Nursing Education Program Approval
Nursing Education Program Approval (program approval) is the College of Nurses of Ontario’s (CNO’s) new evaluation and monitoring process for approving all entry-level nursing education programs (Practical Nursing, Baccalaureate Nursing and Nurse Practitioner) in Ontario. This process is one way CNO meets its mandate of protecting the public.
Program approval ensures graduates are prepared to practise nursing safely, competently and ethically for the nursing category and/or class for which they want to register.
CNO’s registration regulation requires that all applicants have graduated from a program approved by CNO’s Council. Making sure this regulatory accountability is consistently and effectively applied to all nursing education programs is fundamental to protecting the public.
The new program approval process will be applied to all nursing education programs starting with the Nurse Practitioner programs in December 2018, followed by the Baccalaureate Nursing (Registered Nurse) in 2019 and Practical Nursing programs in 2020.
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We have completed the development of the new Nursing Education Program Approval process. (We are still developing the last two outcome indicators that will be implemented into the process in 2020.)
Development started in 2014, and the final step was refining the process based on feedback and data from the pilot in late 2017/early 2018. The pilot included six schools of nursing that spanned the various classes and categories of nursing education in Ontario.
The following are key findings from the pilot that informed the final process:
What worked well?
- the process achieves our principles for being regulatory-focused, objective, evidence-based and transparent
- the tools are a valid and effective way to collect data and assess the program requirements
- the forms and technology portal are easy to use
- the scorecard is a reliable measure of a program’s performance on the indicators
What can be improved?
- streamline the process so it’s sustainable
- clarify the evidence and documentation requirements and remove redundancies
- change the interview process as it is redundant to the documentation submitted by schools
- enhance the curriculum mapping training and instructions to improve the process
Changes based on the pilot include:
- reducing the number of indicators
- streamlining evidence requirements
- scheduling school interviews only as required
We are still developing and validating the last two outcome indicators:
- Recent graduates’ ratings of their preparation to practice safely, competently and ethically
- Preceptor ratings of student’s readiness to practice
These indicators will be implemented into the process in 2020.
Schools will receive the final program approval documents in September 2018, including our new policy and more details on the indicators and evidence requirements. We will reach out to schools in early September to provide more information and to arrange teleconference calls.
The objectives of program approval are to:
fulfill CNO’s legislative duty to approve entry level-nursing education programs
promote the safe practice of nursing through a standardized nursing education approval process for all categories and classes of nursing education
grant jurisdictional recognition to nursing education programs
provide stakeholders with a transparent account of program approval
support continuous evaluation and improvement of nursing education programs
In 2014, CNO’s Council approved the Program Approval Framework, a new approach to evaluating all nursing education programs in Ontario. The same approval standards and process will be applied to Baccalaureate Nursing (RN) programs, Practical Nursing (PN) programs and Nurse Practitioner (NP) programs.
The new approval process will involve a comprehensive review of nursing education programs every seven years. (This term may vary depending on the results from the annual monitoring review.) Additionally, programs will be monitored each year based on a subset of measures, for example, nursing registration exam results. Programs must meet or exceed the approval requirements to be approved.
We list the approval status of all Ontario nursing education programs on our website. This information is updated annually.
CNO’s Council approved the Program Approval Framework in 2014. CNO will evaluate all nursing education programs in Ontario with this new approach.
Each nursing education program is evaluated against three approval standards:
Each of the three standards has indicators and evidence requirements used to evaluate a program’s performance of that standard.
CNO uses the following three processes to approve programs:
- Comprehensive review process
- Annual monitoring process
- CNO Council approval
At the centre of the framework is the program’s effectiveness in preparing graduates to practise in a safe, competent and ethical manner.
CNO engaged evaluation and measurement consultants to provide expert advice and guidance throughout the development of the program approval process. Their work focused on validating the indicators and the scoring methodology, and evaluating the new program approval process and tools through the pilot.
We also used the following five principles to guide the development process, and we will continue to use them to guide our program approval process and decisions.
Regulatory-focused: The program approval standards and process are centred on CNO’s public-protection mandate.
Transparency: The program approval standards, policies and decisions are available to schools, the public and other stakeholders.
Objective: The evaluation and decision-making is based on standardized criteria.
Evidence-informed: The program approval framework and process is based on evidence and best practice.
Sustainability: The program approval process can be maintained by all stakeholders.
Program approval indicators
Each of the three standards has indicators used to evaluate a program’s performance for that standard. A number of methods were used to engage stakeholders and validate the process when developing the indicators (Figure 1).
Each indicator was also assessed for its ability to address the objectives of program approval, CNO’s public protection mandate and whether the indicators were specific, measurable, appropriate, relevant and time-bound.
We have involved the nursing education community in the development of the program approval process through various forums, including:
teleconference presentations to the academic community
the Nurse Educator Subject Matter Expert Working Group, which was established in September 2016 and has provided feedback during the development process
the Academic Reference Group, which was established in September 2016 and provides an opportunity for discussion and collaboration
focus groups, consultation sessions and surveys
piloting the new program approval process at six schools of nursing from late 2017 to early 2018.
HIGHLIGHTS: DECEMBER 2016 TO JUNE 2018
We hired evaluation consultants to provide expert advice and guidance on the development of the program approval process.
We asked for volunteers to participate in focus groups to help validate the indicators and finalize the assessment tools and process; over 200 people responded. We selected 40 participants based on the criteria established by the evaluation consultants to make sure we had representatives from all parts of the nursing community. Focus group participants included educators from Practical Nursing, Baccalaureate Nursing and Nurse Practitioner programs, nursing leaders, front-line nurses from across the health care sector, clinical faculty, preceptors and students.
We held six focus groups with the volunteers. With their help the indicators were finalized and work commenced to develop the assessment tools and scoring guide.
We sent a survey to all nursing education programs. The purpose of the survey was to collect information that will help in the planning of program approval.
Volunteers, including nurse educators and representatives from five nurse regulatory colleges from other provinces, participated in consultation sessions. The results helped inform the development of the final program approval assessment tools and scoring criteria.
We asked for schools to volunteer in a pilot of the new program approval process and assessment tools. Twelve schools volunteered to participate. Schools were selected to represent the range of nursing categories and classes, types of programs and delivery models and different locations in Ontario. Based on this criteria, the six schools were selected for the pilot (they are listed in the Program Approval Pilot section).
We had an orientation session for the six pilot schools where we explained the pilot and the new program approval process and requirements.
July - August 2017
We finalized and translated the new Preliminary Nursing Education Program Approval guidebook to share with the schools in the fall of 2017.
The College selected the Canadian Association of Schools of Nursing (CASN) as the vendor to administer the pilot on behalf of CNO.
Teleconference calls were held with schools to review the new program approval process. The Preliminary Program Approval Guide was distributed to all schools.
September – December 2017
The pilot program approval process was conducted. Schools submitted their evidence to support the requirements and participated in interviews conducted by the assessors. We worked with evaluation consultants during the pilot to assess the validity of the tools and to gather feedback from stakeholders.
The pilot report was completed and informed changes to the program approval process. The six pilot schools were approved at the March Council meeting.
A consultation session was held with the Subject Matter Expert Working Group and representatives from each of the pilot schools. We reviewed the key findings from the pilot and sought their input into the recommended changes to the program approval process.
May – Sept 2018
We are finalizing and translated the final Nursing Education Program Approval policy, guidebook and tools to share with the schools in September 2018.
CNO conducted a pilot of the new program approval process between September 2017 and January 2018. Twelve schools volunteered to participate. Schools were selected to represent the range of nursing categories and classes, types of programs and delivery models and different locations in Ontario. Based on this criteria, the following six schools were selected for the pilot:
- George Brown College (Practical Nurse)
- Georgian College (Practical Nurse)
- Trent University (Registered Nurse)
- University of New Brunswick at Humber (Registered Nurse)
- University of Windsor (Nurse Practitioner)
- Queen’s University (Nurse Practitioner)
The purpose of the pilot was to:
- validate the new program approval assessment tools and process
- obtain feedback from the schools and the program assessors, including input on their experience, their ability to obtain and assess the required evidence and the time and resource requirements.
Our teleconferences share information on the progress and status of the program approval framework project. Download the slides from each teleconference:
When will the new process be used to approve nursing programs?
We will start approving Nurse Practitioner (NP) programs using the new approval process in December 2018. Baccalaureate Nursing (RN) programs will follow in 2019, and Practical Nurse (PN) programs in 2020.
How often are nursing programs approved?
We approve nursing programs on an annual basis using a monitoring review, with a comprehensive review conducted every seven years.
Program Approval Processes
Who is responsible for administering the Program Approval process?
CNO is responsible for administering all aspects of the Program Approval process. CNO assessors will assess each program based on the standardized indicators and criteria. They will prepare the program assessment scorecards and reports, which are reviewed by the CNO Program Approval Committee. The committee makes approval recommendations to Council.
What is the difference between the comprehensive review process and the monitoring review process?
The comprehensive review is a rigorous evaluation of a program based on all three standards in the framework and the associated nine indicators. The comprehensive review is conducted every seven years. The monitoring review involves an annual evaluation of the outcome indicators. Council will use the two processes to determine a program’s approval status.
Will a school that offers both an NP and BScN credential need to complete the approval process for each program?
Yes, a school that offers more than one entry-level nursing education program will be required to undergo an approval evaluation for each category and/or class of nursing.
Will a school that offers different program streams to prepare students for registration need to complete a separate review for each program? For example, a 4-year direct-entry program and a 2-year compressed program?
Yes, a school that offers more than one entry-level nursing education program stream will be required to undergo an approval evaluation for each program.
How are programs approved for university-college collaborative programs?
For Baccalaureate Nursing programs offered through a collaboration between a university and college(s), the approval is given to the university which confers the nursing credential. However, the university and college(s) would work collaboratively to prepare the approval submission for the program.
How are programs that are offered at multiple campuses approved?
Programs with multiple campuses that offer the same program will receive one approval decision. However, the outcome indicators for each campus are monitored annually.
Will bridging programs be approved by the program approval process?
Yes, bridging programs will be approved by this process. A bridging program provides the education needed for Registered Practical Nurses (RPNs) to graduate with a BScN and become eligible to write the RN registration exam.
Will post-graduate programs be approved by the program approval process?
No, post-graduate programs will not be approved. Only entry-level nursing programs are required to be approved.
The Ontario Council of Universities in Nursing (COUPN) has developed a curriculum that is shared amongst a nine-school Nurse Practitioner (NP) consortium. How will approval work for those schools?
Where a curriculum has been standardized, such as the NP consortium, it will be evaluated only once. However, curriculum is only one component of the program approval process. Another eight indicators will be assessed individually for each school in the consortium, and the approval will be applied to each individual school.
How will the registration exam results be used?
First time pass rates for the entry-level registration exams is one of the three outcome indicators used to approve nursing programs. This indicator will have a score that is calculated based on the first time pass rates, which will contribute to the overall score for the program.
With the advent of unlimited writes for the RN-NCLEX, will schools still be evaluated based on the first-time writes of graduates? If so, what is the rationale?
Yes, programs will still be evaluated on the results of first-time writes for the registration exam for each category and/or class. First-time writes are a more reliable indication of how well a program prepares its graduates for competent and safe nursing practice.
Will the evaluation be available in French and English?
Yes, materials required by the schools to complete the program approval process will be available in both French and English.
Will nursing schools have to pay for the evaluation?
Yes, nursing programs will have to pay for the evaluation. CNO is administering the process to ensure it remains sustainable. We will be communicating the costs directly to the schools.
Academic Advisory Group
Who is on the Academic Reference Group?
You can find the members’ names on the website's Academic Reference Group section.
Program approval and accreditation
What is the difference between CNO program approval and CASN program accreditation?
CNO’s program approval is mandatory for all nursing education programs; CASN’s program accreditation process is voluntary.
CNO’s mandatory program approval process is regulatory-focused. It ensures schools are preparing nursing students to practise competently, safely and ethically once they graduate and become registered nurses with CNO. All nursing education programs must have CNO approval because this process is one way we meet our mandate of protecting the public.
CASN’s program accreditation process is voluntary. Based on its own quality criteria and standards, it is recognized worldwide as an important, objective method to assess professional education programs, and ensures programs are benchmarked against the same standards.
The College currently accepts accreditation by CASN as program approval for Baccalaureate Nursing programs (RN). Will this continue?
No, not after 2019. All Baccalaureate Nursing programs (RN) will be reviewed and approved using the new CNO program approval process starting in January 2019. At that time, CASN accreditation and CNO program approval will be two separate processes.
Baccalaureate Nursing programs can choose to continue to participate in CASN accreditation for the purposes of quality improvement.
If a Baccalaureate Nursing program was just approved through the CASN accreditation process, does it have to be reapproved with the new CNO approval process?
CNO will develop a transition plan and schedule for all nursing programs, taking into consideration a program’s current approval status. We will work with educators in developing this plan.
Programs that were recently approved through the CASN accreditation process will be placed at the end of the schedule for their full review. However, programs will have an annual program approval requirement.