Changes to NP practice
Recently, three significant changes to NP scope of practice came into effect. First, NPs can now order ultrasounds and X-rays without restrictions.
They can also prescribe diacetylmorphine (heroin) and methadone. Lastly, NPs have a new reporting requirement. The College is providing regulatory oversight for these changes
to protect the public’s right to safe nursing care.
Ordering ultrasounds and X-rays
As of April 1, 2018, NPs have the authority to order ultrasounds and X-rays without restrictions. This change does not include computerized
tomography (CT) scans.
Previously, NPs could only order ultrasounds and X-rays based on lists under the Regulated Health Professions Act, 1991, and
the Healing Arts Radiation Protection Act, 1990, respectively. The new authority eliminates these lists.
NPs are expected to have the knowledge, skill and judgment to order appropriate tests, and to communicate clinically significant results and their
implications to clients.
For more information about these changes, visit: www.cno.org/nps-ultrasound-xray.
Prescribing diacetylmorphine and methadone
As of May 19, 2018, NPs are authorized to prescribe diacetylmorphine (heroin) and methadone. This new authorization results from changes under
the Controlled Drugs and Substances Act.
Previously, NPs were only authorized to prescribe or administer methadone if they had an exemption under section 56 of the Act. Now that the
government has changed the Act, NPs can prescribe and administer methadone without an exemption. Also, diacetylmorphine is included on the list of controlled substances that
NPs can prescribe.
These changes are part of government’s response to the national opioid crisis. The liberal use of opioids for treating chronic non-cancer pain
has contributed to opioid addiction in North America. The government is making efforts to increase health care access for Canadians who need treatment for substance use
Nurses can learn more about the risks associated with these controlled substances, as well as their accountabilities when prescribing medication
(including diacetylmorphine and methadone) at: www.cno.org/np and in our FAQs.
NPs must now report medically unfit drivers
As a result of recent changes to the Highway Traffic Act, 1990, NPs have a new reporting requirement. NPs are now required to report to
the Ministry of Transportation specific high-risk medical conditions, functional impairments and visual impairments in clients 16 years of age or older.
A list of the conditions that NPs must report can be found in Ontario Regulation 340/94, section 14.1 (3)
. Additionally, NPs can also report clients if they have or may have a condition that, in the NP’s opinion, makes it dangerous for them to drive.
NPs can submit a report and learn more about this new reporting requirement at the Ontario Ministry of Transportation website.