January 2020

Nurses can now initiate psychotherapy without an order

A recently approved initiation regulation will enable Ontario nurses who work in community settings to continue to provide the controlled act of psychotherapy without an order. The initiation regulation came into effect on January 1, 2020. When the controlled act of psychotherapy was proclaimed two years ago, an exemption period was created allowing nurses to practice the controlled act without an order. The exemption period ended on December 31, 2019.

RNs and RPNs can choose to use the title psychotherapist, provided they make it clear they are registered with CNO. For example, Jane Doe, RN, Psychotherapist. You also may wish to register with the College of Registered Psychotherapists of Ontario, but if you choose to do so, CNO must be notified of such registration.

What is the controlled act component of psychotherapy?

Not all psychotherapy falls under the controlled act. If all five of the following criteria are met, it is the controlled act:

  1. You are treating a client

  2. You are applying a psychotherapy technique

  3. You have a therapeutic relationship with the client

  4. The client has a serious disorder of thought, cognition, mood, emotional regulation, perception or memory

  5. This disorder may seriously impair the client’s judgment, insight, behaviour, communication or social functioning

As with any procedure, nurses continue to be accountable for having the knowledge, skill and judgement to perform this controlled act safely. 

Even with this new regulation in place, some nurses may still need an order due to workplace policies or requirements under the Public Hospitals Act. Delegation of the controlled act of psychotherapy by NPs, RNs and RPNs is also prohibited.

To learn more about the component of psychotherapy practice that is the controlled act, read our psychotherapy FAQs. If you have questions about whether or not you require an order, speak to your employer or contact Ask Practice

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