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Publications & Resources > The Standard > September 2005

   Last modified: Aug. 25, 2005

CNO examines regulation of ACNPs

In the public interest, the College is proceeding with its plan to regulate Acute Care Nurse Practitioners (ACNPs) in the Extended Class.

ACNPs are currently registered in the General Class and must obtain appropriate authorization (i.e., in the form of medical directives and/or delegation) to incorporate expanded controlled act activities into their practice. The Extended Class is for nurses who have the advanced education and the knowledge, skill and judgment to independently perform controlled acts—such as ordering diagnostic tests and prescribing certain drugs—that are not authorized to RNs or RPNs.

By incorporating ACNPs into the Extended Class, the authority to regulate their expanded scope of practice will be transferred from individual institutions and physicians to the College. Regulatory responsibility includes examining Extended Class entry competencies, monitoring adherence to standards and assuring continued competence. These processes are already in place for Primary Health Care Nurse Practitioners (PHCNPs) in the Extended Class. This proposed change in legislation will allow ACNPs to practise with greater autonomy on the basis of their education and competencies.

The first step in changing the regulations was CNO Council approving, in March 2005, the replacement of Extended Class core competencies with Canadian Nurse Practitioner Core Competencies (CNPCC). The College helped develop CNPCC and finalized them in 2004.

Then the College clarified the differences in CNPCC when applied to the three streams of Nurse Practitioner (NP) practice: primary health care, adult acute care and child acute care. This clarification involved consulting with external stakeholders, such as practising ACNPs and PHCNPs, and their administrators and educators.

Although most ACNPs focus on an area of practice, it’s not feasible to develop entry examinations specific to each area. The College maintains that one examination for all NPs lacks regulatory rigour (as evidenced by the Canadian Nurses Association 2004 attempt to develop one examination for all NPs). An examination must take into account such variables as the age of the clients, their health situations and the health care environments. To develop such an examination and move forward with the regulatory process, it was essential to describe the context of adult acute care and child acute care NPs.

The CNPCC describes the similarities of all NPs. The differences between primary health care, adult acute care and child acute care are described in Registered Nurses in the Extended Class: Description of Three Streams of Nurse Practitioner Practice (CNO, 2005), which will be distributed to NPs for comment. For more information, visit the new Extended Class — Present and Future section on the College’s website at www.cno.org.

 

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