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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.

CNO is implementing the new approval process in 2018.

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 by implementing a standardized nursing education approval process for all categories and classes of nursing education
  • foster accountability of nursing education programs to provide and sustain relevant content that meet standardized criteria 
  • promote continuous evaluation and improvement of nursing education programs
  • grant jurisdictional recognition to nursing education programs
  • provide stakeholderswith a transparent account of program approval.

In 2016, 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 approximately every five years. 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 all Ontario nursing education programs, and whether they are approved or not, on cno.org. This information is updated annually.

Want more information?  Please contact programapproval@cnomail.org 

CNO’s Council approved the Program Approval Framework in 2016. CNO evaluates all nursing education programs in Ontario with this new approach. They also measure the Baccalaureate Nursing (RN) programs, Practical Nursing (PN) programs and Nurse Practitioner (NP) programs using the same approval standards and process.

The new Nursing Education Program Approval process is based on this framework.

Program Approval Framework

Each nursing education program is evaluated against three approval standards:

  • Structure
  • Curriculum
  • Outcomes 

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 on the development of the program approval process. Their work focused on validating the indicators, and developing the measurement instruments and scoring methodology that will support the evaluation of each program. 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.

Evaluation Principles

Regulatory-focused: The program approval standards and process are centred on CNO’s public-protection mandate.

Transparency: The program approval and decision-making processes are clear, open and forthright.

Objective and evidence-informed: Decision-making is impartial and unbiased, and considers multiple sources of data and information.

Sustainability: The program approval process can be maintained by all stakeholders.

Continuous evaluation and improvement: The program approval process supports our goal to continually review our processes to ensure they remain effective and are using current best practices.

Program approval indicators 

Each of the three standards has indicators used to evaluate a program’s performance for that standard. Each indicator was developed based on:

  • a literature review
  • a jurisdictional scan
  • consultation with key stakeholders, such as academic faculty, clinical instructors, nursing leaders, students and front-line nurses

Each indicator was 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. 

The indicators were developed based on an extensive literature review, jurisdictional scan and interviews, stakeholder consultation and a validation questionnaire. They were also developed through a series of indicator validation focus groups comprised of subject matter experts, nurses, nursing educators, nursing leaders, clinical instructors, students and representatives from many of these roles. The development of the indicators was an iterative process. Each indicator was assessed for its ability to address the objectives of program approval, the College’s public protection mandate and whether the indicators met specific SMART criteria. SMART criteria require the indicators to be specific, measurable, appropriate and attainable, 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
  • various focus groups and consultation sessions in February, March and April 2017.
HIGHLIGHTS: DECEMBER 2016 TO AUGUST 2017

December 2016

We hired evaluation consultants to provide expert advice and guidance on the development of the Program Approval process. Their work focuses on validating the indicators and evidence, and developing the measurement instruments and scoring methodology that will support the evaluation for each program.

January 2017

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, Registered Nursing and Nurse Practitioner programs, nursing leaders, front-line nurses from across the health care sector, clinical faculty, preceptors and students.

February/March 2017

We held six focus groups with the volunteers. With their help the indicators have now been finalized and work is underway to develop the assessment tools and scoring guide.

March 2017

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, and gather baseline data that will be required as part of an annual Program Approval monitoring process.

April 2017

Volunteers, including nurse educators and representatives from five nurse regulatory colleges from other provinces, participated in consultation sessions. The results will help inform the development of the final Program Approval assessment tools and scoring guide.

May 2017

We asked for schools to volunteer in a pilot of the new Program Approval process and assessment tools. Twelve schools volunteered and six were selected 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 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)

We began a formal request for proposal (RFP) process to identify a third-party to administer Program Approval for us. The third-party will be responsible for coordinating Program Approval logistics with the schools, collecting data, reviewing documentation, conducting interviews and completing reports for each of the programs. 

June 2017

We had an orientation session for the six selected schools where we explained the pilot and the new Program Approval process and requirements.

July - August 2017

We are finalizing and translating the new Nursing Education Program Approval guidebook to share with the schools in the fall of 2017. 

Next steps: 
  • We are sending a working version of the Nursing Education Program Approval: Overview of the New Program Approval Process guide to all nursing schools in early October. We are also scheduling teleconferences with the schools at the same time to review the new Program Approval process.
  • We are conducting the pilot Program Approval process from September to December 2017. Following the pilot, we will update the Program Approval process and assessment tools based on the findings from the pilot evaluation. We will share the final Program Approval process and the final Nursing Education Program Approval: Overview of the New Program Approval Process guide with schools in early 2018.
  • We are working with our evaluation consultants during the pilot to assess the validity of the tool and to gather feedback from stakeholders.
  • The approval recommendations for the six schools in the pilot will go to the March 2018 Council meeting for a decision.
  • Once we select a third-party vendor, we will share the information with the schools.

CNO is conducting a pilot of the new program approval process between September and December 2017. We asked for schools to volunteer for the pilot, and the following six schools were selected:

  • 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 is 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:

Nurse Program Approval Process: Education Sector Update – October 2017

Education Sector Update - September/October 2016

Program Approval Framework: An Introduction - May 2016

Timing

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 September 2018. Baccalaureate (RN) programs will follow in January 2019, and Practical Nurse (PN) programs in September 2019.

How often are nursing programs approved?
We approve nursing programs on an annual basis using a monitoring review, with a comprehensive review conducted every five to seven years.

Program Approval Processes

What is the difference between the comprehensive review process and the monitoring review process?
The comprehensive review is a rigorous evaluation of a program’s ability to prepare graduates to be competent and safe in their nursing practice, and is conducted every five to seven years. The monitoring review involves an annual, less rigorous evaluation. 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.

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 nine indicators will be assessed individually for each school in the consortium, and the approval will be applied to each individual school.

Registration exams

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.

French

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. The CASN team that is supporting the administration of the process is bilingual and can respond to schools in French or English as requested.

Cost

Will nursing schools have to pay for the evaluation?
Yes, nursing programs will have to pay for the evaluation. Once we have completed the pilot project, we will have a better idea of the cost of the process.

Academic Advisory Group

Who is on the Academic Reference Group?
You can find the members’ names on the website's Academic Reference Group section.

Role of the Canadian Association of Schools of Nursing in Program Approval

The College has selected the Canadian Association of Schools of Nursing (CASN) to administer the new Nursing Education Program Approval process on behalf of CNO.

How and why was CASN selected?
In the spring of 2017, CNO issued a Request for Proposal (RFP) for a vendor to administer the new program approval process.
CASN was the successful candidate, based on its proposal, its ability to deliver the necessary services in the required timeframes, and its established and strong relationship with the academic community.

What is CASN’s role in program approval?
CASN will coordinate program logistics with schools, collect data, review documentation, conduct interviews and complete assessment reports for each of the programs.
Using the reports, CNO will then make program approval recommendations to Council. Using this information, Council will decide which programs are approved.

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.

The College’s mandatory program approval process focuses on ensuring 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?
The College 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.

The time and resource commitment to complete both program approval and accreditation is significant for schools. Will there be opportunities to streamline these processes and eliminate duplication?
CNO program approval and CASN accreditation are two distinct processes that serve different functions. However, they do overlap in some areas, and we will work with CASN to identify opportunities for efficiencies.

What are the next steps for working with CASN?
CNO is currently piloting the new program approval process at six nursing schools. CASN is supporting the administrative aspects of the pilot. We are scheduling teleconference calls with all nursing schools in October to introduce them to the CASN team and address questions. Based on the results of the pilot, including feedback from schools, the new program approval process will be finalized in early 2018.

Page last reviewed September 28, 2017