide identifies some of the contacts and for others refers applicants to the College's website for contacts.
Internal Review or Appeal Processes (6 / 13)
This section refers to initial internal reviews or appeals.
a) List your timelines for completing internal reviews or appeals of registration decisions.- An Applicant’s file is reviewed within 15 days of the Applicant’s documents being submitted to the College.

- When the College is in receipt of all the required documents and the Applicant is found by the Executive Director not to be registration eligible, the College provides the Applicant with a Notice of Intention to refer their application to the next available Registration Committee. At that time, the College will also notify the Applicant that they have thirty days to submit any additional documents they want reviewed by the Committee, in accordance with Section 15.3 of the Regulated Health Professions Act (“RHPA”)

- Once the Applicant’s written submissions are received by the College, their file is then reviewed by the Registration Committee. If the Applicant fails to provide any written submissions for review by the Registration Committee and does not attempt to communicate with the College, their file is referred to the Registration Committee within 6 months of the College sending out the Notice of Intention to refer the application to the Committee.

- An order signed by the Chair of the Registration Committee is mailed out within 30 days of the committee meeting date.
i. State the number of internal reviews or appeals of registration decisions that exceeded your timelines.- Since applications are presented only after due notification, applications are not delayed and therefore timelines are not exceeded.

- The opportunity is provided to the Applicant to provide any additional submissions and if an Applicant wants additional time to obtain the information, an extension is granted.

- If an Applicant consents to a reduced notice period and would prefer the existing file contents to be presented as complete, the College obtains a written waiver of the 30-day notice.
ii. Among internal reviews or appeals that exceeded your timelines, state the number that were from internationally trained applicants.N.A.
b) Specify the opportunities you provide for applicants to make submissions regarding internal reviews or appeals.see section a)
c) Explain how you inform applicants about the form in which they must make their submissions (i.e., orally, in writing or by electronic means) for internal reviews or appeals.- Applicants are notified, in writing, that they may make written submissions to the Registration Committee within thirty days after receiving the Notice of Intention to refer their application to the Registration Committee.

- The Applicant is also provided with a staff contact in the letter if they have any questions or require any further clarification.
d) State how you ensure that no one who acted as a decision-maker in a registration decision acts as a decision-maker in an internal review or appeal of the same registration decision.- The Registration Committee is comprised of elected members of the nursing profession, including Registered Nurses and Registered Practical Nurses. There are also public members that are appointed to the Registration Committee. The Executive Director is not a member of the Registration Committee.

- Since the appeal process is external, no concern exists that the same people are involved in both decision-making processes.
e) Describe your internal review or appeal process.An internal review occurs when the Executive Director:

(a) has doubts, on reasonable grounds, about whether the Applicant fulfils the registration requirements;

(b) is of the opinion that terms, conditions or limitations should be imposed on a certificate of registration of the Applicant and the applicant does not consent to the imposition; or

(c) proposes to refuse the application.

- As previously stated, the Applicant receives notification the application is being referred by the Executive Director to the Registration Committee and is provided an opportunity to provide any additional written submission that the Applicant would like the Registration Committee to consider.

- The Registration Committee meets, considers the application and can order one or a combination of the following:
1. Direct the Registrar (Executive Director) to issue a certificate of registration.
2. Direct the Registrar to issue a certificate of registration if the Applicant successfully completes examinations set or approved by the panel.
3. Direct the Registrar to issue a certificate of registration if the Applicant successfully completes additional training specified by the panel.
4. Direct the Registrar to impose specified terms, conditions and limitations on a certificate of registration of the Applicant and specifying a limitation on the applicant’s right to apply under subsection 19 (1).
5. Direct the Registrar to refuse to issue a certificate of registration.

- An order signed by the Chair of the Registration Committee is mailed out within 30 days of the committee meeting date. A notice of an order is required to be issued and that notice clearly lays out the appeal rights of an Applicant against a decision of the Registration Committee.

- The Executive Director (Registrar) of the College sends out a covering letter with the order of the Registration Committee, that provides some direction to the Applicant.

- The Registration Committee also has powers to vary terms, limits and conditions on an application being presented before it.

The Appeal Process:

- An applicant who has been provided a decision by the Registration Committee can require the Board (Health Professions Appeals and Review Board) to hold a review or a hearing. The Applicant should make this request within thirty days of receiving notice from the Registration Committee. (http://www.hparb.on.ca/)
f ) State the composition of the committee that makes decisions about registration, which may be called a Registration Committee or Appeals Committee: how many members does the committee have; how many committee members are members of the profession in Ontario; and how many committee members are internationally trained members of the profession in Ontario.The Registration Committee is comprised of nine members. Three of the Committee members are public members, two members are Registration Practical Nurses and three are Registered Nurses. Two of the current members are internationally educated nurses.
Information on Appeal Rights (7 / 13)
This section refers to reviews or appeals that are available after an internal review or appeal. Describe how you inform applicants of any rights they have to request a further review of or appeal from a decision.- Applicants who receive a Notice of Order under section 20(1) of the Health Professions Procedural Code are provided with information on their right to appeal the Registration Committee’s decision at the Health Professions Appeal and Review Board. The correspondence that the Applicant receives states that, in accordance with the Regulated Health Professions Act, they have the right to require the Health Professions Appeal and Review Board (“Board”) to hold a review of their application and the documentary evidence in support of it, or a hearing of their application.

- They are also informed that, if they would like to have their matter reviewed by the Board, they are required to provide written notice to the Board and the Registration Committee within thirty days after they received notice of the Registration Committee’s decision and their reasons.

- They are also provided with copies of the relevant sections of the Regulated Health Professions Act and Ontario Regulation 275/94 made under the Nursing Act. The Applicant is also provided with a College contact who they are encouraged to call if they have any further questions or inquiries about their file or the decision.
Assessment of Qualifications (8 / 13)
This category covers your processes for assessing all qualifications, such as academic credentials, competencies, language ability or practical experience.
a) List the criteria that must be met in order for an applicant’s qualifications to satisfy the entry-to-practice requirements for your profession.- To satisfy entry-to-practice requirements, the following qualifications in the areas of program, practice, examination and good conduct are listed. These requirements are from the Nursing Act from Section 5 to 11.1. Listed below are the requirements for General Class and Extended Class.

Program requirements:

In the case of RNs the applicant:
i. must have received a baccalaureate degree in nursing granted by a university in Ontario whose program was, at the time the applicant graduated, approved by a body or bodies designated by the Council or by the Council itself,
ii. must have received a baccalaureate degree in nursing granted by a university in another province or territory in Canada that, at the time the applicant graduated, was, in the opinion of the Registration Committee, equivalent to the degree described in subparagraph i,
iii. must have graduated prior to January 1, 2005 from a nursing program in another province or territory in Canada that was, at the time the applicant graduated, accepted by the regulatory body for nursing in that province or territory and been registered with that regulatory body or another regulatory body for nursing in a province or territory in Canada in an equivalent class prior to January 1, 2005,
iv. must have graduated from a nursing program outside Canada that the Registration Committee determines was, at the time the applicant graduated, equivalent to a nursing program in Ontario that is currently approved in accordance with subparagraph i, or
v. must have graduated from a nursing program other than one referred to in subparagraph i, ii, iii or iv and must also satisfy the Registration Committee that he or she has obtained additional nursing education or experience that, together with the education provided by the nursing program from which he or she graduated, is equivalent to the education provided by a nursing program in Ontario that is currently approved in accordance with subparagraph i.

RPNs applicants to the general class :
i. must have received a diploma in practical nursing granted by a College of Applied Arts and Technology in Ontario whose program was, at the time the applicant graduated, approved by a body or bodies designated by the Council or by the Council itself,
ii. must have received a diploma in practical nursing granted in another province or territory in Canada that, at the time the applicant graduated, was, in the opinion of the Registration Committee, equivalent to the diploma described in subparagraph i,
iii. must have graduated prior to January 1, 2005 from a practical nursing program in another province or territory in Canada that was, at the time the applicant graduated, accepted by the regulatory body for practical nursing in that province or territory and been registered with that regulatory body or another regulatory body for practical nursing in a province or territory in Canada in an equivalent class prior to January 1, 2005,
iv. must have graduated from a practical nursing program outside Canada that the Registration Committee determines was, at the time the applicant graduated, equivalent to a practical nursing program in Ontario that is currently approved in accordance with subparagraph i,
v. must have graduated from a practical nursing program other than one referred to in subparagraph i, ii, iii or iv and must also satisfy the Registration Committee that he or she has obtained additional practical nursing education or experience that, together with the education provided by the practical nursing program from which he or she graduated, is equivalent to the education provided by a practical nursing program in Ontario that is currently approved in accordance with subparagraph i, or
vi. must have graduated from one of the nursing programs referred to in paragraph 1 of subsection (1) or paragraph 1 of subsection (1.1) and must also satisfy the Registration Committee that he or she has obtained additional practical nursing education or experience that, together with the education provided by the nursing program from which he or she graduated, is equivalent to the preparation provided by a practical nursing program in Ontario that is currently approved in accordance with subparagraph i.
b) Describe the methodology used to determine whether a program completed outside of Canada satisfies the requirements for registration.- If the Applicant’s educational program has not previously been assessed by the College and it was completed outside Canada, the College refers the documents to World Education Services (WES).

- WES evaluates the education level equivalency. The College absorbs the cost of the WES assessment and then carries out a paper-based content and competency assessment to determine if the nursing program is comparable to an Ontario nursing program.

- If the assessment finds that the education requirement is met, the Applicant is eligible to apply for the exam. Failure to meet the educational requirement based on the education program alone means the Applicant is requested to provide any additional education and/or work experience information to the College.

- If an Applicant has additional education and/or work experience, the file is referred to a work group of expert nurses to review and make a recommendation on education equivalency.

- The file and the work group’s recommendation are sent to the Registration Committee for a decision. The decision is to either:
• register the Applicant, or
• register the Applicant with terms, limitations or conditions imposed on the certificate, or
• refuse the Applicant, or
• refer the application back to staff for further information.

- Alternatively, if the Applicant has no other education or experience, the file is referred to the Registration Committee for a decision.

- All applications referred to the Registration Committee are reviewed for two factors: to see if the Applicant’s basic program meets the education requirement, and if it does not, then to see if their nursing experience and additional education along with the basic nursing program are equivalent to the education requirement.
c) Explain how work experience in the profession is assessed.- For Applicant's work experience to be accepted, the College requires verification of registration directly from the jurisdiction (province, territory or country) where Applicant worked as a nurse, or are eligible to be registered, licensed or certified.

- The College requires verification of registration from any other jurisdictions where applicant has worked, or still are, registered, licensed or certified as nurses.

- Graduation from an approved Registered Nurse or Registered Practical Nurse program within the last five years, is considered as evidence of recent safe practice.

- If the Applicant has worked as a nurse outside Ontario, the College requires evidence of recent safe nursing practice, such as a reference from the most recent employer verifying that the Applicant worked a minimum of 1,125 hours in nursing within the previous five years.

- Applicants are required to request their employer(s) to complete the Verification of Employment and Reference (B-4) form that is included in the application package. This form must be received directly by the College from the employer.

- The 1,125 hours of nursing practice does not have to be Canadian experience. In addition, this requirement is flexible, and Applicants with less than 1,125 hours of nursing experience will be assessed individually by the Registration Committee.

- If the College receives verification that an Applicant does not meet the recent safe practice requirement, the file is referred to the Registration Committee for a decision.

- If the Applicant’s demonstrated five years of safe nursing practice ends before he or she passes the registration examination, the Applicant may still attempt the exam but is required to complete additional education before becoming eligible to register.

- An Applicant who has not worked in nursing in the past five years and completed a nursing program more than five years ago is required to complete additional education. The length of the study required is based on the number of years since the applicant last practised nursing.

- The requirements for registration in the Extended Class is that the Applicant will have to show evidence of a minimum of two years of safe experience, of which one year has to be in advanced practice.
d) Describe how your organization ensures that information used in the assessment about educational systems and credentials of applicants from outside Canada is current and accurate.- The use of a credible third party credential evaluation agency, like WES, ensures the currency of documents used for assessment.

- The College provides WES with documents that were received by the College directly from the official source. For example, the College requests that, if possible, transcripts be provided directly from the official source to the College.

- The College then supplies these original documents to WES for their evaluation and consideration. WES validates that these documents are from the official source, and when unsatisfied about the authenticity of a document, WES clarifies this with the official source of the documents.

- The College, upon receiving the documentation, ensures that the documents contain the appropriate seals and/or signatures based on a repository of documents on site.

- College staff have received training and education on assessing the authenticity of documentation which assists in the identification of accurate and current documentation.

- Information provided by the Applicant can trigger processes that require us to conduct research and consult other jurisdictions in ensuring assessments are accurate.
e) Describe how previous assessment decisions are used to assist in maintaining consistency when assessing credentials of applicants from the same jurisdictions or institutions.- The database used at the College is a repository of information that has been collected over a number of the years. The database retains the results of prior credential assessments of educational programs that were evaluated by WES and further reviewed by College staff.

- Results of the evaluations completed by WES, are stored in the database for use in assessing Applicants that have applied with a program that has previously been assessed.

- If a program is reviewed and approved, the information is captured and the next Applicant from the same program is assessed based on the previous assessment.

- Documents of previous assessments are also available to staff for reference. Comparison often helps even in checking authenticity of documentation submitted by Applicants.
f ) Explain how the status of an institution in its home country affects recognition of the credentials of applicants by your organization.- The status of an institution in the home country is not significant. The content of the programs are evaluated to ensure the competencies expected in an equivalent Ontario nursing program are present.
g) Describe how your organization accommodates applicants with special needs, such as visual impairment.- All Applicants are provided with an opportunity to request special accommodations for an exam.

- The documentation that the College requests once a special accommodation request has been received is dependent upon the request and may include, for example, a diagnosis from a specialist for those requesting special accommodations due to a medical condition or impairment, or a psycho-educational assessment for those who are requesting special accommodation arising from a learning disability.

- The specialist's information will indicate a diagnosis and a recommendation regarding what special accommodations are necessary to assist the Applicant and how the accommodation might compensate for the disadvantage(s) that may be faced by the Applicant if they did not receive special accommodation.

As mentioned earlier the types of accommodation provided are:
a) Separate Room
b) Time and a Half extra time
c) Double time extra time
d) Reader
e) Recorder
f) Software assisted reader
g) Calculator
h) State the average length of time required to complete the entire registration process, from when the process is initiated to when a registration decision is issued.- As stated earlier, average length of time has not been calculated to date as there is a significant amount of time in obtaining documentation and for an applicant to meet a requirement (i.e. pass the exam) that is not within the control of the College but rather in the control of third parties (education facilities, employers, translaters, and other registering bodies) and the applicant.
i. State whether the average time differs for internationally trained individuals.- Yes, the time is significantly different.
ii. If the average time differs for internationally trained individuals, state whether it is greater or less than the average for all applicants, and the reasons for the difference.- International Applicants take longer to register than Ontario applicants.

- International Applicants require
1) verification of their education program from the school which takes time to receive and validate documentation as it is up to the school to provide, while Ontario Applicants programs are approved prior to students being enrolled in them;
2) verification of their practice from current and past employer(s) takes time to receive and validate documentation as it is up to the employer to provide, while Ontario Applicants practice is usually contained in their approved program;
3) fluency in English or French may require passing a test, while Ontario Applicants meet this by graduating from an approved Ontario program;
4) International applicants exam pass rates are usually lower than Ontario applicants particularly do to communication issues;
5) general retrieval of documentation takes time to communicate, clarify, receive and validate; and
6) translation may be required of documents received from third parties.
i) If your organization conducts credential assessments:
i. Explain how you determine the level (e.g., baccalaureate, master’s, Ph.D.) of the credential presented for assessment.Vist the WES website for this information. (www.wes.org)
ii. Describe the criteria that are applied to determine equivalency.- Apart from the level of the credential, the College analyzes the transcripts to determine if the competency elements are present.

- With the assistance of educators (University and College partners), the College has been able to summarize the competencies in programs offered in Ontario into elements.

- The presence of these elements in the programs completed by Internationally Educated Nurse Applicants is used for meeting the competencies and for determining the equivalency to a current program in Ontario.

- If the program does not meet the requirement the applicant is allowed to demonstrate that the basic program and any additional nursing education and/or practice is equivalent to a current Ontario program for registration by completing a Baccalaureate Equivalency Table. Instructions are provided to assist the applicant.
iii. Explain how work experience is taken into account.- Work experience is not considered in credential assessment.
j) If your organization conducts competency assessments:
i. Describe the methodology used to evaluate competency.- For Applicants whose program was previously assessed by WES as equivalent to an approved Ontario Baccalaureate in Nursing program for Registered Nurse Applicants or an approved Ontario diploma in Nursing program for Registered Practical Nurse Applicants, an assessment by the College is completed to determine whether their program includes the required competencies.

- Apart from the level of the credential, the College analyzes the Applicant's transcripts to determine if the competency elements are present.

- For Applicants whose program is not deemed equivalent to an approved Ontario baccalaureate in nursing for Registered Nurse Applicants or an approved diploma in nursing for Registered Practical Nurse applicants, their program is also reviewed to determine which elements may be absent from their transcripts and other supporting documents.

- The Registered Nurse Applicants who have completed additional education or work experience in nursing are asked to complete and submit an Baccalaureate Equivalency Table ("BET").

- Applicants are asked to complete the table in order to provide evidence of the nursing competencies in their work experience and/or additional education.

- The Baccalaureate Equivalency Work Group, described above, reviews the Applicant's original nursing education, additional education and work experience and the BET.

- The Baccalaureate Equivalency Work Group's opinions are then provided to the Registration Committee who completes a similar review of the Applicant's file.
ii. Explain how the methodology used to evaluate competency is validated, and how often it is validated.- The Entry to Practice Department at the College remains up to date and acts as a resource in constructing and developing competencies in the nursing profession.

- The College has formed strong relationships with nursing educators and institutions of higher education also involved in the development of nursing competencies and nursing programs.

- The elements that are engaged to determine program equivalence for both national and international Applicants are frequently reviewed by the College's Entry to Practice Department to ensure currency and validity.

- When competencies change or are amended, the Entry to Practice Department reviews the elements to ensure that they remain reflective of the current nursing competencies.
iii. Explain how work experience is used in the assessment of competency.- The Applicant is offered an opportunity to submit any documents they believe may be helpful to the Registration Committee in assessing their applications.

- Applicants often submit job descriptions and employer references to the Registration Committee. The Applicant may also choose to draw on their work experience in completing their BET table.

- The Registration Committee reviews all of these documents when completing an assessment of competency.
k) If your organization conducts prior learning assessments:
i. Describe the methodology used to evaluate prior learning.- The Applicant is encouraged to submit additional documents they would like reviewed by the Registration Committee.

- Some common examples of documents submitted by Applicants include job descriptions, employer references, course descriptions and a BET table.

- These items are first reviewed by the Baccalaureate Equivalent Work Group for Registered Nurse Applicants. The work group's opinion regarding competency equivalency is then provided to the Registration Committee.

- The Registration Committee reviews all applicant documentation to decide whether the Applicant has evidence of the required competencies and then determines equivalency.
ii. Explain how the methodology used to evaluate prior learning is validated, and how often it is validated.-The Baccalaureate Equivalent Work Group applies their nursing knowledge, skill, and judgement in assessing applications.

- The work group is comprised of nursing experts that are active in the community of nursing education. The work group provides a report on the competencies that are present and/or absent from the applicant's information.

- The elements that are used to determine program equivalencies are reviewed and updated by the Entry to Practice Department that is involved in the development of nursing competencies.
iii. Explain how work experience is used in the assessment of prior learning.- The Applicant's job descriptions and employer references are reviewed by both the Baccalaureate Equivalent Work Group and the Registration Committee for evidence of the competencies required for either Registered Nurses.

- The Applicant's job descriptions and employer references are reviewed by the Registration Committee for evidence of the competencies required for either Registered Practical Nurses.

- The applicant is asked to draw on their work experience in completing their BET table. The Registration Committee reviews all of these documents when completing an assessment of competency.
l) If your organization administers examinations:
i. Describe the exam format, scoring method and number of rewrites permitted.- Multiple choice format

- Pass marks are set using the modified Angoff method.

- 2 rewrites are permitted (according to regulation).
ii. Describe how the exam is tested for validity and reliability. If results are below desired levels, describe how you correct the deficiencies.- The exams are national examinations provided by a third party vendor (Canadian Nurses Association and Assessment Services Inc.

- All Canadian jurisdictions (except Quebec) participate in the blueprint development, item writing, and exam review.

- Validation and reliability testing is done by Psychometricians at the third party vendor.

- Exams are not administered if found not valid or reliable.

- An Examination Administration Committee (composed of representatives from the participating jurisdictions) reviews the item bank and sets exams pass scores using the modified Angoff method.

- Jurisdictional reviews also occur to ensure that jurisdictional issues are addressed.
iii. State how often exam questions are updated and the process for doing so.- Questions are retired based upon changes to the blueprint, which is reviewed every five years.

- Questions are retired based on frequency of use and validity testing.

- Questions are added to the item bank each year following appropriate testing.
Third-Party Organizations (9 / 13)
a) List any third-party organizations (such as language testers, credential assessors or examiners) relied upon by your organization to make assessment decisions.- Language Testers: TOEFL, TOEIC, IELTS, CELBAN, MELAB

- Canadian Nurses Association (CNA) - Registered Nurse Examination

- Assessment Strategies Incorporated (ASI) - Registered Practical Nurse Examination

- World Education Services (WES) - Evlauation of credentials re: Baccalaureate equivalency.
b) Explain what measures your organization takes to ensure that any third-party organization that it relies upon to make an assessment:
i. provides information about assessment practices to applicants- Information is available in the Application Guides and the Website.

- The List of language testers are available and the score required to meet the requirement are on the website and in guides that accompany an application package.

- The Applicant is provided with minimum pass scores for the different tests. Most of these tests are internationally available and Applicants can write these tests in the country of origin.

- WES: Applicants who require there documents to be evaluated are informed if the results if it was determined that the program they completed is not equivalent to a Baccalaureate degree. If it was determined as equivalent the Applicant's program is further assessed to met the competencies in an Ontario program. This role of WES is as advisory input the College considers in evaluating a credential.

- Examination information is available on our website, facts sheets and links to CNA and ASI websites are also provided.
ii. utilizes current and accurate information about qualifications from outside CanadaN.A.
iii. provides timely decisions, responses and reasons to applicants- Exam results are provided to the College based on a preset calendar.

- Exam results are distributed to Applicants by the College.

- Language testing is between the Applicant and the testing facility. Results are sent by the Applicant to the College.
iv. provides training to individuals assessing qualifications- Language testing organizations are worldwide and not within our perview.

- Training of question writers ocurrs at each session by ASI and CNA.
v. provides access to records related to the assessment to applicantsN.A.
vi. accommodates applicants with special needs, such as visual impairmentN.A.
c) If your organization relies on a third party to conduct credential assessments:
i. Explain how the third party determines the level (e.g., baccalaureate, master’s, Ph.D.) of the credential presented for assessment.- Please refer to WES. (www.wes.org)
ii. Describe the criteria that are applied to determine equivalency.- Please refer to WES. (www.wes.org)
iii. Explain how work experience is taken into account.N.A.
d) If your organization relies on a third party to conduct competency assessments:
i. Describe the methodology used to evaluate competency.N.A.
ii. Explain how the methodology used to evaluate competency is validated, and how often it is validated.N.A.
iii. Explain how work experience is used in the assessment of competency.N.A.
e) If your organization relies on a third party to conduct prior learning assessments:
i. Describe the methodology used to evaluate prior learning.N.A.
ii. Explain how the methodology used to evaluate prior learning is validated, and how often it is validated.N.A.
iii. Explain how work experience is used in the assessment of prior learning.N.A.
f ) If your organization relies on a third party to administer examinations:
i. Describe the exam format, scoring method and number of rewrites permitted.- Please see Section 8 L(i); the College administers the exam but does not create or score the exam.

- The exams are multiple choice.

- The modified Angoff method is used to score.

- Base on the College's regulation applicants are allowed 2 rewrites.
ii. Describe how the exam is tested for validity and reliability. If results are below desired levels, describe how you correct the deficiencies.- Please see Section 8 L(ii).
iii. State how often exam questions are updated and the process for doing so.- Please see Section 8 L(iii).
Training (10 / 13)
a) Describe the training that your organization provides to:
i. individuals who assess qualifications- New staff are oriented to the processes of evaluating credentials and authenticating documents.

- New staff are trained on the applicable Registration regulations.

- Information that is unique to an application is provided to all assessment staff through weekly meetings.

- Professional development occurs through the attendance at courses offered by WES and webnars held by other evaluating organizations.

- Registration Committee decisions are reviewed at debriefing meetings held following each Registration Committee meeting.

- Changes to competencies are provided to the assessment group by the Entry to Practice Department.
ii. individuals who make registration decisions- The Executive Director is hired with the requisite knowledge concerning regulation and is committed to ongoing professional development and has access to legal counsel when needed.
iii. individuals who make internal review or appeal decisions- The Registration Committee members are provided a thorough orientation to their mandate which includes familiarization with all relevant legislation, regulations, policies, and procedures by legal counsel and staff each year.

- Ongoing briefing notes are provided to the Registration Committee in order to keep them updated with new developments in testing and evaluations that support possible changes to policies and procedures.

- Appeals are to an external Board, HPARB (www.hparb.on.ca).
Agreements on the Recognition of Qualifications (11 / 13)
Examples of agreements on the recognition of professional qualifications include mutual recognition, reciprocity and labour mobility agreements. Such agreements may be national or international, between regulatory bodies, associations or jurisdictions.
a) List any agreements on the recognition of qualifications that were in place during the reporting period.- Registered Nurse - Mutual Recognition Agreement (MRA) with other provinces and territories that allows for mutual recognition of applicants registered in another province or territory of Canada.

- The agreement recognizes the Quebec exam as equivalent to the national exam for Registered Nurses.
b) Explain the impact of these agreements on the registration process or on applicants for registration.- Facilitates mobility of Applicants from other Canadian jurisdictions. Applicants who fall under the MRA agreement are not required to provide confirmation of program information.

- The verification received from a Canadian jurisdiction confirms that an approved education program or equivalent was completed, the applicant meets the examination requirement, and if there are any or no conduct issues.
Data Collection (12 / 13)
Languages in which application information materials are available a) Indicate the languages in which application information materials are available.
Language Yes/No
English Yes
French No
Other (please specify)
Paid staff employed by your organization b) State the number of paid staff employed by your organization in the following categories.
Category Staff
Total staff employed by the regulatory body 178
Staff involved in appeals process 5
Staff involved in registration process 29
Enter “n/a” when the process does not exist in your registration practices. Enter "0" when the process exists in your registration practices but the correct value is zero.
Countries where internationally educated applicants were initially trained c) List the countries where your internationally educated applicants* were initially trained in the profession, and the number of applicants trained in each country.
Applicants Country of training (Canada excluded) Number of applicants**
Largest number Philppines 1180
Second-largest number India 345
Third-largest number Nigeria 130
Fourth-largest number United Kingdom 93
Fifth-largest number China 92
* Persons who have applied to start the process for entry to the profession.
**Enter “n/a” when the process does not exist in your registration practices. Enter "0" when the process exists in your registration practices but the correct value is zero.
Jurisdiction where members were initially trained d) Indicate where your members* were initially trained in the profession (use only numbers, do not enter commas or decimals).
  Jurisdiction where members were initially trained in the profession (before they were granted use of the protected title or professional designation in Ontario)
Jan. 1 to Dec. 31 Ontario Other Canadian Provinces USA Other International Unknown Total
Total Members 129531 4134 1310 13622 687
149284
Non-practising members 476 n/a 8 117 3
604

* Persons who are currently able to use the protected title or professional designation of your profession.
Enter “n/a” when the process does not exist in your registration practices. Enter "0" when the process exists in your registration practices but the correct value is zero.

Additional comments:

Applications your organization processed in the past year e) State the number of applications your organization processed in the past year (use only numbers, do not enter commas or decimals).
  Jurisdiction where members were initially trained in the profession (before they were granted use of the protected title or professional designation in Ontario)
Jan. 1 to Dec. 31 Ontario Other Canadian Provinces USA Other International Unknown Total
New applications received 9301 706 251 2896 0
13154
Applicants actively pursuing licensing (applicants who had some contact with your organization in the reporting year) 5739 1508 435 7091 0
14773
Inactive applicants (applicants who had no contact with your organization in the reporting year) 888 1191 287 5699 0
8065
Applicants who met all requirements and were authorized to become members but did not become members 561 227 43 180 0
1011
Applicants who became members 8455 551 128 674 0
9808
Applicants who were authorized to receive an alternative class of license* but were not issued a license n/a n/a n/a n/a n/a
0
Applicants who were issued an alternative class of license* 3271 86 26 99 0
3482
Enter “n/a” when the process does not exist in your registration practices. Enter "0" when the process exists in your registration practices but the correct value is zero.

Additional comments:

* An alternative class of license enables its holder to practise with limitations, but additional registration requirements must be met in order for the member to be fully licensed. Please list and describe below the alternative classes of license that your organization grants, such as student, intern, associate, provisional or temporary.
  Class of License Description
a) Temporary Class Applicants who meet all the requirements for entry to the General Class including recent safe practice within the last year but have not written the examination are entitled to register in the Temporary Class.
b) Transitional Class Registered members from other Canadian juridictions who do not meet the Ontario program requirement for registration in the General Class are registered in the Transitional Class. Registration in this class is for a period of 2 years for Registered Practical Nurses and for 4 years for Registered Nurses to allow for upgrading.
c)
Reviews and appeals your organization processed in the past year f) State the number of reviews and appeals your organization processed in the past year (use only numbers, do not enter commas or decimals).
  Jurisdiction where members were initially trained in the profession (before they were granted use of the protected title or professional designation in Ontario)
Jan. 1 to Dec. 31 Ontario Other Canadian Provinces USA Other International Unknown Total
Applications that were subject to an internal review or that were referred to a statutory committee of your governing council, such as a Registration Committee 191 101 65 610 0
967
Applicants who initiated an appeal of a registration decision 1 1 3 9 0
14
Appeals heard 0 0 0 2 0
2
Registration decisions changed following an appeal 0 0 0 1 0
1
Enter “n/a” when the process does not exist in your registration practices. Enter "0" when the process exists in your registration practices but the correct value is zero.

Additional comments:
All appeals of Registration Committee decisions are made to the Health Professions Appeals and Review Board (HPARB).

Appeals heard include one appeal withdrawn and one sent back by HPARB to the Registration Committee.
Certification (13 / 13)
I hereby certify that:
  • - I have reviewed the information submitted in this Fair Registration Practices Report (the "Report")
  • - all information required to be provided in the Report is included; and
  • - the information contained in the Report is accurate.
Name of individual with authority to sign on behalf of the organization:Paul Reinhart
Title:Director of Corporate Services
Date:February 28, 2009