November 2020

We answer your questions about RPN scope of practice changes

The Ministry of Health is currently reviewing proposed regulations to expand the RPN scope of practice. If the government approves the changes, RPNs who have the relevant competencies will be able to initiate components of four specific controlled acts that they are currently able to provide when ordered. You can read more about the proposed changes in the October issue of The Standard.

Many of you had questions about the changes and what they would mean for your practice. Here are answers to a few of your most frequently asked questions

Why is the RPN scope expanding?

In a letter to CNO, the Minister asked CNO to change regulations to expand the RPN scope of practice. The Minister shared that expanding the RPN scope will provide patients more timely access to healthcare services, therefore reducing barriers to patient care.

Those who will be most affected by this change—namely nurses at the point of care and patients—told CNO’s Council that having competent RPNs safely initiate these controlled acts would increase access to care and remove a barrier for patients in need. You can read more about the feedback that informed the Council’s decision in the October issue of The Standard.

Will these changes affect all RPNs?

No. These changes will only impact RPNs working in the community who already perform these controlled acts (with an order) as part of their practice. They will not impact nurses who work in hospitals. This is because the Public Hospitals Act, 1990 specifies that RPNs and RNs who work in hospitals always require an order to perform a controlled act.

These changes will give RPNs the legal authority to independently decide that performing certain components of controlled acts is required and to safely perform them without an order. However, RPNs can only initiate these controlled acts if they have the competence and an environment/location that allows them to initiate the controlled acts safely. If any of these are missing, a nurse must not initiate the controlled act, even if they have the legal authority to do so.

Will CNO require RPNs to take specific courses now?

No. The competencies needed to initiate controlled acts are built on the foundational education of all nurses but are generally developed through experience in practice and continuous learning.

All nurses must continually reflect on their practice and identify if they have the competence to initiate a controlled act. If a nurse identifies that initiating a controlled act is beyond their competency but this aspect of care would benefit their patient population, they should outline an action plan to attain the needed competence.

In short, this scope expansion gives RPNs who already have the competence to perform the controlled act the legal authority to independently decide that the act is required and safely perform it without an order. If the RPN does not have the competence to perform the act, they should not do so.

Read our answers to more of your questions about the changes — including what CNO’s role is in changing regulation — on our RPN scope of practice FAQ page.

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