Evidence of practice in the NP role is a registration requirement that you cannot be exempt from. If you completed an approved NP program within the past three years, then you will satisfy the evidence of NP practice requirement.

If it has been more than three years since you completed an approved NP program, then you must demonstrate that you have practiced within the past three years in a clinical NP role that included:

• direct interaction with patient population(s) and
• the use of advanced nursing knowledge and decision-making skill in health assessment, diagnosis and therapeutics in the treatment of those patients.

If you have not practiced in this way, then you will be required to undergo an evaluation approved by CNO’s Registration Committee to determine whether you meet the practice requirement. The evaluation may conclude that you meet the NP practice requirement for registration, or it may identify the need for you to complete further training, experience, examinations or assessments to meet the requirement.

The jurisprudence exam is a registration requirement for applicants that you cannot be exempt from. The exam assesses your awareness and understanding of the legislative and regulatory framework (the laws, regulations, by-laws, practice standards and guidelines) that governs the nursing profession specifically in Ontario.

For NP applicants, the jurisprudence exam includes both questions applicable to all nurses in Ontario and questions that are unique to NP practice. While many NP applicants are already practicing nursing in Ontario as RNs in the General Class and would likely be familiar with the concepts assessed on the jurisprudence exam, they must demonstrate that they have this knowledge by successfully completing the RN(EC) Jurisprudence Examination before they can register in the Extended Class.

You cannot use the title NP, portray yourself or be employed as an NP until you are registered as an NP with CNO. If you are already registered with CNO as a registered nurse (RN),  you will function as such until you receive your registration with CNO as an NP.

It is up to the employer’s discretion to determine their hiring requirements, including whether they would like to hire an RN who has recently graduated from an NP program. Nurses are encouraged to clarify hiring policies with their potential employer and ensure the employer is fully aware that they cannot practice as an NP or hold themselves out as an NP until they complete registration with CNO.

See Legislation and Regulation: An Introduction to the Nursing Act, 1991 for more information on registration categories and classes.

Under the Registration Regulation, NPs must maintain clinical NP practice to remain registered in the Extended Class. This clinical practice must include:

• direct interaction with  patients  and
• the use of advanced nursing knowledge and decision-making skill in health assessment, diagnosis and therapeutics in the treatment of those patients.

Each year, NPs will be asked to declare whether they have practiced as described above within the previous three years. NPs who do not meet this requirement will not be eligible to remain registered in the Extended Class.

CNO recognizes there are numerous ways in which nurses provide positive contributions to patient care and the health system, and that nursing practice does not always involve direct interaction with patients. Examples include policy development, administration, research and education. CNO appropriately and safely regulates these aspects of nursing practice through the General Class.

The Extended Class exists to authorize RNs who have met specific requirements to perform certain controlled acts (such as communicating diagnoses and prescribing medication) that are directly linked to clinical practice. To protect the public, NPs are expected to demonstrate and maintain competence to practice in a clinical NP role. This has been an expectation under the Nurse Practitioner practice standard since 2011. Adding this requirement to the Registration Regulation reinforces the expectations and standards and is consistent with those of other nursing jurisdictions across Canada.

When you complete Annual Renewal each year, and at any other time upon CNO’s request, you are required to declare whether you practiced in a clinical role as an NP within the previous three years. Upon request by CNO, members must provide evidence to support their declaration.

If you have not practiced as an NP in the previous three years, but have practiced nursing during that time, then your Extended Class certificate will be revoked and replaced with a General Class certificate. If you have not practiced nursing at all in the previous three years, then you must either register in the Non-Practising Class or resign from CNO.

CNO does not specify the number of hours that NPs must practice within the three-year timeframe. The amount of practice needed to maintain NP competence in the areas of health assessment, diagnosis and therapeutics in the treatment of patients will vary for individual NPs based on their experience, knowledge and skill level. It is up to each NP to determine how much practice is required to maintain that level of competence. NPs are also required to meet continuing competence requirements related to applying the practice standards and related NP competencies.

Volunteering as an NP

Providing nursing services in a volunteer capacity meets the declaration of practice requirement for current NPs if:

• the nursing services were consistent with the definition of NP practice and included a clinical NP role
• the NP performed the volunteer practice within the last three years while registered in the Extended Class. Upon request by CNO, members must provide evidence to support their declaration.
  

To reinstate your NP certificate that you previously held, you will have to demonstrate evidence of NP practice within the previous three years. That practice must be clinical and include:

• direct interaction with patients and
• the use of advanced nursing knowledge and decision-making skill in health assessment, diagnosis and therapeutics in the treatment of those patients.

If you have been practicing as an NP in another jurisdiction, then your practice there will be assessed to determine whether it meets the requirement. You may also need to meet other reinstatement requirements, such as successful completion of the jurisprudence exam.

For more information, visit our Evidence of Practice page.