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Scope of Practice – Proposed changes
The Ministry of Health and Long-Term Care has asked us to work on regulations to expand the scope of practice for NPs, RNs and RPNs. These changes will increase patients’ choice of and access to health care services.
To be notified about ongoing work on changes to nursing scope of practice, watch the News section of cno.org The Standard, and our social media channels, including Facebook, Twitter, LinkedIn and Instagram for more info.
Nurse Practitioners (NPs)
As of July 1, 2022, NPs will have the authority to:
- order magnetic resonance imaging tests (MRIs) and computed tomography (CTs) scans
- perform point-of-care testing
Regulation changes made to the Laboratory and Specimen Collection Centre Licensing Act grant NPs the authority to perform point-of-care testing. Regulation changes made to the Healing Arts Radiation Protection Act and the Regulated Health Professions Act, 1991 grant NPs the authority to order CTs and MRIs.
Registered Nurses (RNs)
CNO has proposed changes to permit RNs to prescribe medication and to communicate diagnoses for the purpose of prescribing medication for certain non-complex conditions.
We've submitted draft regulations to the Ministry of Health. Government approval is required for the regulation to take effect.
We will provide updates on www.cno.org when we have more information from government about these changes.
Registered Practical Nurses (RPNs)
The Ministry of Health is reviewing proposed changes under the Nursing Act, 1991 that will allow RPNs to have the authority to independently initiate the following controlled acts:
- Irrigating, probing, debriding and packing of a wound below the dermis or below a mucous membrane
- venipuncture in order to establish peripheral intravenous access and maintain patency, in certain circumstances
- putting an instrument, hand or finger beyond the individual’s labia majora for the purpose of assessing or assisting with health management activities
- putting an instrument or finger beyond an artificial opening into the client’s body for the purpose of assessing or assisting with health management activities
RPNs with relevant competence can currently perform these activities if they have an order.
Initiation is the process of independently deciding that the procedure is required, then performing that procedure without an order. While nurses may have access to perform controlled acts, they may not be able to do so in certain practice settings because of legislation or facility policies. For example, RPNs who practice in hospitals will always need an order. This is a requirement under the Public Hospitals Act. To learn more about initiation, read the Authorizing Mechanisms practice guideline.
These changes will take effect if and when government approves the regulation.
In 2017, CNO started work to expand RPN scope of practice at the Minister of Health’s request. CNO led policy work and a robust public consultation, and reviewed stakeholder feedback to create regulations for the Nursing Act, 1991 to expand the RPN’s scope of practice. We reviewed entry requirements, practice standards, enforcement requirements and our Quality Assurance Program to enable nurses to practice safely and competently within the new proposed RPN scope.
CNO’s Council (or board) approved the proposed regulation, which we submitted to government for review in September 2020.
Resources provided to CNO Council: