Wondering about scope? Here are some FAQs

Of all the questions you ask us about nursing practice, scope tops the list. Lately, scope of practice has been more popular than ever, since the Ontario government is reviewing proposed changes to expand the scope of practice for RPNs.

Let’s break down some of your most frequently asked questions about scope of practice.

What is “nursing scope of practice”?

Scope of practice refers to your authority as a nurse to perform certain procedures, actions and processes. This authority comes from law, namely the Nursing Act, 1991 and the Regulated Health Professions Act, 1991. These laws give nurses the legal authority needed to perform procedures and activities, including controlled acts.

Think of this legal authority as being overarching for all nurses. However, it’s important to note that your scope of practice is only one part of what determines your individual practice. Your individual practice is defined by legislation, plus employer policies and practice setting, as well as your individual competence.

So... how do I know if I can do something?

CNO does not maintain a list of activities or procedures nurses can perform, because determining if you can perform a procedure or activity is something only you can decide.

To make this decision, consider the following:

Legislation 

Depending on your practice setting, certain laws may further define your authority to perform certain procedures of activities. For example, the Public Hospitals Act governs nurses working in hospitals and the Fixing Long-Term Care Act, 2021 governs nurses working in long-term care facilities.       

If you are unsure which laws affect your practice, talk to your employer, consult with other members of your health care team or contact Practice Support.

Employer and practice setting 

Employers — not CNO — are responsible for determining the roles and responsibilities of their employees. This includes determining whether nurses can perform certain activities and procedures in the practice setting.

We encourage you to maintain an ongoing dialogue with your employer and the health care team about the nursing procedures and activities your practice setting supports, and the organizational policies that impact your practice. In cases when policies are needed or require revising, we encourage you to assist with developing them.

Individual competence 

Your education, training and knowledge, skill and judgment are an important part of what determines your nursing practice. Nursing is a self-reflective profession — just because you have the authority to do something, doesn’t mean you should, or that it’s in the best interest of your patient. You have a responsibility to your patients to consider whether you should perform an activity or procedure and to manage any adverse outcomes.

When thinking about your own nursing practice, scope is just the beginning.