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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 cno.org, The Standard, and our social media channels including Facebook, Twitter, LinkedIn and Instagram for more info.
Nurse Practitioners (NPs)
By late 2020, NPs will have the authority to:
- order magnetic resonance imaging tests (MRIs) and computed tomography (CTs) scans
- perform point-of-care testing
Laws related to NPs performing diagnostic tests are captured under three different pieces of legislation (Regulated Health Professions Act, 1991, Healing Arts Radiation Protection Act and the Laboratory and Specimen Collection Centre Licensing Act). Since CNO has the authority to only create regulations under the Nursing Act, 1991, it is the government’s responsibility to amend the laws to expand the NP scope of practice.
Registered Nurses (RNs)
For the past three years, we’ve been working to expand RNs’ scope of practice. The changes we’ve proposed will permit RNs to prescribe medication and to communicate diagnoses for the purpose of prescribing medication for certain non-complex conditions.
Registered Practical Nurses (RPNs)
At the request of the Ministry of Health, we will be submitting a proposed regulation change to the government for its review and approval that would 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, RNs and RPNs who practice in hospitals will always need an order. This is a requirement under the Public Hospitals Act, 1990. To learn more about initiation, read the Authorizing Mechanisms practice guideline.
These changes would take effect if and when government approves the regulation.
Prior to submitting to the government our proposed regulation changes, we worked closely with government, nurses, educators, academics and others 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.
Resources provided to CNO Council: