October 2020

Moving forward with RPN scope of practice expansion

At its September meeting, Council approved proposed regulations that will expand the RPN scope of practice.

The change will allow RPNs to initiate components of four specific controlled acts. This means RPNs who have the relevant competence will be able to independently decide that a procedure is required, then safely perform the procedure without an order from a prescriber.

The Minister of Health requested these regulation changes, which will amend the Nursing Act, 1991, and asked us to develop the regulations that would put patient safety first and enable RPNs to initiate four controlled acts.

Currently, RPNs with relevant competence can perform these controlled acts only if they have an order. The regulation change removes the need for an order. However, before initiating care, the nurse must consider if they have the required knowledge, skill and judgment to proceed, and if they are restricted by other legislation, such as requirements under the Public Hospitals Act, 1990.

How your feedback informs Council

When developing the regulations, we worked closely with government, nurses, educators and academics. We also reviewed entry-to-practice requirements, practice standards, professional conduct requirements and the requirements of our Quality Assurance program, to make sure nurses can practice safely and competently within the new scope.

In March 2020 the proposed regulations were circulated to nurses, including RNs, RPNs and NPs, as well as educators, employers, academics, nursing associations, unions and the public for their feedback. This consultation process lasted 60 days (as required by law) and more than 3,150 individuals and organizations provided feedback about expanding RPN scope of practice.

At the September meeting Council members carefully reviewed all the data, including comments from those in favour of, as well as opposed to, the changes. Those who will be most affected by this change (namely nurses at the point of care and patients) said that having competent RPNs safely initiate these controlled acts would increase access to care and remove a barrier for patients in need. Council, making their decision with the best interests of patients in mind, decided to submit the new regulations to the Ministry of Health for their review and approval.

What happens now?

The RPN scope of practice changes are currently with the Ministry of Health for review and approval. To stay up-to-date and hear when the changes are implemented, read updates on www.cno.org and The Standard, and follow us on Facebook, Twitter, LinkedIn and Instagram.

Currently, scope of practice changes are in development for NPs, RNs and RPNs. To read more about the proposed changes, go to our new Scope of Practice – Proposed Changes page.

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